Relationship of Type 2 diabetes to the prevalence,incidence and progression of age‐related hearing loss

Aims Type 2 diabetes and associated microvascular abnormalities are postulated to affect hearing. Our study reports on the relationship between Type 2 diabetes and the prevalence, 5‐year incidence and progression of hearing impairment in a representative, older, Australian population. Methods The Blue Mountains Hearing Study is a population‐based survey of age‐related hearing loss conducted in a defined suburban area, west of Sydney. Hearing loss was defined as the pure‐tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz > 25 decibels hearing level (dB HL) in the better ear (bilateral hearing loss). Type 2 diabetes was defined from reported physician‐diagnosed diabetes or fasting blood glucose ≥ 7.0 mmol/l. Results Age‐related hearing loss was present in 50.0% of diabetic participants (n = 210) compared with 38.2% of non‐diabetic participants (n = 1648), odds ratio (OR) 1.55 [95% confidence interval (CI) 1.11–2.17], after adjusting for multiple risk factors. A relationship of diabetes duration with hearing loss was also demonstrated. After 5 years, incident hearing loss occurred in 18.7% of participants with, and 18.0% of those without diabetes, adjusted OR 1.01 (CI 0.54–1.91). Progression of existing hearing loss (> 5 dB HL), however, was significantly greater in participants with newly diagnosed diabetes (69.6%) than in those without diabetes (47.8%) over this period, adjusted OR 2.71 (CI 1.07–6.86). Conclusions Type 2 diabetes was associated with prevalent, but not incident hearing loss in this older population. Accelerated hearing loss progression over 5 years was more than doubled in persons newly diagnosed with diabetes. These data explore further reported links between Type 2 diabetes and age‐related hearing loss.     

High incidence of type 2 diabetes and increasing conversion rates from impaired fasting glucose and impaired glucose tolerance to diabetes in Mauritius

OBJECTIVE: To describe the incidence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. RESEARCH DESIGN, METHODS AND SUBJECTS: Population-based surveys were undertaken in the multi-ethnic nation of Mauritius in 1987, 1992 and 1998 with 5083, 6616 and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Three cohorts aged between 25 and 79 years with classifiable glucose tolerance data were identified; 3680 between 1987 and 1992, 4178 between 1992 and 1998, and 2631 between 1987 and 1998. Glucose tolerance was classified according to WHO 1999 criteria. RESULTS: The incidence rate of type 2 diabetes was higher between 1992 and 1998 than between 1987 and 1992. In men, the incidence was similar between cohorts (24.5 and 25.4 per 1000 person-years) whereas the incidence increased in women (23.3 and 16.4 per 1000 person-years). The incidence of diabetes peaked in the 45-54 year age group and then plateaued or fell. The incidences of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) decreased in both men and women. Of normoglycaemic subjects at baseline, more women than men developed IGT and more men than women developed IFG. Of those labelled as IFG in 1987, 38% developed diabetes after 11 years. The corresponding figure for IGT was 46%. CONCLUSIONS: In this study, we report changes in incidence rates of glucose intolerance over a 11-year period. In particular, differences between men and women were observed. The increased incidence of IGT in women compared with men, and increased incidence of IFG in men compared with women was consistent with, and explains the sex biases seen in the prevalences of these states.     

Retinal vascular caliber and metabolic syndrome in a Chinese population

Background: Microvascular changes have been associated with the metabolic syndrome. Methods: We included 869 participants aged ≥40 years from the High‐risk for Diabetes Changfeng Study, who had gradable fundus photographs. On digital photographs sum retinal arteriolar and venular calibers were measured with a semi‐automated system. Metabolic syndrome was defined according to the International Diabetes Federation consensus. Results: A total of 286 (32.9%) participants was diagnosed with metabolic syndrome. Participants with narrower retinal arteriolar caliber were more often diagnosed with metabolic syndrome (odds ratio 1.78, 95% confidence interval 1.02–3.10; lowest vs highest quintile). Additionally adjusting for age, gender, education, smoking and weekly activity, and adding arteriolar and venular caliber simultaneously in the same models did not alter these associations. In the component analyses, participants with narrower retinal arteriolar caliber were more likely to have central obesity, dyslipidaemia or raised blood pressure, and less likely to have raised fasting plasma glucose. The association between wider venular caliber and metabolic syndrome was less pronounced and non‐significant (odds ratio 1.34; 95% confidence interval 0.79–2.38; highest vs lowest quintile). Conclusion: Retinal arteriolar narrowing and, to a lesser extent, retinal venular dilatation were associated with metabolic syndrome in this Chinese population. These vascular changes, although small in magnitude, may still be important in the pathophysiological mechanisms involved in the metabolic syndrome.     

White blood-cell count and the risk of impaired fasting glucose or Type II diabetes in middle-aged Japanese men

Aims/hypothesis: To investigate the association between white blood-cell (WBC) count and the development of diabetes, independent of cigarette smoking. Methods: We examined 2953 Japanese men who were office workers and between 35 and 59 years of age and who did not have impaired fasting glucose (IFG) (a fasting glucose concentration of 6.1–6.9 mmol/l), Type II (non-insulin-dependent) diabetes mellitus (a fasting glucose concentration of ≥ 7.0 mmol/l or more or receipt of hypoglycaemic medication), medication for hypertension, and a history of cardiovascular disease. Fasting glucose concentrations were measured at annual health examinations from May 1994 through May 2000. Results: After controlling for potential predictors of diabetes, the relative risk for IFG or Type II diabetes mellitus compared with a WBC count of less than 5.3 · 10⁹ cells/l was 1.2 (95 %-CI, 0.6–2.3), 1.6 (CI, 0.8–3.1), and 2.5 (CI, 1.2–5.1) among non-smokers (p for trend = 0.009): and 1.0 (CI, 0.4–2.5), 2.3 (CI, 1.0–5.1), and 3.1 (CI, 1.4–7.1) among ex-smokers (p for trend = 0.001) with WBC counts of 5.3–6.1, 6.2–7.2, and 7.3 · 10⁹ cells/l or more, respectively. Among current smokers, the respective multivariate-adjusted relative risks for IFG or Type II diabetes mellitus were 1.1 (CI, 0.6–2.1), 1.4 (CI, 0.8–2.4), and 1.2 (CI, 0.7–2.1) (p for trend = 0.460). Conclusion/hypothesis: Although the selection of a rigorously normoglycaemic cohort might have had an influence on these observations, higher WBC counts seem to predict the development of IFG or Type II diabetes mellitus, primarily in non-smokers. [Diabetologia (2002) 45: 42–48] Received: 16 July 2001 and in revised form: 13 September 2001     

Frequency of fish consumption, retinal microvascular signs and vascular mortality

OBJECTIVE: Fish consumption has established cardiovascular and cerebrovascular benefits, but its effects on microvascular structure have not been examined in population-based studies. We investigated this association, in relation to vascular mortality in an Australian cohort (1992-2004). METHODS: Of 3654 participants aged 49+ years, 2683 (73%) with available data were included. Retinal arteriolar and venular diameters were measured, and signs of arterio-venous nicking and retinopathy were assessed from digital retinal images. Fish consumption was evaluated using a food frequency questionnaire. RESULTS: Both wider mean arteriolar diameter (p = 0.002) and narrower venular diameter (p = 0.02) were associated with increasing frequency of consuming any or oily fish, after adjusting for cardiovascular risk factors, diet, inflammatory factors and socioeconomic status. This association was mainly present in persons with hypertension. Greater frequency of fish consumption was associated with a reduced prevalence of arterio-venous nicking and a borderline significant trend for reduced retinopathy prevalence. Ten year stroke-related mortality was significantly lower in persons consuming fish at least once per week compared to less frequent consumption (hazard ratio 0.57, 95% CI: 0.35 to 0.93). CONCLUSIONS: Recent evidence shows that narrower arterioles and wider venules may predict vascular events. Our new findings suggest that the vascular protective effects of consuming fish could act, in part, by preventing pathological microvasculature change.     

糖代谢异常和糖尿病患者血浆纤维蛋白原的观察

目的探讨血浆纤维蛋白原在糖代谢异常和糖尿病患者中的变化。方法对155例糖尿病、糖代谢异常患者和正常对照者进行血浆纤维蛋白原、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、尿素氮和血肌酐检测。结果糖尿病、糖代谢异常和正常对照组之间纤维蛋白原和三酰甘油在各组之间比较差异有统计学意义(P<0.01或P<0.05);纤维蛋白原的多因素linear regression分析发现空腹血糖、三酰甘油是纤维蛋白原的相关因子(P<0.05)。结论糖尿病和糖代谢异常患者血浆纤维蛋白原升高,而且纤维蛋白原与空腹血糖水平相关。因此,血浆纤维蛋白原升高可能参与糖尿病患者心脑血管疾病的形成。     

硫化氢对老年空腹血糖调节受损和2型糖尿病的影响

目的 通过检测老年空腹血糖调节受损（IFG）和2型糖尿病患者的血清硫化氢（H2S）水平,探讨气体分子H2S在老年空腹血糖调节受损和2型糖尿病中的临床意义.方法 2型糖尿病患者66例,空腹血糖调节受损患者36例,正常对照组33例,检测入选者的血清H2S浓度.结果 与对照组相比,空腹血糖调节受损患者和2型糖尿病患者HOMA-IR指数明显升高[（3.24±0.93）、（2.34±1.12）比（1.70±1.10）,P＜0.05]、HOMA-β指数降低[（76.41±26.20）、（36.13±23.37）比（93.00±40.46）,P＜0.05],血清H2S水平明显升高[（60.93±12.95）、（63.64±10.96）比（50.07±10.85） μmol/L,P＜0.05].Pearson相关分析结果显示,H2S浓度与空腹血糖调节受损组和糖尿病组患者HOMA-β均呈显著负相关（γ值分别为-0.65、-0.69,P＜0.05）,与HOMA-IR均呈显著正相关（γ值分别为0.73、0.76,P＜0.05）.结论 内源性H2S可能通过抑制β细胞功能和增强胰岛素抵抗参与空腹血糖调节受损和2型糖尿病的发病过程.     

High prevalence of diabetes and impaired fasting glucose in urban Latin America: the CARMELA Study

Aims Cardiovascular risk is increased with glucose metabolism abnormalities. Prevalence data can support public health initiatives required to address this risk. The Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study was designed to estimate the prevalence of Type 2 diabetes, impaired fasting glucose and related risk factors in seven urban Latin American populations. Methods CARMELA was a cross‐sectional, population‐based study of 11 550 adults 25–64 years of age. With a multi‐stage sample design of a probabilistic nature, approximately 1600 subjects were randomly selected in each city. Results Overall, the prevalence of diabetes was 7.0% (95% confidence intervals 6.5–7.6%). The prevalence of individuals with diabetes or impaired fasting glucose increased with increasing age. In the oldest age category, 55–64 years of age, prevalence of diabetes ranged from 9 to 22% and prevalence of impaired fasting glucose ranged from 3 to 6%. Only 16.3% of people with prior diagnosis of diabetes and who were receiving pharmacologic treatment, were in good glycaemic control (fasting glucose < 6.1 mmol/l). The prevalence of diabetes in individuals with abdominal obesity was approximately twofold higher. Participants with hypertension, elevated serum triglycerides and increased common carotid artery intima‐media thickness were also more likely to have diabetes. Conclusions The prevalence of diabetes and impaired fasting glucose is high in seven major Latin American cities; intervention is needed to avoid substantial medical and socio‐economic consequences. CARMELA supports the associations of abdominal obesity, hypertension, elevated serum triglycerides and carotid intima‐media thickness with diabetes.     

老年空腹血糖受损62例进展研究

目的分析老年空腹血糖受损者(IFG)8年间进展情况。方法于2002年5～6月对我区离退休老干部中IFG行口服75g葡萄糖试验(OGTT),选取单纯空腹血糖受损者(I-IFG)62例,依据2003年美国糖尿病学会IFG诊断标准,将空腹血糖(FPG)为5.6～6.09mmol/L的受损者分为新增IFG组(A组),空腹血糖为6.1～6.99mmol/L的受损者分为原IFG组(B组),定期随访8年。结果基线时2组IFG者的血压、血脂、体质量指数(BMI)等临床指标差异均无统计学意义(P>0.05)。至随访结束时,A组进展为糖尿病(DM)的比率为20.59%,B组IFG进展为DM的比率为46.43%,是A组的2.25倍,差异有统计学意义(P<0.05);2组IFG逆转为糖耐量正常(NGT)、仍保持I-IFG以及进展为空腹血糖受损合并糖耐量受损(IFG/IGT)者的比率差异均无统计学意义(P>0.05)。全部IFG进展为DM的比率是32.25%,逆转为NGT的比率是14.52%,仍维持在I-IFG或IFG/IGT状态的比率是53.23%。结论 IFG诊断标准下调后,IFG患病率明显上升,但新增IFG进展为DM的风险明显低于原IFG。     

Ethnic disparities in the association of impaired fasting glucose with the 10-year cumulative incidence of type 2 diabetes

Aims

Evidence of ethnic disparities in the conversion of prediabetes to type 2 diabetes is scarce. We studied the association of impaired fasting glucose (IFG) and fasting plasma glucose (FPG) with the 10-year cumulative incidence of type 2 diabetes in three ethnic groups.

Methods

We analyzed data for 90 South-Asian Surinamese, 190 African-Surinamese, and 176 ethnic Dutch that were collected in the periods 2001–2003 and 2011–2012. We excluded those with type 2 diabetes or missing FPG data. We defined baseline IFG as FPG of 5.7–6.9 mmol/L. We defined type 2 diabetes at follow-up as FPG ≥ 7.0 mmol/L, HbA1c ≥ 48 mmol/mol (6.5%), or self-reported type 2 diabetes.

Results

10-Year cumulative incidences of type 2 diabetes were: South-Asian Surinamese, 18.9%; African-Surinamese, 13.7%; ethnic Dutch, 4.5% (p < 0.05). The adjusted association of baseline IFG and FPG with the 10-year cumulative incidence of type 2 diabetes was stronger for South-Asian Surinamese than for African-Surinamese and ethnic Dutch. The IFG (compared to normoglycaemia) ORs were 11.1 [3.0–40.8] for South-Asian Surinamese, 5.1 [2.0–13.3] for African-Surinamese, and 2.2 [0.5–10.1] for ethnic Dutch.

Conclusions

The 10-year cumulative incidence of type 2 diabetes was higher and associations with baseline IFG and FPG were stronger among South-Asian Surinamese and African-Surinamese than among ethnic Dutch. Our findings confirm the high risk of type 2 diabetes in South-Asians and suggest more rapid conversion in populations of South-Asian origin and (to a lesser extent) African origin than European origin.     

Incidence of Type 2 diabetes in England and its association with baseline impaired fasting glucose: the Ely study 1990-2000.

AIM: To determine the incidence of Type 2 diabetes and to examine the effect of different cut-points for impaired fasting glucose (IFG) on diabetes incidence. METHODS: Population-based longitudinal study (1990-2000) with clinical, anthropometric and biochemical measurements, including an oral glucose tolerance test (OGTT), in 1040 non-diabetic adults aged 40-69 years at baseline. Baseline glucose status was defined as normoglycaemia < 5.6, IFG-lower 5.6-6.0 and IFG-original 6.1-6.9 mmol/l. The all-IFG group included fasting glucose values of 5.6-6.9 mmol/l. RESULTS: The 10-year cumulative incidence of diabetes was 7.3 per 1000 person-years. Diabetes incidence was 2.4 [95% confidence interval (CI) 1.2, 4.8], 6.2 (4.0, 9.8) and 17.5 (12.5, 24.5) per 1000 person-years in those with normoglycaemia, IFG-lower and IFG-original, respectively. Compared with normoglycaemia, the age/sex-adjusted risk [hazard ratio (HR) and 95% CI] for incident diabetes was greatest in the IFG-original category (HR 6.9; 3.1, 15.2) and increased to a lesser degree in the IFG-lower (HR 2.5; 1.1, 5.7) and all-IFG categories (HR 4.1; 1.9, 8.7). When adjusted for confounding factors, the magnitude and direction of associations persisted, with HR 1.9, 4.4 and 2.9, for the categories IFG-lower, IFG-original and all-IFG, respectively. CONCLUSIONS: Diabetes incidence is more strongly related to IFG defined as fasting glucose between 6.1 and 6.9 mmol/l than to the lower category of 5.6-6.0 mmol/l, or entire range of 5.6-6.9 mmol/l. Future studies should examine the association of IFG with cardiovascular outcomes, but for diabetes risk our study supports the use of the IFG cut-point at 6.1 mmol/l.     

Long-term influences of body-weight changes, independent of the attained weight, on risk of impaired glucose tolerance and Type 2 diabetes.

AIM: To investigate if weight gain during adulthood has effects on the risk of developing impaired glucose tolerance (IGT) or Type 2 diabetes beyond effect of attained weight. RESEARCH DESIGN AND METHODS: Data were obtained from a longitudinal study of two cohorts: one of juvenile-onset obese (n = 248) and one of randomly selected control (n = 320) men, weighed at average ages of 20, 33, 44 and 51 years, respectively. RESULTS: For any given BMI, the risk of IGT was higher the greater the weight gain since age 20 (odds ratio of 1.10 per unit kg/m2 of BMI gain, confidence interval 1.03-1.17, P = 0.004), and weight gain during both the early and later ages contributed to the increased risk. Obese men, maintaining weight since age 20, had lower risk of IGT than non-obese men who became similarly obese by age 51. The risk of Type 2 diabetes increased by weight gain in early adult life, but not by more recent weight gain in the later periods, probably because of the development of Type 2 diabetes leading to weight loss. CONCLUSIONS: Independent of attained level of body weight in middle-aged men, weight gain is associated with increased risk of IGT, and is greater in those not overweight in childhood.     

红细胞体积分布宽度与糖代谢异常/糖耐量异常和糖尿病相关

目的探讨红细胞体积分布宽度（RDW）与2型糖尿病（T2DM）、空腹血糖受损／葡萄糖耐量异常（IFG／IGT）的相互关系。方法对152例在我院定期进行健康体检或治疗的患者,依据血糖情况分为3组,其中T2DM组42例,IFG／IGT组38例,正常对照（NGT）组72例,采取空腹血,采用全自动血液分析仪测定RDW、血红蛋白,多功能血生化自动分析仪测定血总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血肌酐、血尿素氮和空腹血糖,同时统计高血压、冠心病的发病率并分析其关系。结果RDW在T2DM组、IFG／IGT组和NGT组之间比较具有统计学差异,其中T2DM组和NGT组、IFG／IGT组比较,差异均有统计学意义（P〈0．05或P〈0．01）,IFG／IGT组与NGT组比较差异无统计学意义（P〉0．05）。多因素直线回归分析显示空腹血糖（P〈0．01）和高密度脂蛋白胆固醇（P〈0．05）是RDW的独立危险因子。结论T2DM患者RDW升高,RDW的变化与空腹血糖水平相关。     

Retinal vessel diameter and cardiovascular mortality: pooled data analysis from two older populations.

AIMS: The retinal microvasculature may reflect pre-clinical changes in the cerebral and coronary microcirculations. We assessed whether smaller retinal arterioles and larger venules predicted coronary heart disease (CHD)- and stroke-mortality. METHODS AND RESULTS: We pooled data from the Beaver Dam Eye Study (n = 4926, aged 43-86) and the Blue Mountains Eye Study (n = 3654, aged 49-97). Retinal vessel diameters were measured from digitized retinal photographs. Change point models were used to assess and document the existence of threshold effects. We defined smaller arterioles as diameters within the narrowest quintile and larger venules as diameters within the widest quintile, with other quintiles as the reference. Of 8550 participants, 7494 (88%) with complete data were included, of whom 653 died from CHD and 299 from stroke over 10-12 years follow-up. After multivariable adjustment, each standard deviation (SD) increase in arteriolar diameter, or SD decrease in venular diameter, was not found to be significantly associated with either CHD-mortality or stroke-mortality. However, smaller arterioles [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.11-1.62] and larger venules (HR 1.24, CI 1.02-1.52), predicted increased risk of CHD-mortality. These associations were mainly evident among persons aged 43-69 (smaller arterioles: HR 1.70, CI 1.27-2.28; larger venules: HR 1.41, CI 1.06-1.89). Smaller arterioles (HR 1.64, CI 1.00-2.67) and larger venules (HR 1.53, CI 0.94-2.47) were also associated with an increased risk of stroke-mortality among persons aged 43-69. CONCLUSION: Retinal vessel diameter may predict risk of CHD and stroke deaths in middle-aged persons.     

Coffee consumption and incidence of impaired fasting glucose,impaired glucose tolerance,and type 2 diabetes: the Hoorn Study

Aims/hypothesis Coffee contains several substances that may affect glucose metabolism. The aim of this study was to evaluate the relationship between habitual coffee consumption and the incidence of IFG, IGT and type 2 diabetes.Methods We used cross-sectional and prospective data from the population-based Hoorn Study, which included Dutch men and women aged 50–74 years. An OGTT was performed at baseline and after a mean follow-up period of 6.4 years. Associations were adjusted for potential confounders including BMI, cigarette smoking, physical activity, alcohol consumption and dietary factors.Results At baseline, a 5 cup per day higher coffee consumption was significantly associated with lower fasting insulin concentrations (–5.6%, 95% CI –9.3 to –1.6%) and 2-h glucose concentrations (–8.8%, 95% CI –11.8 to –5.6%), but was not associated with lower fasting glucose concentrations (–0.8%, 95% CI –2.1 to 0.6%). In the prospective analyses, the odds ratio (OR) for IGT was 0.59 (95% CI 0.36–0.97) for 3–4 cups per day, 0.46 (95% CI 0.26–0.81) for 5–6 cups per day, and 0.37 (95% CI 0.16–0.84) for 7 or more cups per day, as compared with the corresponding values for the consumption of 2 or fewer cups of coffee per day (p=0.001 for trend). Higher coffee consumption also tended to be associated with a lower incidence of type 2 diabetes (OR 0.69, CI 0.31–1.51 for 7 vs 2 cups per day, p=0.09 for trend), but was not associated with the incidence of IFG (OR 1.35, CI 0.80–2.27 for 7 vs 2 cups per day, p=0.49 for trend).Conclusions/interpretation Our findings indicate that habitual coffee consumption can reduce the risk of IGT, and affects post-load rather than fasting glucose metabolism.     

Increasing prevalence of diabetes mellitus and impaired glucose tolerance among 60-year-old Danes.

AIMS: The age-specific prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was estimated in 60-year-old individuals in 1996/97 and compared to the prevalence in 1974/75. The study also examined whether or not the change in prevalence of diabetes and IGT could be explained by changes in body mass index (BMI) and physical activity. METHODS: Diabetes and IGT were diagnosed by a standardized oral glucose tolerance test (OGTT) in two Danish population-based, age-specific, birth cohorts. RESULTS: The prevalence of diabetes in 1996/97 was 12.3% among 60-year-old men and 6.8% among women, representing an increase in diabetes of 58% in men and 21% in women compared to 1974/75. The prevalence of IGT was 15.9% among men and 13.1% among women, representing increases of 109 and 16%, respectively. A concurrent increase in BMI in the 22-year period between the two studies explained the increase found in the prevalence of diabetes and IGT. CONCLUSIONS: A marked increase in the prevalence of diabetes and IGT among 60-year-old individuals over a 22-year period was observed - especially in men. The increase was fully explained by a concurrent increase in BMI.     

Progression to clinically diagnosed and treated diabetes from impaired glucose tolerance and impaired fasting glycaemia.

AIMS: To evaluate the risk of diabetes in subjects with impaired fasting glycemia (IFG) as compared with impaired glucose tolerance (IGT) and normal glucose tolerance. METHODS: Men (1223) and women (1370) aged 45-64 years and free of diabetes at baseline were followed-up for 10 years, with 26 737 person years accumulated. The incident diabetic cases were identified through the national Drug Register and the Hospital Discharge Register. RESULTS: During the 10 years of follow-up, 53 (4.3%) men and 47 (3.4%) women developed diabetes. IFG alone defined 22 (15.5/1000 person years) diabetic cases, which was higher than for subjects with normal fasting glucose. Subjects with isolated IGT identified an additional 34 cases (155% more) which could not be defined by IFG alone. The area under the ROC curve was larger for 2-h glucose (0.77, 95% CI 0.72-0.82) than for fasting glucose (0.65, 0.58-0.71). The multivariate adjusted Cox hazard ratio was higher for isolated IGT (3.9, 95% CI 2.4-6.2) than for isolated IFG (2.3, 0.9-5.7) as compared with subjects with neither IFG nor IGT. CONCLUSION: Both IFG and IGT are risk predictors for diabetes, but IGT defines a much larger target population for prevention.     

糖代谢异常和糖尿病患者颈动脉粥样硬化的观察

目的:探讨糖尿病、糖代谢异常患者颈动脉粥样硬化的情况。方法:通过多普勒超声检查颈动脉粥样硬化的方法,观察了糖尿病、糖代谢异常患者颈动脉粥样硬化斑块的发生率及内中膜厚度,并与正常对照组进行比较。结果:糖尿病、糖代谢异常的患者与正常对照组相比其颈动脉粥样硬化斑块的发生率及内中膜厚度显著增加(P<0.01)。结论:糖尿病、糖代谢异常与颈动脉粥样硬化相互关联。     

Five‐year incidence and progression of thyroid dysfunction in an older population

Background: Very few studies have assessed both the incidence and progression of thyroid dysfunction in a single older population‐based cohort. In this study, we aimed to assess the 5‐year incidence, progression and risk factors for development of thyroid dysfunction in an older Australian population. Methods: The Blue Mountains Eye Study is a longitudinal population‐based cohort study. During 1997–1999, 1768 participants (≥55 years) had thyroid function assessed. After excluding participants reporting any form of treatment for their thyroid condition at baseline, 951 participants (91.4%) without thyroid dysfunction and 54 (5.4%) with thyroid dysfunction were re‐examined 5 years later. Thyroid dysfunction was defined using serum thyrotropin (thyroid stimulating hormone (TSH)) screen, followed by serum free T4 assessment. Results: The overall 5‐year incidence of thyroid dysfunction was 4.7% (95% confidence interval (CI) 3.4–6.1). Obesity (body mass index ≥ 30 kg/m²) and serum TSH > 2 mIU/L at baseline predicted incident overt hypothyroidism (odds ratio (OR) 4.05, CI 1.74–9.41) and (OR 5.46, CI 1.16–25.67) respectively. The 5‐year incidence of subclinical hypothyroidism was significantly higher in women than in men, 2.5% versus 0.7% (P= 0.03). Progression to overt hypothyroidism was observed in 17.9% of subjects with subclinical hypothyroidism over 5 years. Conclusions: The 5‐year incidence of thyroid dysfunction in this older population was relatively low, and was associated with obesity and serum TSH level > 2 mIU/L at baseline. Over one in six persons with subclinical hypothyroidism progressed to overt thyroid dysfunction over the 5‐year period. Our findings highlight the need for appropriate management of subclinical hypothyroidism among older people.     

Serum gamma-glutamyltransferase and development of impaired fasting glucose or type 2 diabetes in middle-aged Japanese men

OBJECTIVE: To investigate the association between serum gamma-glutamyltransferase (GGT) and risk for development of diabetes. DESIGN: Longitudinal study (followed from 1994 to 2001). SETTING: A work site in Japan. SUBJECTS: A total of 2918 Japanese male office workers aged 35-59 years who did not have impaired fasting glucose (IFG) (a fasting plasma glucose concentration of 6.1-6.9 mmol L-1), type 2 diabetes (a fasting plasma glucose concentration of >/=7.0 mmol L-1 or receipt of hypoglycaemic medication), medication for hypertension or hepatitis, alanine aminotransferase concentrations higher than three times the upper limit of the reference range or a history of cardiovascular disease at study entry. MAIN OUTCOME MEASURE: Incidence of IFG or type 2 diabetes over a 7-year period. RESULTS: With adjustment for potential risk factors for diabetes, the relative risk for IFG compared with serum GGT <16 U L-1 was 1.23 (95% CI, 0.79-1.90), 1.50 (CI, 0.97-2.32) and 1.70 (CI, 1.07-2.71) with serum GGT of 16-24, 25-43 and >/=44 U L-1, respectively (P for trend = 0.014). The respective relative risks for type 2 diabetes compared with serum GGT <16 U L-1 were 2.54 (CI, 1.29-5.01), 2.64 (CI, 1.33-5.23) and 3.44 (CI, 1.69-6.70) (P for trend = 0.002). From stratified analyses by body mass index (BMI) and alcohol intake, a stronger linear association between serum GGT and development of IFG or type 2 diabetes was found in men with a BMI >/=23.2 kg m-2 in both those who drank <46 and >/=46 g day-1 of ethanol. CONCLUSIONS: The risk for development of IFG or type 2 diabetes increased in a dose-dependent manner as serum GGT increased in middle-aged Japanese men. The increased relative risk for IFG or type 2 diabetes associated with serum GGT was more pronounced in obese men.