The effect of participatory community-based diabetes cares on the control of diabetes and its risk factors in western suburb of Yasouj, Iran

This study aimed to investigate whether a community-based participatory diabetes care program could efficiently improve diabetic care and reduce its risk factors. To induce a participatory approach, a local group was established in partnership with academics, local leaders, health providers and public representatives. The group conducted community needs assessment and priority setting process. Diabetes was identified as the first priority health problem in this area. A total of 2569 30- to 65-year-old residents were screened for diabetes and 405 of them took part in a 13-week nutrition education and physical exercise intervention. Out of 1336 high-risk individuals, 17% had fasting blood sugar (FBS) ≥126 mg/dl and 13.5% with FBS between 110 and 125 mg/dl. Percentages of participants with triglycerides (TG) ≥150 mg/dl and cholesterol ≥200 mg/dl were 33.8% and 23.5%, respectively. After completion of the intervention, the mean FBS, HbA1C, TG and cholesterol were decreased significantly. Although systolic and diastolic blood pressure and body mass index were decreased too, the differences were not statistically significant. The mean physical activity increased and consumption of fried foods and saturated oil decreased significantly. The results suggest that participatory community-based care could be a feasible model for control of diabetes and its risk factors.     

Health care costs of persons with diabetes prior to and following hospitalization in Argentina]

OBJECTIVE: To analyze and compare the ambulatory care expenditures for persons with diabetes during prehospitalization and posthospitalization periods with those of diabetics who were not hospitalized for diabetes-related illnesses during the same period. METHODS: We determined the hospitalization and ambulatory care expenses incurred by an Argentine health insurer for the hospitalization of diabetic clients during the study period, and compared these expenses to the expenses of insured diabetics who were not hospitalized during that period. RESULTS: We identified 2,760 persons with diabetes (2.4% of the total number of persons covered by the insurance company). Of those, 1,683 (59%) were on medication for diabetes and its associated cardiovascular risk factors. Diabetes was associated with either one (41%) or two (24%) cardiovascular risk factors. Of those 1 683 persons, 102 (6%) were hospitalized for diabetes-related reasons during the study period. The frequency of hospitalization increased significantly in cases where diabetes was associated with arterial hypertension and dyslipidemia. Cardiovascular illness was the cause of 43.1% of the hospitalizations, with a significantly higher per capita cost than any of the other causes identified (mean +/- standard error of the mean: US 1,673 dollars +/- US 296.8 dollars; P < 0.05). The total annual per capita cost for health care for the diabetics who had been hospitalized was greater than for those who had not (US 2,907.8 dollars +/- US 262.5 dollars compared to US 473.4 dollars +/- US 9.8 dollars, respectively; P < 0.01). While the total posthospitalization ambulatory care expenditures were 12% higher than the prehospitalization costs (US 903.6 dollars +/- US 108.6 dollars vs. US 797.6 dollars +/- US 14.9 dollars), the difference was not significant. CONCLUSION: Ambulatory care expenditures increase significantly in the prehospitalization and posthospitalization periods. The results suggest that intensive treatment of hyperglycemia and its associated cardiovascular risk factors may prevent hospitalization and is a more cost-effective option than hospitalization and posthospitalization ambulatory care.     

Prognostic value of haemoglobin A1c and fasting plasma glucose for incident diabetes and implications for screening

The aim of this analysis is to compare screening strategies with haemoglobin A_1c (HbA_1c), fasting plasma glucose (FPG) or combined measures in the identification of individuals at high risk for diabetes. Applying American Diabetes Association thresholds for FPG and HbA_1c screening, 6,803 subjects free of diabetes were classified as non-diabetic, pre-diabetic and possibly diabetic by FPG (<100, 100–125 and >125 mg/dl) and HbA_1c (<5.7, 5.7–6.4 and >6.4%). Hazard ratios, sensitivity and specificity were estimated for individuals with pre-diabetes with respect to incident diabetes in the following 5 years. Areas under the receiver operating characteristic curves (AUC) were estimated for levels of FPG ≤ 125 mg/dl and HbA_1c ≤ 6.4% in diabetes prediction. Although FPG and HbA_1c screenings poorly agreed in classifying individuals as pre-diabetic, hazard ratios [95% confidence interval] for incident diabetes were similarly increased in univariate models in the two pre-diabetic groups: FPG 100–125 mg/dl, 4.72 [3.69; 6.05]; HbA_1c 5.7–6.4%, 3.97 [3.05; 5.23]. HbA_1c and FPG had comparable AUCs (FPG, 0.732; HbA_1c, 0.725) and consequently similar 5-year sensitivities and specificities for their pre-diabetes definitions (when the lower cut-off for HbA_1c-defined pre-diabetes was increased to a level between 5.8 and 5.9%). Combining HbA_1c and FPG increased the AUC to 0.778, and a further increase to 0.817 was seen with additional inclusion of conventional risk factors. FPG and HbA_1c have comparable (yet insufficient) abilities in identifying individuals at high risk for diabetes. Effectiveness of a diabetes screening program could be improved by a risk score including FPG and HbA_1c.     

Early diagnosis, early treatment and the new diagnostic criteria of diabetes mellitus

The main purpose of treating diabetes is to prevent chronic complications. Strict glycemic control is known to suppress the occurrence and progression of these complications. The test for plasma glucose is essential to identify diabetic patients, as mild hyperglycemia without symptoms can be a risk factor for complications. The new classification and diagnostic criteria for diabetes were proposed by the American Diabetes Association (ADA), WHO and Japan Diabetes Society (JDS) between 1997 and 1999. Diabetes is classified into four etiological categories; type 1, type 2, diabetes due to other specific mechanisms or conditions, and gestational diabetes. Another classification system according to the degree of metabolic abnormality has also been adopted. For diagnosis of diabetes, the JDS Committee classified the glycemic state into three categories based on fasting plasma glucose (FPG) and 2-h plasma glucose in the 75 g oral glucose tolerance test (2hPG); normal type (FPG <110 and 2hPG <140 mg/dl), diabetic type (FPG > or =126 and/or 2hPG > or =200 mg/dl), and borderline type (neither normal nor diabetic type). The borderline type corresponds to the sum of impaired fasting glycemia (IFG) and impaired glucose tolerance (IGT) based on ADA and WHO. Using the JDS criteria, diabetes is diagnosed when hyperglycemia of 'diabetic type' is confirmed on two or more occasions. ADA recommends the use of FPG alone for the diagnosis of diabetes, but findings from both Japan and Europe indicate that many diabetic subjects would be classified as non-diabetic solely on the FPG test. JDS recommends the use of the glucose tolerance test when the elevation of FPG is mild. Keeping glycemia near-normal by periodic monitoring of glycemic parameters and by appropriate treatment would prevent or reduce the diabetic complications in patients to a minimum.     

Risk factor knowledge,status, and change in a community screening project

This report describes a community-based cardiovascular risk-reduction program which targeted high-risk individuals. A total of 1,471 individuals participated and were screened for blood pressure, fasting serum cholesterol, blood glucose level, and appearance of the serum. These individuals also completed a questionnaire regarding their knowledge of heart disease. Overall, 522 (35.5%) individuals had a cholesterol level of 240+ mg/dl; 261 (17.7%) had hypertension; 118 (8%) had a glucose level of 120+ mg/100 ml blood; 266 (18.1%) smoked; and the serum was evaluated as turbid or lipemic in 105 (7.1%). Therefore, of the 1,471 individuals examined, 733 (49.8%) could be considered at risk due to the presence of one or more risk factors. Interestingly, 73% of respondents knew their blood pressure, whereas only 15% and 12%, respectively, knew their cholesterol and glucose levels. Eighty percent of the sample knew that smoking, hypertension, and cholesterol were risk factors, but only 50% of the sample identified diabetes as an independent risk factor. Contrary to expectation, knowledge of heart disease and diabetes wasnot related to either initial level or change in cholesterol at 18-month retest. Overall, these results indicate that a community screening program can identify high risk individuals at a relatively low cost, and that knowledge of risk factors and disease is not related to initial risk status or self-initiated change in risk status.James R. Sutterer, Ph.D. is Associate Professor of Psychology at Syracuse University. Michael P. Carey, Ph.D. is Assistant Professor of Psychology at Syracuse University. David K. Silver is a Vice President of Manning, Selvage, and Lee, Inc. which managed the funds provided by The Upjohn Company for the initial education and screening program. David T. Nash, MD is Clinical Professor of Medicine at the State University of New York Health Science Center and Director of the Syracuse Cardiovascular Disease/Diabetes Project.The authors would like to express appreciation to Leslie Ader, Ann Caskins, Coleen Clapper RN, Lynn Eckart, Bret Ingerman MS, Patricia McGarry LPN, Robin Tetrault, and Helen Wallace who provided generous assistance for the collection and entry of data during the retest phase of this project. Special thanks go to Matthew Krumholz who devoted many hours to the accurate computer entry of the survey data.     

Reproducibility of the new diagnostic criteria for impaired glucose tolerance

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

Glucose tolerance and risk of gestational diabetes mellitus in nulliparous women who smoke during pregnancy

Gestational diabetes mellitus has been associated with adverse maternal and infant outcomes, including preeclampsia and fetal macrosomia. Although cigarette smoking has been associated with increased insulin resistance, its effect on gestational diabetes mellitus risk is uncertain. The authors evaluated the effects of smoking on glucose tolerance in a cohort of pregnant women who participated in the Calcium for Preeclampsia Prevention trial, a randomized study of nulliparous women conducted in five US medical centers from 1992 to 1995. Results of screening and diagnostic testing for gestational diabetes mellitus were analyzed. For 3,774 of the 4,589 women enrolled, plasma glucose concentration 1 hour after a 50-g oral glucose challenge and complete information on pregnancy outcome were available; for 3,602 of the women, gestational diabetes mellitus status was known. Adjusted mean 1-hour plasma glucose concentration (mg/dl) was elevated in women who smoked at study enrollment (112.6, 95% confidence interval: 110.0, 115.3) compared with women who had never smoked (108.3, 95% confidence interval: 106.7, 109.8; p < 0.01). Women who smoked were at increased risk of gestational diabetes mellitus when criteria proposed by the National Diabetes Data Group were used (adjusted odds ratio = 1.9, 95% confidence interval: 1.0, 3.6). These findings support an association between smoking and gestational diabetes mellitus.     

Drug-induced severe hypoglycaemia in Type 2 diabetic patients aged 80 years or older

Our knowledge about the risk of hypoglycaemia associated with diabetes treatment is derived from studies that often exclude elderly people. Aim of this study was to determine the incidence and risk factors for developing severe hypoglycaemia among persons aged 80 yr or older, with Type 2 diabetes mellitus (T2DM). During a 2-yr period, all episodes of severe hypoglycaemia occurred in T2DM patients aged 80 yr or older were identified. Hypoglycaemia was defined as a symptomatic event requiring treatment with i.v. glucose and confirmed by a blood glucose determination of less than 50 mg/dl. A detailed history and blood laboratory profile were obtained for each patient. During the period of the survey a total of 124 diabetic subjects aged 80 yr or older were hospitalised and severe hypoglycaemia was reported in 31 patients (25%). This group of patients had a marked comorbidity and was found to have HbA1c values of 5.1% indicating that their diabetes was well controlled. Of these hypoglycaemic episodes, 23 (74%) occurred in patients taking glibenclamide. Diabetes therapy was prescribed by general practitioners in 24 of these patients. Seventeen subjects concomitantly received drugs that potentiated hypoglycaemia. Only 10 patients performed regular blood glucose self-monitoring. In conclusion, severe hypoglycaemia is a serious and not uncommon problem among elderly patients with T2DM; it is more frequent in patients undergoing aggressive diabetes management and in users of a long-acting sulphonylurea (eg, glibenclamide). A normal HbA1c level in this age group appears to be a powerful indicator of the risk of severe hypoglycaemia and should alert clinicians to change therapy. Finally, each patient's risk for hypoglycaemia should be considered and therapy should be individualised accordingly; in our opinion, a great number of episodes of serious hypoglycaemia may be prevented by teaching the principles of blood glucose monitoring and involving general practitioners in outpatient management of diabetes mellitus in the elderly.     

Economic analysis of a screening program for diabetes mellitus in Brazil

OBJECTIVE: Diabetes mellitus is a common disease and costly public health concern and an expressive number of affected individuals have undiagnosed diabetes mellitus. In 2001, the Brazilian Ministry of Health conducted a national diabetes screening campaign. The purpose of this study was to estimate the yield and economic impact of this screening strategy. METHODS: Based on positive screenees (fasting glucose >100 mg/dL or nonfasting >140 mg/dL) probable new cases of diabetes were estimated and a decision analytic model was built up. Primary and secondary data were used to estimate screening cost (in Brazilian Reais, R$) and yield (new cases of diabetes detected), assuming a single-payer-perspective. Sensitivity analyses were performed. RESULTS: Assuming a prevalence of undiagnosed diabetes mellitus of 4.8%, probable new cases of diabetes were 518,579 (23 new cases per 1,000 subjects screened), considering that 33% of positive-screening individuals underwent confirmatory glucose testing. The cost per new case of diabetes diagnosed would be R$89. The results were sensitive to percentage of confirmatory tests performed. CONCLUSIONS: The costs of nationwide community screening in Brazil were significant, however, in absolute terms lower than those described by other countries.     

Gestational Diabetes Mellitus (GDM): Relationship Between Higher Cutoff Values for 100 g Oral Glucose Tolerance Test (OGTT) and Insulin Requirement During Pregnancy

Objectives To study if there is any relationship about higher cutoff values for 100 g oral glucose tolerance test and the need for insulin in women diagnosed with gestational diabetes. Materials and Methods This is a retrospective population-based study of 201 women diagnosed with Gestational Diabetes Mellitus (GDM) between January 2012 and June 2014 in the area of Oviedo, Asturias, Spain. According to diagnostic criteria recommended by GEDE, NDDG, gestational diabetes is diagnosed if two or more plasma glucose levels meet or exceed the following threshold: fasting glucose of 105 mg/dl, 1-h 190 mg/dl, 2-h 165 mg/dl, or 3-h 145 mg/dl. We aim to know if there is any relationship between higher cutoffs and insulin requirement. Results 36 out of 201 patients (17.91%) needed insulin to achieve the targets of blood glucose control. There were no differences in mean maternal age and birthweights. Fasting blood glucose levels were significantly higher in women with further need for insulin than those who only needed diet and exercise (p?<?0.001). Also, blood glucose levels 2 h after the oral glucose intake were statistically different between the two groups (p 0.032). AUC for fasting glucose value was the highest according to ROC curve. Conclusions Fasting cutoff vales for 100 g oral glucose tolerance test are consistently higher in women diagnosed with Gestational Diabetes that further needed insulin to achieve adequate blood glucose control. The positive predictive value of fasting glucose value 105 mg/dl on OGTT was 81.1%, whereas for the cut-off 95 mg/dl it was 54.0%.     

Prevalence and clinical implications of American Diabetes Association-defined diabetes and other categories of glucose dysregulation in older adults: the health, aging and body composition study

Using data on history of diabetes, fasting glucose (FG) and the oral glucose tolerance test (OGTT), the authors contrasted cardiovascular disease (CVD) risk factors (body mass index, blood pressure, lipids and glycated hemoglobin) in 3052 African-American and White adults aged 70-79 in mutually exclusive categories of diagnosed diabetes, undiagnosed diabetes defined by the American Diabetes Association (ADA), isolated post-challenge hyperglycemia (IPH; FG < 126 mg/dL and 2 h post-OGTT > or = 200 mg/dL), impaired fasting glucose (IFG; FG > or = 110 but < 126 mg/dL), and individuals who were non-diabetic by both ADA and World Health Organization (WHO) criteria (FG < 126 mg/dL and 2 h post-challenge glucose < 200 mg/dL). The prevalence of diagnosed diabetes, undiagnosed ADA diabetes and IPH were 15.2, 3.8 and 4.7%, respectively, with more diagnosed and undiagnosed ADA diabetes in African-Americans than Whites. Compared to mean glycated hemoglobin (HbA(1c)) among ADA/WHO non-diabetic individuals (6.0%), HbA(1c) was substantially higher in the diagnosed diabetes and undiagnosed ADA diabetes groups (8.0% and 7.7%), but not in the IPH group (6.3%). The diagnosed and undiagnosed ADA diabetic groups had worse CVD risk factor profiles than the ADA/WHO non-diabetic group. IPH subjects had elevated levels of some CVD risk factors, but differences were more modest than those for the diabetic groups. Among people with IPH, those who also had IFG had worse CVD profiles than those with IPH alone. Although the OGTT may identify additional adults with more CVD risk factors than normals, these differences appear to be clustered among those who also have IFG.     

The association of fatty liver and diabetes risk

We examined whether fatty liver, as diagnosed with abdominal ultrasonography, is an independent risk factor for diabetes mellitus during 10 years of follow-up. A total of 840 subjects (467 men and 373 women) were followed for the entire 10 years. The criteria for being non-diabetic were having no history of diabetes, having a fasting plasma glucose level of less than 110 mg/dl and a serum hemoglobin A1c level of 6.4% or less. We indicated that every examine received all examinations after 12 hours of fasting. Well-trained technicians performed abdominal ultrasonography. Although univariate analysis revealed that the presence of fatty liver was related to hyperglycemia 10 years later, multiple logistic regression analysis did not support this finding. In the multiple logistic regression analysis fasting plasma glucose levels at the baseline and age were significantly related to hyperglycemia (odds ratio [OR] = 1.16, 95% confidence interval [CI]: 1.11-1.21, OR = 1.07, 95% CI: 1.01-1.14, respectively). Fatty liver was not an independent risk factor for hyperglycemia in our follow-up study 10 years after the first diagnosis. The high fasting plasma glucose levels were a risk factor for diabetes, even in the normal range.     

High Prevalence of Diabetes and Impaired Fasting Glucose Among Chinese Immigrants in New York City

Asians have an increased susceptibility to type 2 diabetes, despite relatively low prevalence of obesity in this population. Asian American is a diverse population and there are yet limited data on the prevalence of diabetes among different Asian subgroups and existing studies are limited by small sample size. Hence, we conducted a cross-sectional survey to estimate the prevalence of diabetes and impaired fasting glucose (IFG) in this population among Chinese Americans, the largest Asian subgroup in the US. Our study population consisted 2,071 individuals (52.8% women; mean age: 52.7 ± 13.8 years and mean body mass index (BMI): 23.9 ± 3.2 kg/m²) living in New York City. Data on sociodemographic factors, anthropometric measurements and medical history is obtained during a 1 day clinic visit. In addition, a fasting blood sample was collected to perform measurements on plasma glucose and lipids. Diabetes was defined as self-reported treatment or a fasting glucose ≥126 mg/dl) and IFG was defined as fasting glucose of 100–125 mg/dl. The age-adjusted prevalence of diabetes in this population was 8.6% and that of IFG was 34.6%. The prevalence of IFG/diabetes was high (38.3%) even among those with low BMI by Asian standards (<23.0 kg/m²) and showed a linear increasing trend with increasing waist circumference. These data suggest a high prevalence of impaired glucose regulation in Chinese immigrants even among individuals with normal BMI. Future studies should focus on evaluating the mechanisms of increased susceptibility of IFG and diabetes in this population.     

The effect of physician office visits on CHD risk factor modification as part of a worksite cholesterol screening program

BACKGROUND: Elevated serum cholesterol is a major risk factor for CHD. Primary prevention through behavioral modification has been designated first-line treatment for patients with elevated cholesterol. In this study, we assessed the impact of a physician office visit after a worksite cholesterol screening on self-reported changes in diet, weight loss, exercise, and smoking. We hypothesized that those individuals who had a physician office visit regarding cholesterol would make more changes in CHD risk factors than those who did not have such a visit. METHODS: A cohort of 4,928 participants from 33 work-sites in Massachusetts and Rhode Island had baseline CHD risk factors evaluated at a cholesterol screening and 4,473 were available at follow-up 6 months later by telephone interview. A total of 1,957 had elevated cholesterol levels (>/=200 mg;/dl) and were instructed to visit their physician, in addition to receiving educational materials related to CHD risk factor modification. RESULTS: Most individuals with elevated cholesterol levels had other prevalent self-reported CHD risk factors at baseline: 58% consumed high-fat diets (>30% fat), 43% were overweight, 60% had a sedentary lifestyle (sweat-related physical activity <3 x per week), and 22% were cigarette smokers. After 6 months of follow-up, 74% of participants with high-fat diets reported eating a lower fat diet, 71% of overweight participants reported weight loss, 53% of sedentary participants attempted to increase physical activity, and 38% of smokers decreased or quit cigarette smoking. Thirty-five percent of participants completed the referral for a physician office visit to discuss their elevated cholesterol determined at the baseline worksite screening. However, these individuals showed only a modest change (which was not statistically significant) in self-reported CHD risk factors compared with those who did not have follow-up physician visits after adjusting for age, sex, race, education, occupation, medical insurance, time since last doctor visit, diabetes, and hypertension. Objective measurements of serum cholesterol, body mass index, and dietary score were likewise modestly improved and not statistically significant. CONCLUSIONS: In 6 months of follow-up, high absolute levels of CHD risk factor modification were observed after a worksite cholesterol screening. A physician office visit added only a modest but not statistically significant benefit for further CHD risk factor modification. These findings indicate that the follow-up cholesterol-related physician visit had little added clinical benefit over the screening intervention alone.     

尿酸水平与代谢综合征关系的横断面研究

目的研究代谢综合征在不同尿酸水平人群中的流行病学特征。方法通过对某大型石化企业员工进行调查和体检．空腹抽血进行血清学检查,并采用计算机编辑程序;根据2005年IDF的代谢综合征定义判别代谢综合征,同时根据2004年CDS定义判别代谢综合征相应分析。结果9543名体检人群中患有代谢综合征1．289例,患病率12．3％。在尿酸水平（6mg／dL,6-8mg/dL,≥8mg／dL人群中,代谢综合征患病率分别为10．0％,17．6％,43．3％（根据2005 IDF）。代谢综合征各组分在高尿酸水平中也有高的患病率。结论代谢综合征患病率随着尿酸水平的升高有升高趋势。应该重视高尿酸血症中存在高代谢综合征患病率。     

Quality of diabetes care in primary care setting in egypt: an example of health sector reform in developing countries

The aim of this study was to evaluate the extent of provider adherence to evidence-based guidelines for diabetes care and the extent of glycemic, blood pressure, and lipid control in patients with diabetes in a developing country. A retrospective cohort study was carried out to evaluate diabetes care provided under Health Sector Reform Program (HSRP) in a major medical center in Alexandria, Egypt. Data on care provided for 137 patients were abstracted from medical records. Several process measures were studied including annual proportion of patients with measurements of blood glucose, blood pressure, and lipid levels. Patient outcomes on these measures were also examined. Logistic and poisson regressions were used to study factors related to having measurements done and number of measurements respectively. Multilevel analysis was then used to examine rate of change in patient outcomes and factors associated with this rate over one year of follow-up. For 137 patients with diabetes, annual testing was adequate for fasting blood glucose (FBG) (94.1%), blood pressure (100%), foot (92.7%), and fundus examination (86.6%) was adequate. On the other hand less attention was given to total cholesterol (60.6%), triglycerides (52.6%) and albuminuria (10.3%). At the end of 1 year follow-up, 89.2% did not meet the target level of fasting blood glucose of < 130 mg/dl. A total of 40.2% and 46.7% did not meet the goal of 130 mmHg for systolic and 80 mmHg for diastolic blood pressure. Fifty nine percent, and 76.4% did not meet the goal of total cholesterol level of <200 mg/dl, or triglycerides level of <150 mg /dl respectively. There was evidence of suboptimal treatment with insulin, antihypertensive drugs, and lipid- lowering drugs. This study demonstrates that diabetes care provided under HSRP is unsatisfactory. As a result more effort to increase compliance with evidence based guidelines in diabetes care is needed.     

Chin-Shan Community Cardiovascular Cohort in Taiwan-baseline data and five-year follow-up morbidity and mortality

A cohort consisting of 3602 residents (82.8% of the target population) aged 35 years and older was established in 1990 in the Chin-Shan Community, a suburb 20 miles outside of metropolitan Taipei, Taiwan. The long-term objective was to investigate the prospective impact on cardiovascular health in a society undergoing transition from a developing to a developed nation. This article presents the study design, selected baseline risk factors of cardiovascular diseases (CVD), and CVD events at the 5-year follow-up evaluation with an emphasis on sociodemographic differences. The multivariate logistic regression analyses revealed that white-collar individuals were more likely than blue-collar workers to have dyslipidemia including high-density lipoprotein cholesterol (HDL-C) levels <35 mg/dl [odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.2-2.4] and low-density lipoprotein cholesterol (LDL-C) levels >/=160 mg/dl (OR = 1.3, 95% CI = 1.0-1.7). However, they were at slightly lower risk for stroke and CVD/sudden death, and at moderately higher risk for coronary artery disease and diabetes, although both these trends were not significant. Men were more likely than women to have HDL-C levels <35 mg/dl (OR = 1.8, 95% CI = 1.4-2.2), but they were less likely to have LDL-C levels >/=160 mg/dl (OR = 0.7, 95% CI = 0.6-0.8). The risk of CVD/sudden death was higher for men than for women during the follow-up period (OR = 1.9, 95% CI = 1.3-2.9). This could be due to risk factors such as a much higher prevalence of tobacco (61.9% vs. 4.5%) and alcohol (43.7% vs. 6.4%) use in men. In conclusion, individuals of higher socioeconomic status have a higher prevalence of dyslipidemia but slightly lower 5-year incidence of CVD events.     

Screening for gestational diabetes in a high-risk population

One hundred eighty-one pregnant Navajo women were screened for gestational diabetes. The 50-g oral glucose screening test was greater than 7.2 mmol/L (130 mg/dL) in 44 of 181 subjects (24.3 percent) and greater than 8.3 mmol/L (150 mg/dL) in 23 of 181 subjects (12.7 percent). The incidence of gestational diabetes in the study population was 6.1 percent of all pregnancies by standard oral glucose tolerance testing. Incidence of gestational diabetes was 9.5 percent in 21 subjects whose screening test was 7.2 to 8.3 mmol/L (130 to 149 mg/dL) and 39.1 percent in 23 subjects whose screening test was 8.3 mmol/L (150 mg/dL) or greater. Using equal to or greater than 7.2 mmol/L (130 mg/dL) of glucose as the definition of an abnormal screening test yielded a 0.80 specificity and a 0.25 positive predictive value, while the cost for each case of gestational diabetes detected was $114. Using equal to or greater than 8.3 mmol/L (150 mg/dL) of glucose as the definition of an abnormal screening test yielded a 0.81 sensitivity, 0.58 specificity, and 0.39 positive predictive value, while the cost for each case of gestational diabetes detected was $106. Logistic regression analyses demonstrated that the screening test was more strongly associated with the diagnoses of gestational diabetes than any other risk factor for gestational diabetes. Universal screening of gestational diabetes is recommended in this high-risk population using equal to or greater than 7.2 mmol/L (130 mg/dL) of glucose as the definition of an abnormal screening test.     

Cardiovascular risk factors in the urban Mexican population: the FRIMEX study

BACKGROUND: Atherosclerotic ischaemic heart disease is the second leading cause of general mortality in Mexico due to the growing prevalence of atherosclerotic risk factors in our society. The data of the FRIMEX study (Factores de Riesgo en México, Risk Factors in Mexico), considered together with those of other contemporary epidemiological surveys, will aid in our comprehension of the current state of cardiovascular epidemics in Mexico. METHODS: Frequencies of obesity, hypertension and smoking, and total cholesterol and glucose in capillary blood were estimated in a non-probabilistic sample comprised of 140017 individuals (aged 44+/-13 years; 42% men and 58% women), from six Mexican cities (Mexico City, Guadalajara, Monterrey, Puebla, Leon and Tijuana). RESULTS: Obesity or overweight status was found in 71.9% of participants. Hypertension was found in 26.5%, and the proportions of awareness, treatment and control for this disease were 49.3, 73 and 36%, respectively. Prevalence of hypertension increased with age; while it was higher in men under 60 years of age, in the more aged individuals it was higher in women. Hypercholesterolaemia was found in 40% of the individuals and cholesterolaemia > or =240 mg/dl was significantly higher in women. Thirty-five and a half percent of men and 18.1% of women were smokers. Type 2 diabetes mellitus was found in 10.4% of participants. There was significant Pearson's correlation between body mass index and blood pressure, between hypertension and glucose levels, and between hypertension and total cholesterol concentrations. CONCLUSIONS: We conclude that this population has a high cardiovascular risk profile and a high probability of the occurrence of metabolic syndrome.