Estimated burden of diabetes mellitus in Manitoba according to health insurance claims: a pilot study.

OBJECTIVE: To estimate the burden of diabetes mellitus in Manitoba from 1980 to 1984. DESIGN: Review of the Manitoba Health Services Commission (MHSC) database. The validity of the MHSC data was established through two substudies: one involved self-reports from a survey of elderly Manitobans, and the other involved people with confirmed diabetes enrolled in the provincial diabetes education program. SUBJECTS: Sample of 100,000 people stratified by age, sex and MHSC health region: 50,000 were aged 25 to 64 years, and 50,000 were aged 65 or more. All MHSC claims containing the ICD-9-CM code for diabetes mellitus or gestational diabetes were identified. MAIN RESULTS: Of the sample 7627 people were found to have a diagnosis of diabetes, the annual prevalence being 0.8% among those 25 to 44 years of age, 3.5% among those 45 to 64 and 7.6% among those 65 or older. The annual incidence rate among those over 25 years of age was 7.8 per 1000. Of the 4556 pregnant women 25 to 44 years old 85 (1.9%) had diabetes; 23 were believed to have gestational diabetes. CONCLUSIONS: The incidence and prevalence rates were similar to those determined on the basis of self-reports in Canadian and US national surveys. The use of an administrative database such as that of the MHSC will provide key information for planning health services for diabetic patients and will permit the monitoring of long-term trends in the incidence and prevalence of the disease.     

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

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

Prospective study of cigarette smoking,alcohol use,and the risk of diabetes in men.

OBJECTIVE--To examine the association between smoking, alcohol consumption, and the incidence of non-insulin dependent diabetes mellitus in men of middle years and older. DESIGN--Cohort questionnaire study of men followed up for six years from 1986. SETTING--The health professionals'' follow up study being conducted across the United States. SUBJECTS--41,810 male health professionals aged 40-75 years and free of diabetes, cardiovascular disease, and cancer in 1986 and followed up for six years. MAIN OUTCOME MEASURE--Incidence of non-insulin dependent diabetes mellitus diagnosed in the six years. RESULTS--During 230,769 person years of follow up 509 men were newly diagnosed with diabetes. After controlling for known risk factors men who smoked 25 or more cigarettes daily had a relative risk of diabetes of 1.94 (95% confidence interval 1.25 to 3.03) compared with non-smokers. Men who consumed higher amounts of alcohol had a reduced risk of diabetes (P for trend < 0.001). Compared with abstainers men who drank 30.0-49.9 g of alcohol daily had a relative risk of diabetes of 0.61 (95% confidence interval 0.44 to 0.91). CONCLUSIONS--Cigarette smoking may be an independent, modifiable risk factor for non-insulin dependent diabetes mellitus. Moderate alcohol consumption among healthy people may be associated with increased insulin sensitivity and a reduced risk of diabetes.     

Recent epidemiologic trends of diabetes mellitus among status Aboriginal adults

Background:

Little is known about longitudinal trends in diabetes mellitus among Aboriginal people in Canada. We compared the incidence and prevalence of diabetes, and its impact on mortality, among status Aboriginal adults and adults in the general population between 1995 and 2007.

Methods:

We examined de-identified data from Alberta Health and Wellness administrative databases for status Aboriginal people (First Nations and Inuit people with treaty status) and members of the general public aged 20 years and older who received a diagnosis of diabetes mellitus from Apr. 1, 1995, to Mar. 31, 2007. We calculated the incidence and prevalence of diabetes and mortality rate ratios by sex and ethnicity in 2007. We examined the average relative changes per year for longitudinal trends.

Results:

The average relative change per year in the prevalence of diabetes showed a smaller increase over time in the Aboriginal population than in the general population (2.39 v. 4.09, p < 0.001). A similar finding was observed for the incidence of diabetes. In the Aboriginal population, we found that the increase in the average relative change per year was greater among men than among women (3.13 v. 1.88 for prevalence, p < 0.001; 2.60 v. 0.02 for incidence, p = 0.001). Mortality among people with diabetes decreased over time to a similar extent in both populations. Among people without diabetes, mortality decreased in the general population but was unchanged in the Aboriginal population (−1.92 v. 0.11, p = 0.04). Overall, mortality was higher in the Aboriginal population than in the general population regardless of diabetes status.

Interpretation:

The increases in the incidence and prevalence of diabetes over the study period appeared to be slower in the status Aboriginal population than in the general population in Alberta, although the overall rates were higher in the Aboriginal population. Mortality decreased among people with diabetes in both populations but was higher overall in the Aboriginal population regardless of diabetes status.The health of Aboriginal people in Canada is generally poorer than their non-Aboriginal counterparts, and diabetes mellitus is a significant contributor.^1,2 Studies have shown that type 2 diabetes and its complications occur at rates two to five times higher in Canada’s Aboriginal population than in the general population.^3–7 In response, diverse diabetes programs have materialized, including various community-based prevention and screening projects.^8–10 The federally funded Aboriginal Diabetes Initiative was created to emphasize health promotion and diabetes prevention.¹¹ In addition, numerous Aboriginal communities have established their own diabetes and health programs.¹²Accurate diabetes surveillance data are essential for governments and health care organizations to plan health care delivery and translate knowledge into policy and funding decisions. However, research into the longitudinal trends of diabetes in Aboriginal populations is scarce. For the most part, data have come from small, community-based studies and self-reported surveys. Population-based studies of primary data are few and have been conducted only for limited periods. Even less is known about outcomes, mortality in particular, among Aboriginal individuals with diabetes.The use of administrative data is becoming more common for tracking diabetes in Canada.¹³ The National Diabetes Surveillance System uses administrative health data to document the burden of the disease, but it has little information on Aboriginal people. Dyck and colleagues recently used the methodology of the National Diabetes Surveillance System to examine the incidence and prevalence of diabetes among Aboriginal people in the province of Saskatchewan,¹⁴ and similar analyses were conducted in Manitoba and Ontario.^15,16As part of the Alberta Diabetes Surveillance System, we conducted this study to compare the incidence and prevalence of diabetes among people 20 years and older in the status Aboriginal population (First Nations and Inuit people with treaty status) and the general population in the province of Alberta between 1995 and 2007. We also compared trends in mortality in the two populations among people with and without diabetes.     

Type 2 Diabetes Mellitus and Kidney Cancer Risk: A Retrospective Cohort Analysis of the National Health Insurance

Purpose

To evaluate the association between incidence of any kidney cancer and type 2 diabetes mellitus.

Methods

A random sample of 1,000,000 subjects covered by the National Health Insurance was recruited. A total of 998728 people (115655 diabetes and 883073 non-diabetes) without kidney cancer at recruitment were followed from 2003 to 2005. The cumulative incidence of kidney cancer from 2003 to 2005 in diabetic patients and non-diabetic people in all ages and in age <40, 40–64, 65–74 and ≥75 years were calculated in the diabetic patients and the non-diabetic people, respectively. Logistic regression was used to estimate the odds ratios comparing diabetic patients to non-diabetic people in the respective age groups. Multivariable-adjusted odds ratios for kidney cancer with regards to diabetes status and diabetes duration (as a continuous variable or categorized into subgroups of non-diabetes, diabetes duration <1 year, 1–2.9 years, 3–4.9 years and ≥5 years) were estimated after multivariable adjustment. The multivariable-adjusted odds ratios for all baseline variables were also estimated for diabetic patients and non-diabetic people, respectively.

Results

The 3-year cumulative incidence of kidney cancer in the diabetic patients and the non-diabetic people was 166.9 and 33.1 per 100,000 person-years, respectively. The incidence increased with regards to increasing age in both the diabetic patients and the non-diabetic people, but a higher risk of kidney cancer for the diabetic patients compared to the non-diabetic people was consistently observed in different age groups. After multivariable adjustment, the odds ratio for diabetic patients versus non-diabetic people was 1.7 (95% confidence interval: 1.3–2.1, P<0.01). While compared to the non-diabetic people, the odds ratio (95% confidence interval) for diabetes duration <1, 1–2.9 years, 3–4.9 years and ≥5 years was 1.5 (0.8–2.7), 1.6 (1.0–2.4), 1.6 (1.1–2.4) and 1.7 (1.3–2.3), respectively (P-trend <0.01). Analyses conducted in the diabetic patients and the non-diabetic people, respectively, consistently showed age, nephropathy and end-stage renal disease as significant risk factors of kidney cancer. Additionally, living in metropolitan Taipei region might also be associated with a higher risk of kidney cancer in the non-diabetic people, indicating a potential link between kidney cancer and some factors related to urbanization.

Conclusions

Patients with type 2 diabetes mellitus have a significantly higher risk of kidney cancer.     

Diabetes mellitus in Mohawks of Kahnawake,PQ: a clinical and epidemiologic description.

The authors report the rates of obesity, hypertension, hypercholesterolemia, smoking, and macrovascular and microvascular complications among Mohawks of Kahnawake, PQ, who have non-insulin-dependent diabetes mellitus. The data were derived from a study comparing rates of macrovascular and microvascular complications among the diabetic subjects and a nondiabetic group matched for age and sex. The data for both groups were collected by means of chart review, interview and body measurement. There were no important differences between the male and female diabetic subjects. Both sexes had high levels of obesity, hypertension, hypercholesterolemia and diabetic complications. A total of 86% of the diabetic subjects were obese; the rate was also very high (74%) among the nondiabetic subjects. The mean age at onset of diabetes, 59 years, was 10 years higher than that observed in Oneida Iroquois of Ontario. The rates of macrovascular disease among the diabetic subjects were higher than those found among Cree/Ojibwa in Ontario and Manitoba. Our findings add to the knowledge of non-insulin-dependent diabetes in North American Indians in Canada and show that there are differences between our Mohawk subjects and diabetic people of other native communities.     

Incidence and causes of end-stage renal disease among Aboriginal children and young adults

Background:

Although Aboriginal adults have a higher risk of end-stage renal disease than non-Aboriginal adults, the incidence and causes of end-stage renal disease among Aboriginal children and young adults are not well described.

Methods:

We calculated age- and sex-specific incidences of end-stage renal disease among Aboriginal people less than 22 years of age using data from a national organ failure registry. Incidence rate ratios were used to compare rates between Aboriginal and white Canadians. To contrast causes of end-stage renal disease by ethnicity and age, we calculated the odds of congenital diseases, glomerulonephritis and diabetes for Aboriginal people and compared them with those for white people in the following age strata: 0 to less than 22 years, 22 to less than 40 years, 40 to less than 60 years and older than 60 years.

Results:

Incidence rate ratios of end-stage renal disease for Aboriginal children and young adults (age < 22 yr, v. white people) were 1.82 (95% confidence interval [CI] 1.40–2.38) for boys and 3.24 (95% CI 2.60–4.05) for girls. Compared with white people, congenital diseases were less common among Aboriginal people aged less than 22 years (odds ratio [OR] 0.56, 95% CI 0.36–0.86), and glomerulonephritis was more common (OR 2.18, 95% CI 1.55–3.07). An excess of glomerulonephritis, but not diabetes, was seen among Aboriginal people aged 22 to less than 40 years. The converse was true (higher risk of diabetes, lower risk of glomerulonephritis) among Aboriginal people aged 40 years and older.

Interpretation:

The incidence of end-stage renal disease is higher among Aboriginal children and young adults than among white children and young adults. This higher incidence may be driven by an increased risk of glomerulonephritis in this population.Compared with white Canadians, Aboriginal Canadians have a higher prevalence of end-stage renal disease,^1,2 which is generally attributed to their increased risk for diabetes. However, there has been limited investigation of the incidence and causes of end-stage renal disease among Aboriginal children and young adults. Because most incident cases of diabetes are identified in middle-aged adults, an excess risk of end-stage renal disease in young people would not be expected if the high risk of diabetes is responsible for higher overall rates of end-stage renal disease among Aboriginal people. About 12.3% of children with end-stage renal disease in Canada are Aboriginal,³ but only 6.1% of Canadian children (age < 19 yr) are Aboriginal.^4,5A few reports suggest that nondiabetic renal disease is common among Aboriginal populations in North America.^2,6–8 Aboriginal adults in Saskatchewan are twice as likely as white adults to have end-stage renal disease caused by glomerulonephritis,^7,8 and an increased rate of mesangial proliferative glomerulonephritis has been reported among Aboriginal people in the United States.^6,9 These studies suggest that diabetes may be a comorbid condition rather than the sole cause of kidney failure among some Aboriginal people in whom diabetic nephropathy is diagnosed using clinical features alone.We estimated incidence rates of end-stage renal disease among Aboriginal children and young adults in Canada and compared them with the rates seen among white children and young adults. In addition, we compared relative odds of congenital renal disease, glomerulonephritis and diabetic nephropathy in Aboriginal people with the relative odds of these conditions in white people.     

Alcohol consumption and type 2 diabetes among older adults: the Cardiovascular Health Study

Objective: The objective was to examine the role of total and beverage‐specific alcohol consumption on the incidence of type 2 diabetes mellitus (DM) among elderly men and women. Research Methods and Procedures: We studied prospectively 4655 participants of the Cardiovascular Health Study who were free of DM at baseline. Alcohol consumption was obtained at baseline and during follow‐up examinations. DM was defined using fasting glucose and/or use of hypoglycemic medications. We used Cox proportional hazard models to estimate adjusted relative risks of diabetes across alcohol categories. Results: During a mean follow‐up of 6.3 years, 234 incident cases of DM were documented. Compared with never drinkers, hazard ratios [95% confidence interval (CI)] for DM were 0.7 (0.3 to 1.4), 0.5 (0.3 to 0.9), 0.6 (0.4 to 1.1), and 0.8 (0.4 to 1.3) for former drinkers and current drinkers of <1, 1 to 6, and 7+ drinks per week, respectively, for men after adjustment for age, BMI, education, and smoking. Corresponding values for women were 1.2 (0.6 to 2.3), 0.7 (0.4 to 1.1), 0.6 (0.3 to 1.1), and 0.4 (0.2 to 1.0), respectively. A reduced risk of DM was observed with all types of beverage consumed. Similar findings were observed when we repeated the above analyses using simple or weighted cumulative alcohol update and covariates over time. Discussion: Light to moderate alcohol consumption was associated with a lower incidence of DM among elderly people, irrespective of the type of beverage consumed.     

Lifetime risk of diabetes among First Nations and non–First Nations people

Background:Lifetime risk is a relatively straightforward measure used to communicate disease burden, representing the cumulative risk of an outcome during the remainder of an individual’s life starting from a disease-free index age. We estimated the lifetime risk of diabetes among men and women in both First Nations and non–First Nations populations using a cohort of adults in a single Canadian province.Methods:We used a population-based cohort consisting of Alberta residents from 1997 to 2008 who were free of diabetes at cohort entry to estimate the lifetime risk of diabetes among First Nations and non–First Nations people. We calculated age-specific incidence rates with the person-year method in 5-year bands. We estimated the sex- and index-age–specific lifetime risk of incident diabetes, after adjusting for the competing risk of death.Results:The cohort included 70 631 First Nations and 2 732 214 non–First Nations people aged 18 years or older. The lifetime risk of diabetes at 20 years of age was 75.6% among men and 87.3% among women in the First Nations group, as compared with 55.6% among men and 46.5% among women in the non–First Nations group. The risk was higher among First Nations people than among non–First Nations people for all index ages and for both sexes. Among non–First Nations people, men had a higher lifetime risk of diabetes than women across all index ages. In contrast, among First Nations people, women had a higher lifetime risk than men across all index ages.Interpretation:About 8 in 10 First Nations people and about 5 in 10 non–First Nations people of young age will develop diabetes in their remaining lifetime. These population-based estimates may help health care planners and decision-makers set priorities and increase public awareness and interest in the prevention of diabetes.Diabetes mellitus is a major health problem worldwide and is associated with increased morbidity, mortality, life expectancy and health care costs.^1–4 The prevalence of diabetes in Canada has increased more than twofold over the past decade.⁵ Currently, the disease affects almost 2.4 million Canadians,⁶ and its management, along with that of associated complications, costs more than $9 billion annually.⁷ The burden of diabetes is particularly high among First Nations people in Canada, with prevalence rates 3–5 times higher than those among non–First Nations people.⁸Reducing the risk of type 2 diabetes will require a broad set of population-based and individual-level interventions that target diabetogenic aspects of lifestyle, as well as social determinants of health. The changes required to achieve these objectives will need buy-in from a wide range of stakeholders. Thus, it will be important to communicate risk in a way that is understood by the general population and by health authorities.Although estimates of incidence and prevalence provide important information about the burden of a disease in the community, they do not provide adequate information regarding the perspective of risk at the individual level. Lifetime risk (the probability of a disease-free individual developing the disease during his or her remaining lifespan) may be more informative for the general population and for decision-makers. Life-table modelling techniques use incidence and mortality data to estimate the lifetime risk of diabetes. This important assessment of the disease burden of diabetes has been undertaken in a few studies,^9–11 but it has not been done in Canada. The need for such estimates is particularly relevant given the higher prevalence of diabetes among First Nations people in Canada.We estimated the lifetime risk of diabetes among men and women in both First Nations and non–First Nations populations using a cohort of adults residing in a single Canadian province.     

Prospective study of incidence of juvenile diabetes mellitus over 10 years in Dar es Salaam,Tanzania.

OBJECTIVE--To ascertain the annual incidence of diabetes requiring treatment with insulin in children and adolescents aged 0-19 years in Dar es Salaam, Tanzania, during a 10 year period from 1 January 1982 to 31 December 1991. DESIGN--Prospective registration at a major urban hospital of all patients with newly diagnosed diabetes who were resident in Dar es Salaam. SETTING--Muhimbili Medical Centre, Dar es Salaam, Tanzania. PATIENTS--86 patients: 45 male, 41 female. RESULTS--The annual incidence of juvenile diabetes for both sexes was 1.5 per 100,000 population aged 0-19 years (95% confidence interval 1.3 to 1.7). Incidence per 100,000 population per year increased with age: 0.6 (0.0 to 0.13) in the age group 0-4 years, 0.5 (0.3 to 0.7) at 5-9 years, 2.2 (1.8 to 2.6) at 10-14 years, and 3.4 (2.9 to 3.9) at 15-19 years. CONCLUSION--Juvenile diabetes mellitus is fairly rare in sub-Saharan Africa. If environmental factors such as infection and material deprivation were important determinants of insulin dependent diabetes in Africans, as they may be in Europeans, much higher rates would have been expected unless genetic factors possibly exert a protective role. The eightfold greater incidence in African Americans than in Tanzanians may be related to greater genetic admixture in African Americans with people from countries in Europe with a high incidence.     

Incidence of insulin dependent diabetes in England: a study in the Oxford region, 1985-6.

OBJECTIVE--To determine the incidence of insulin dependent diabetes mellitus up to the age of 21 in a geographically defined population in England with independent validation of completeness of case ascertainment. DESIGN--Prospective registration of newly diagnosed cases supplemented by centralised hospital discharge records and death certificates. Validation of ascertainment from general practitioners. SETTING--Oxford Regional Health Authority area (population 2.4 million). PATIENTS--All patients with insulin dependent diabetes diagnosed below age 21 during 1985-6 and resident in the region at the time of diagnosis. INTERVENTIONS--None. END POINT--Validation of a method of case ascertainment for assessing temporal variation in incidence of insulin dependent diabetes. MEASUREMENTS AND MAIN RESULTS--The overall yearly incidence of newly diagnosed insulin dependent diabetes mellitus in people under 21 was 15.6 cases/100,000 (95% confidence interval 13.6 to 17.6). Among males the incidence was 16.8 cases (14.0 to 19.7)/100,000 and among females 14.3 cases (11.6 to 17.1)/100,000. The highest incidence, in the 10-14 year age group, was 26.4 (20.9 to 31.8) new cases/100,000 population yearly. Case ascertainment was greater than 95%. CONCLUSIONS--The incidence of insulin dependent diabetes in England is considerably higher than reported from large scale studies. It is consistent with described patterns of geographical variation. The figures provide a baseline for assessing temporal change.     

Family History of Diabetes is Associated with Increased Risk of Recurrent Diabetic Ketoacidosis in Pediatric Patients

Objective: To determine the relationship between family history of diabetes mellitus (DM) and diabetic ketoacidosis (DKA) recurrence in youth with established type 1 diabetes mellitus (T1DM).Methods: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January, 2009, and December, 2014. We compared patients with recurrent (≥2 admissions) and nonrecurrent DKA (1 admission) and investigated patient level factors, including family history, that may be associated with DKA recurrence in pediatric patients with established T1DM.Results: Of the 131 subjects in the study, 51 (39%) subjects were in the recurrence group. Age ≥15 years old, public health insurance, and family history of T1DM or type 2 diabetes mellitus were associated with recurrent DKA admissions in both univariable and multivariable analyses. Family history was associated with DKA recurrence, with an incidence rate ratio of 1.5 (95% confidence interval = 1.0 to 2.3; P = .03). The association was not explained by type of familial diabetes, first degree relative status, or whether the family member lived in the household.Conclusion: Recognition that a positive family history of DM may be associated with a higher risk for DKA recurrence in patients with established T1DM may allow for targeted education and focus on a previously unidentified population at increased risk for DKA. Understanding the mechanism underlying the effect of family history of diabetes on the rates of DKA in patients with established T1DM may allow for improved identification and education of patients who may be at risk for DKA recurrence.Abbreviations: CI = confidence interval; DKA = diabetic ketoacidosis; EHR = electronic health record; IBD = inflammatory bowel disease; IRR = incidence rate ratio; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus     

Risk of hypothermia in elderly patients with diabetes.

The incidence of admissions of patients with hypothermia was determined to examine whether hypothermia was more common in elderly patients with diabetes than in the general population after diabetic metabolic emergency cases had been excluded. A prospective survey of three accident and emergency departments identified 134 cases of hypothermia admitted from a catchment population of almost 157,000 aged 65 or over during the winters of 1981-2 to 1983-4. The predicted number of patients with diabetes in the population was nearly 5600 (3.5%). Twenty three admissions for hypothermia (17%) occurred in 20 patients with previously diagnosed diabetes. Women made up 87% of the diabetic admissions; the ratio of diabetic to non-diabetic admission rates in women was 7.9 (95% confidence interval 5.3 to 12.0). After excluding diabetic metabolic emergency admissions the ratio was 6.4. The ratio in men was 2.4, but the small number of admissions produced wide confidence intervals. Ten of the admissions with diabetes (43%) had pathological disorders that are associated with an increased risk of hypothermia. The frequency of these conditions is higher in patients with diabetes than in the general population and partly explains the increased risk of hypothermia in these patients.     

Increased risk of severe acute pancreatitis in patients with diabetes

Aims We prospectively assessed the age- and sex-specific incidence rates and relative risks of overall and severe acute pancreatitis in Taiwanese with diabetes. Methods The study cohort included age- and-sex-matched groups of patients with (n?=?547?554) and without (n?=?584?373) diabetes. Incidence rate was estimated under Poisson assumption and relative risks of acute pancreatitis and severe acute pancreatitis, based on modified Atlanta criteria, were indicated by hazard ratios estimated from Cox proportional hazard regression models. Results Over an 8-year follow-up period, the incidence of acute pancreatitis was 2.98 and 1.68 per 1000 person-years for patients with and without diabetes, respectively, representing a covariate adjusted hazard ratio of 1.53 (95% confidence interval 1.49-1.58). Diabetes was associated with a significantly elevated risk of acute pancreatitis in all sex and age stratifications, with the highest hazard ratio noted for study subjects aged 相似文献   

Prevalence and Cardiovascular Associations of Diabetic Retinopathy and Maculopathy: Results from the Gutenberg Health Study

Objective

Diabetic retinopathy (DR) is the leading cause of blindness in people of working age. The purpose of this paper is to report the prevalence and cardiovascular associations of diabetic retinopathy and maculopathy (DMac) in Germany.

Research Design and Methods

The Gutenberg Health Study (GHS) is a population-based study with 15,010 participants aged between 35 at 74 years from the city of Mainz and the district of Mainz-Bingen. We determined the weighted prevalence of DR and DMac by assessing fundus photographs of persons with diabetes from the GHS data base. Diabetes was defined as HbA1c ≥ 6.5%, known diagnosis diabetes mellitus or known diabetes medication. Furthermore, we analysed the association between DR and cardiovascular risk factors and diseases.

Results

Overall, 7.5% (1,124/15,010) of the GHS cohort had diabetes. Of these, 27.7% were unaware of their disease and thus were newly diagnosed by their participation in the GHS. The prevalence of DR and DMac was 21.7% and 2.3%, respectively among patients with diabetes. Vision-threatening disease was present in 5% of the diabetic cohort. In the multivariable analysis DR (all types) was associated with age (Odds Ratio [95% confidence interval]: 0.97 [0.955–0.992]; p = 0.006) arterial hypertension (1.90 [1.190–3.044]; p = 0.0072) and vision-threatening DR with obesity (3.29 [1.504–7.206]; p = 0.0029). DR (all stages) and vision-threatening DR were associated with duration of diabetes (1.09 [1.068–1.114]; p<0.0001 and 1.18 [1.137–1.222]; p<0.0001, respectively).

Conclusions

Our calculations suggest that more than a quarter-million persons have vision-threatening diabetic retinal disease in Germany. Prevalence of DR was lower in the GHS compared to East-Asian studies. Associations were found with age, arterial hypertension, obesity, and duration of diabetes mellitus.     

Prevalence of left ventricular hypertrophy in hypertensive and normotensive type 2 diabetic females in Port Harcourt

This study investigated the prevalence of electrocardiographically determined left ventricular hypertrophy in hypertensive and normotensive type 2 diabetic females who went for consultation at the University of Port Harcourt Teaching Hospital (UPTH), Rivers State, Nigeria. Two hundred participants mean age 52years, attending the medical outpatient clinic over a 6-month period were recruited for the study.  Of the population studied, 16.5% of the hypertensive and 13.0% of the normotensive diabetics had left ventricular hypertrophy. Cardiovascular abnormalities notably bifascicular block, left atrial block, right ventricular enlargement, and right atrial enlargement were predominately among hypertensive diabetes and also notably  was arrhythmia  and atrial flutter among normotensive diabetes. The significance of these findings is discussed. Keywords: Hypertension, Diabetes mellitus, Cardiovascular disease, Left ventricular hypertrophy.     

Children diagnosed with diabetes during infancy have unique clinical characteristics

OBJECTIVE: Characterizing clinical and biochemical features of children diagnosed with diabetes mellitus between the ages of 6-24 months. DESIGN AND METHODS: Medical records of 42 children diagnosed with diabetes mellitus at age of 6-24 months were reviewed for gender, ethnic origin, family medical history, clinical and biochemical features at onset of diabetes compared with 60 diabetic patients diagnosed at age 5-16 years. RESULTS: Children diagnosed at 6-24 months had at onset more symptoms of apathy, restlessness, hyperglycemia during acute illness and a lower rate of remission than those diagnosed at older age (p < 0.001), significantly more episodes of diabetic ketoacidosis (83% vs. 40%, p < 0.001), lower HbA1c levels (mean 11.6 +/- 3.4 vs. 13.75 +/- 3.4%, p < 0.05) and a higher rate of celiac disease (12% vs. 3%, p = 0.046). There were no significant differences as to other autoimmune diseases. CONCLUSIONS: Patients with diabetes presenting at 6-24 months might be associated with a different clinical pattern and higher rate of celiac disease than diabetes presenting later in life. Understanding the nature and course of diabetes in this age group is crucial for planning interventional and preventive programs.     

France Verus Wales

Assessment of roentgenographic measurements of cortical bone of the radius in 196 elderly females, including 63 diabetics, revealed that: (1) in the non-diabetic group there was a significant loss of cortical bone relative to the number of years after the menopause and to body weight; (2) although there was a significant loss of cortical bone relative to years postmenopausal in a group of diabetic patients the cortex in the diabetic group was better preserved than in those non-diabetic controls in whom no vertebral compressions were diagnosed in the roentgenograms; no correlation between bone loss and body weight was found among the diabetics; (3) the thinnest cortical bone and the lowest average body weight was found in the 34 non-diabetics with vertebral compression deformities. It thus appears that involutional osteoporosis will be less prevalent among old women suffering from diabetes mellitus than in comparable non-diabetic subjects, and more prevalent among non-diabetics of low body weight than in old women who are obese or of normal weight.     

Analysis of the cause of death in diabetic ketoacidosis based on 5 years of personal observation

The authors observed 53 cases of diabetic ketoacidosis treated with low doses of insulin. Mean age of the patients was 41 +/- 17 years, duration of diabetes mellitus 7.5 +/- 6.4 years. Ketoacidosis was due to: infections in 36%, other diseases in 7%, and cessation of insulin therapy in 25% of cases. Ketoacidosis was a first sign of diabetes mellitus in 19% of cases while causative factor was not detected in 13% of cases. At the admission to hospital mean blood pH was 7.02 +/- 0.15, mean bicarbonate concentration 6.17 +/- 3.45 mM/l, and glycaemia 40.6 +/- 16.8 mM/l. Therapy of ketoacidosis was complicated by hypopotassemia in 1 patient and transient hypoglycaemia in another patient. Five patients (9.6%) died. Infections, myocardial infarction, acute pancreatitis, pulmonary edema, and disseminated intravascular coagulation were the causes of deaths.