Prevalence and incidence of NIDDM in Iceland: evidence for stable incidence among males and females 1967-1991--the Reykjavik Study

The effect of level of injury on diabetes incidence and mortality after spinal cord injury - a longitudinal cohort study

STUDY DESIGN

Retrospective longitudinal cohort study of veterans with SCI.

OBJECTIVES

Spinal cord injury (SCI) is associated with an increased risk of developing diabetes mellitus (DM), likely due to body composition alterations and autonomic nervous system dysfunction. These factors are more pronounced in persons with tetraplegia (TP) versus paraplegia (PP). However, the effect of level of injury (LOI) on DM incidence is largely unknown. Therefore, the objective is to examine the effect of LOI on DM incidence in persons with SCI.

SETTING

South Texas Veterans Health Care System.

METHODS

We obtained electronic record data on age, sex, race/ethnicity, LOI and HbA1c concentration from January 1st 2001 through December 31st 2021. Cox proportional hazard regression analyses were used to assess the association between LOI, DM and all-cause mortality.

RESULTS

Among 728 non-diabetic veterans with SCI (350 TP/ 378 PP, 52 ± 15 years, 690 male/38 female) 243 developed DM, of which 116 with TP and 127 with PP. Despite chronological variations between TP and PP, DM risk over the entire follow-up did not differ between the groups (hazard ratio (HR): 1.06, 95% CI: 0.82-1.38). Mortality was higher in TP versus PP (HR: 1.40, 95% CI: 1.09-1.78). However, developing DM did not increase the risk of death, regardless of LOI (HR: 1.07, 95% CI: 0.83-1.37).

CONCLUSION

Despite chronological variations between both groups, the level of injury had minimal effect on long-term DM development in this cohort of veterans with SCI. Sponsorship NIH (DK105379; MS), RR&D SPiRE (I21RX003724-01A1; MT and SH).

Sirtuins-Mediated System-Level Regulation of Mammalian Tissues at the Interface between Metabolism and Cell Cycle: A Systematic Review

Sirtuins are a family of highly conserved NAD+-dependent proteins and this dependency links Sirtuins directly to metabolism. Sirtuins' activity has been shown to extend the lifespan of several organisms and mainly through the post-translational modification of their many target proteins, with deacetylation being the most common modification. The seven mammalian Sirtuins, SIRT1 through SIRT7, have been implicated in regulating physiological responses to metabolism and stress by acting as nutrient sensors, linking environmental and nutrient signals to mammalian metabolic homeostasis. Furthermore, mammalian Sirtuins have been implicated in playing major roles in mammalian pathophysiological conditions such as inflammation, obesity and cancer. Mammalian Sirtuins are expressed heterogeneously among different organs and tissues, and the same holds true for their substrates. Thus, the function of mammalian Sirtuins together with their substrates is expected to vary among tissues. Any therapy depending on Sirtuins could therefore have different local as well as systemic effects. Here, an introduction to processes relevant for the actions of Sirtuins, such as metabolism and cell cycle, will be followed by reasoning on the system-level function of Sirtuins and their substrates in different mammalian tissues. Their involvement in the healthy metabolism and metabolic disorders will be reviewed and critically discussed.

Trends in incidence of total or type 2 diabetes: systematic review

OBJECTIVE

To assess what proportions of studies reported increasing, stable, or declining trends in the incidence of diagnosed diabetes.

DESIGN

Systematic review of studies reporting trends of diabetes incidence in adults from 1980 to 2017 according to PRISMA guidelines.

DATA SOURCES

Medline, Embase, CINAHL, and reference lists of relevant publications.

ELIGIBILITY CRITERIA

Studies of open population based cohorts, diabetes registries, and administrative and health insurance databases on secular trends in the incidence of total diabetes or type 2 diabetes in adults were included. Poisson regression was used to model data by age group and year.

RESULTS

Among the 22 833 screened abstracts, 47 studies were included, providing data on 121 separate sex specific or ethnicity specific populations; 42 (89%) of the included studies reported on diagnosed diabetes. In 1960-89, 36% (8/22) of the populations studied had increasing trends in incidence of diabetes, 55% (12/22) had stable trends, and 9% (2/22) had decreasing trends. In 1990-2005, diabetes incidence increased in 66% (33/50) of populations, was stable in 32% (16/50), and decreased in 2% (1/50). In 2006-14, increasing trends were reported in only 33% (11/33) of populations, whereas 30% (10/33) and 36% (12/33) had stable or declining incidence, respectively.

CONCLUSIONS

The incidence of clinically diagnosed diabetes has continued to rise in only a minority of populations studied since 2006, with over a third of populations having a fall in incidence in this time period. Preventive strategies could have contributed to the fall in diabetes incidence in recent years. Data are limited in low and middle income countries, where trends in diabetes incidence could be different.

SYSTEMATIC REVIEW REGISTRATION

Prospero CRD42018092287.

Type 2 diabetes and obesity in midlife and breast cancer risk in the Reykjavik cohort

PURPOSE

As obesity and type 2 diabetes (T2D) have been increasing worldwide, we investigated their association with breast cancer incidence in the Reykjavik Study.

METHODS

During 1968-1996, approximately 10,000 women (mean age = 53 ± 9 years) completed questionnaires and donated blood samples. T2D status was classified according to self-report (n = 140) and glucose levels (n  = 154) at cohort entry. A linkage with the Icelandic Cancer Registry provided breast cancer incidence through 2015. Cox regression with age as time metric and adjusted for known confounders was applied to obtain hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

Of 9,606 participants, 294 (3.1%) were classified as T2D cases at cohort entry while 728 (7.8%) women were diagnosed with breast cancer during 28.4 ± 11.6 years of follow-up. No significant association of T2D (HR 0.95; 95% CI 0.56-1.53) with breast cancer incidence was detected except among the small number of women with advanced breast cancer (HR 3.30; 95% CI 1.13-9.62). Breast cancer incidence was elevated among overweight/obese women without (HR 1.18; 95% CI 1.01-1.37) and with T2D (HR 1.35; 95% CI 0.79-2.31). Height also predicted higher breast cancer incidence (HR 1.03; 95% CI 1.02-1.05). All findings were confirmed in women of the AGES-Reykjavik sub-cohort (n  = 3,103) who returned for an exam during 2002-2006. With a 10% T2D prevalence and 93 incident breast cancer cases, the HR for T2D was 1.18 (95% CI 0.62-2.27).

CONCLUSIONS

These findings in a population with low T2D incidence suggest that the presence of T2D does not confer additional breast cancer risk and confirm the importance of height and excess body weight as breast cancer risk factors.

Midlife Blood Pressure and Late-Life GFR and Albuminuria: An Elderly General Population Cohort

BACKGROUND

Chronic kidney disease (CKD) is common in the elderly, but the cause is often not identifiable. Some posit that age-related reductions in glomerular filtration rate (GFR) and increases in albuminuria are normal, whereas others suggest that they are a consequence of vascular disease.

STUDY DESIGN

Cross-sectional analysis of a substudy of a prospective cohort.

SETTING & PARTICIPANTS

AGES (Age, Gene/Environment Susceptibility)-Reykjavik Study.

PREDICTOR

Exposure to higher blood pressure in midlife.

OUTCOMES & MEASUREMENTS

Measured GFR using plasma clearance of iohexol and urine albumin-creatinine ratio.

RESULTS

GFR was measured in 805 participants with mean age in midlife and late life of 51.0±5.8 and 80.8±4.0 (SD) years, respectively. Mean measured GFR was 62.4±16.5 mL/min/1.73 m(2) and median albuminuria was 8.0 (IQR, 5.4-16.5) mg/g. Higher midlife systolic and diastolic blood pressures were associated with lower later-life GFRs. Associations persisted after adjustment. Higher midlife systolic and diastolic blood pressures were also associated with higher albumin-creatinine ratios, and associations remained significant even after adjustment.

LIMITATIONS

This is a study of survivors, and people who agreed to participate in this study were healthier than those who refused. Blood pressure may encompass effects of the other risk factors. Results may not be generalizable to populations of other races. We were not able to adjust for measured GFR or albuminuria at the midlife visit.

CONCLUSIONS

Factors other than advanced age may account for the high prevalence of CKD in the elderly. Midlife factors are potential contributing factors to late-life kidney disease. Further studies are needed to identify and treat midlife modifiable factors to prevent the development of CKD.

Age and sex differences in the incidence of diabetes mellitus in a population-based Spanish cohort

BACKGROUND

The prevalence of diabetes mellitus (DM) in Spain ranges between 10% and 20%. However, very little is known about the incidence of DM because of difficulties involved in estimating it and its apparent lack of usefulness in practice. The aim of the present study was to describe the incidence of type 1 and type 2 DM (T1DM and T2DM, respectively) in the Castilla y León diabetes cohort (CODICyL).

METHODS

New diabetes cases, were registered on a standard form that included diagnostic criteria, background, symptoms, results of clinical examination, complications, other cardiovascular risk factors, and treatment. There were 1 354 619 person-years monitored between 2000 and 2013. We estimated the incidence of DM and calculated the relative risks adjusted for age, gender, and year of diagnosis with Poisson regression models.

RESULTS

The incidence of DM in individuals aged ≥15 years was 196.9 per 100 000 person-years (95% confidence interval [CI] 188.4-205.7), whereas in those aged <15 years the incidence was 10.8 per 100 000 person-years (95% CI 7.8-14.8). Men had a 36% higher risk than women of developing T2DM (95% CI 25%-49%). The greatest incidence of T2DM was found in 55-64-year-old men and 65-69-year-old women.

CONCLUSIONS

The annual incidence of T2DM is approximately 2 per 1000 person-years, higher in men, and peaks in middle age. Although specific tests to differentiate between the two types of DM are not available in this study, the estimation of incidence in those <15 years of age (10.8 per 100 000 person-years) represents a close approximation of the incidence of T1DM.

Diabetes in older people: Prevalence, incidence and its association with medium- and long-term mortality from all causes

OBJECTIVE

To estimate the prevalence and incidence of self-reported diabetes and to study its association with medium- and long-term mortality from all causes in persons ≥ 65 years.

DESIGN

A population-based cohort study begun in 1993.

SETTING

"Envejecer en Leganés" cohort (Madrid).

PARTICIPANTS

A random sample of persons ≥ 65 years (n=1277 in the 1993 baseline sample).

METHODS

Participants were classified as having diabetes if they so reported and had consulted a physician for this reason within the last year. Diabetes history was categorized in <10 and ≥ 10 years in 1993. Incidence density was calculated in 2-year periods in non-diabetic individuals (1965 persons/2 years). Vital status was recorded on 31 December 2011. The association between diabetes history ≥ 10 years and mortality at 6 and 18 years follow-up was studied by the Kaplan-Meier and Cox regression analyses after adjusting for age, sex, heart disease and comorbidity.

RESULTS

The prevalence of self-reported diabetes rose from 10.3% in 1993 to 16.1% in 1999 (p ≤ 0.001) and was higher in women than men (p ≤ 0.05). Total incidence density was 2.6 cases/100 persons/2 years (95% CI: 2.0-3.3). Medium- and long-term mortality was higher in persons with diabetes history ≥ 10 years than in non-diabetic individuals (HR: 2.0; 95% CI: 1.2-3.3 and HR: 1.7; 95% CI: 1.1-2.5, respectively). In diabetics with history <10 years the HR was 1.3 (95% CI: 0.9-1.9) and HR: 1.5 (95% CI: 1.2-1.9, respectively).

CONCLUSIONS

Although diabetes is clearly associated with increased risk of mortality, it is significant only for patients with ≥ 10 years' history of diabetes.

Persistence of the effect of birth size on dysglycaemia and type 2 diabetes in old age: AGES-Reykjavik Study

We studied the effect of birth size on glucose and insulin metabolism among old non-diabetic individuals. We also explored the combined effect of birth size and midlife body mass index (BMI) on type 2 diabetes in old age. Our study comprised 1,682 Icelanders whose birth records included anthropometrical data. The same individuals had participated in the prospective population-based Reykjavik Study, where BMI was assessed at a mean age of 47 years, and in the AGES-Reykjavik Study during 2002 to 2006, where fasting glucose, insulin and HbA1c were measured and homeostasis model assessment for the degree of insulin resistance (HOMA-IR) calculated at a mean age of 75.5 years. Type 2 diabetes was determined as having a history of diabetes, using glucose-modifying medication or fasting glucose of >7.0 mmol/l. Of the participants, 249 had prevalent type 2 diabetes in old age. Lower birth weight and body length were associated with higher fasting glucose, insulin, HOMA-IR and HbA1c among old non-diabetic individuals. Higher birth weight and ponderal index at birth decreased the risk for type 2 diabetes in old age, odds ratio (OR), 0.61 [95 % confidence interval (CI), 0.48-0.79] and 0.96 (95 % CI, 0.92-1.00), respectively. Compared with those with high birth weight and low BMI in midlife, the odds of diabetes was almost five-fold for individuals with low birth weight and high BMI (OR, 4.93; 95 % CI, 2.14-11.37). Excessive weight gain in adulthood might be particularly detrimental to the health of old individuals with low birth weight.

Effect of birth year on birth weight and obesity in adulthood: comparison between subjects born prior to and during the great depression in Iceland

Background

Many epidemiological studies have linked small size at birth to adverse adult health outcomes but the relative influence of environmental exposures is less well established.

Methods

The authors investigated the impact of prenatal environmental exposure by comparing 2750 participants born before (1925–1929) and during (1930–1934) the Great Depression in Reykjavik, Iceland. Calendar year served as proxy for environmental effects. Anthropometric measurements at birth and school-age (8–13 years) were collected from national registries. Participants were medically examined as adults (33–65 years).

Results

Mean birth weight, adjusted for maternal age and parity, decreased by 97 g (95% confidence interval (CI): 39, 156) for men and 70 g (95% CI: 11, 129) for women from 1925 to 1934; growth at school-age was significantly reduced for participants growing during the Depression. As adults, women prenatally exposed to the Depression had higher body mass index (Δ0.6 kg/m², 95% CI: 0.2, 1.1), higher fasting blood glucose levels (Δ0.16 mmol/L, 95% CI: 0.07, 0.23) and greater odds of being obese 1.43 (95% CI: 1.01, 2.02) compared to unexposed counterparts. Non-significant associations were observed in men.

Conclusion

Reduction in birth weight due to rapid shifts in the economic environment appears to have a modest but significant association with later obesity for women while male offspring appear to be less affected by these conditions.

Rye bread consumption in early life and reduced risk of advanced prostate cancer

OBJECTIVE

To determine whether consumption of whole-grain rye bread, oatmeal, and whole-wheat bread, during different periods of life, is associated with risk of prostate cancer (PCa).

METHODS

From 2002 to 2006, 2,268 men, aged 67-96 years, reported their dietary habits in the AGES-Reykjavik cohort study. Dietary habits were assessed for early life, midlife, and current life using a validated food frequency questionnaire. Through linkage to cancer and mortality registers, we retrieved information on PCa diagnosis and mortality through 2009. We used regression models to estimate odds ratios (ORs) and hazard ratios (HRs) for PCa according to whole-grain consumption, adjusted for possible confounding factors including fish, fish liver oil, meat, and milk intake.

RESULTS

Of the 2,268 men, 347 had or were diagnosed with PCa during follow-up, 63 with advanced disease (stage 3+ or died of PCa). Daily rye bread consumption in adolescence (vs. less than daily) was associated with a decreased risk of PCa diagnosis (OR = 0.76, 95 % confidence interval (CI): 0.59-0.98) and of advanced PCa (OR = 0.47, 95 % CI: 0.27-0.84). High intake of oatmeal in adolescence (≥5 vs. ≤4 times/week) was not significantly associated with risk of PCa diagnosis (OR = 0.99, 95 % CI: 0.77-1.27) nor advanced PCa (OR = 0.67, 95 % CI: 0.37-1.20). Midlife and late life consumption of rye bread, oatmeal, or whole-wheat bread was not associated with PCa risk.

CONCLUSION

Our results suggest that rye bread consumption in adolescence may be associated with reduced risk of PCa, particularly advanced disease.

Etiology of overactive bladder: a diet and lifestyle model for diabetes and obesity in older women

OBJECTIVE

To evaluate a coherent, evidence-based hypothesis that specific modifiable lifestyle factors implicated in the development of diabetes and associated obesity are related to the onset of OAB.

METHODS

A hypothetical causative model for OAB involving modifiable lifestyle factors implicated in the development of diabetes and obesity was constructed, based on a systematic literature review. Secondary analysis of data was undertaken in a prospective cohort of women aged 40 and over, living in Leicestershire, UK. Subjects included 3,411 women free from OAB at baseline and 277 incident cases of OAB. Reported diet, lifestyle, morbid, and social factors were measured at baseline and incident cases at 1-year follow-up. Graphical chain modeling was used to estimate the associations between variables and identify likely pathways involved.

RESULTS

All hypothesized lifestyle factors (physical activity, high glycemic index, and high energy intake) plus diabetes and obesity were retained within the graph as potential contributors. However, low physical activity was the only direct risk factor linked prospectively to the onset of OAB (RR 2.47; 95% CI 1.82, 3.36), in addition to older age.

CONCLUSIONS

Poor lifestyle factors causally linked to diabetes and obesity may contribute to the onset of OAB; low physical activity appears to be an important modifiable causal factor for OAB operating directly as well as indirectly via pathways involving obesity or diabetes. Further research is needed to demonstrate a causal link between lifestyle and OAB.

Milk intake in early life and risk of advanced prostate cancer

The authors investigated whether early-life residency in certain areas of Iceland marked by distinct differences in milk intake was associated with risk of prostate cancer in a population-based cohort of 8,894 men born between 1907 and 1935. Through linkage to cancer and mortality registers, the men were followed for prostate cancer diagnosis and mortality from study entry (in waves from 1967 to 1987) through 2009. In 2002-2006, a subgroup of 2,268 participants reported their milk intake in early, mid-, and current life. During a mean follow-up period of 24.3 years, 1,123 men were diagnosed with prostate cancer, including 371 with advanced disease (stage 3 or higher or prostate cancer death). Compared with early-life residency in the capital area, rural residency in the first 20 years of life was marginally associated with increased risk of advanced prostate cancer (hazard ratio = 1.29, 95% confidence interval (CI): 0.97, 1.73), particularly among men born before 1920 (hazard ratio = 1.64, 95% CI: 1.06, 2.56). Daily milk consumption in adolescence (vs. less than daily), but not in midlife or currently, was associated with a 3.2-fold risk of advanced prostate cancer (95% CI: 1.25, 8.28). These data suggest that frequent milk intake in adolescence increases risk of advanced prostate cancer.

Can Thrifty Gene(s) or Predictive Fetal Programming for Thriftiness Lead to Obesity?

Obesity and related disorders are thought to have their roots in metabolic "thriftiness" that evolved to combat periodic starvation. The association of low birth weight with obesity in later life caused a shift in the concept from thrifty gene to thrifty phenotype or anticipatory fetal programming. The assumption of thriftiness is implicit in obesity research. We examine here, with the help of a mathematical model, the conditions for evolution of thrifty genes or fetal programming for thriftiness. The model suggests that a thrifty gene cannot exist in a stable polymorphic state in a population. The conditions for evolution of thrifty fetal programming are restricted if the correlation between intrauterine and lifetime conditions is poor. Such a correlation is not observed in natural courses of famine. If there is fetal programming for thriftiness, it could have evolved in anticipation of social factors affecting nutrition that can result in a positive correlation.

Risk of retinal neovascularization in the second eye in patients with proliferative diabetic retinopathy

PURPOSE

This study aimed to evaluate the risk of proliferative diabetic retinopathy (DR) in the fellow eye of an eye with existing proliferative DR.

METHODS

Our DR screening programme database listed 1513 diabetes patients alive at the time of the study. Seventy-six had proliferative DR in one or both eyes.

RESULTS

In 28 of the 76 (37%) diabetes patients, proliferative DR was diagnosed in both eyes at the same examination. Another 28 patients developed proliferative DR in the second eye within 5 years of its diagnosis in the first eye, bringing the total number of diabetes patients with proliferative DR in both eyes at 5 years to 56 (74%). Almost all the diabetes patients eventually developed proliferative DR in the second eye. The median duration of diabetes before the development of proliferative retinopathy was 19 years for type 1 and 14 years for type 2 diabetes.

CONCLUSIONS

Proliferative DR is a bilateral disease. Diabetes patients with proliferative DR in one eye are at high risk of developing neovascularization in the second eye and close follow-up is recommended.

Global estimates of the prevalence of diabetes for 2010 and 2030

AIM

We estimated the number of people worldwide with diabetes for the years 2010 and 2030.

METHODS

Studies from 91 countries were used to calculate age- and sex-specific diabetes prevalences, which were applied to national population estimates, to determine national diabetes prevalences for all 216 countries for 2010 and 2030. Studies were identified using Medline, and contact with all national and regional International Diabetes Federation offices. Studies were included if diabetes prevalence was assessed using a population-based methodology, and was based on World Health Organization or American Diabetes Association diagnostic criteria for at least three separate age-groups within the 20-79 year range. Self-report or registry data were used if blood glucose assessment was not available.

RESULTS

The world prevalence of diabetes among adults (aged 20-79 years) will be 6.4%, affecting 285 million adults, in 2010, and will increase to 7.7%, and 439 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries.

CONCLUSION

These predictions, based on a larger number of studies than previous estimates, indicate a growing burden of diabetes, particularly in developing countries.

Increasing glucose levels and BMI predict future heart failure Experience from the Reykjavík Study

BACKGROUND

Heart failure is common in diabetes and ischaemic heart disease is the most likely link. Still, it has been suggested that the relation extends beyond such disease.

METHODS

7060 subjects with two or more visits in the Reykjavík Study were followed--during 30 years from 1967. All underwent oral glucose tolerance tests. Disease status was defined according to the glycaemic level and presence of heart failure. The incidence and predictive factors for these diseases were determined.

FINDINGS

Age and sex standardized incidence of heart failure was 5.3/1000/year, of diabetes 4.6/1000/year and abnormal glucose regulation 12.6/1000/year. Body mass index (BMI) and fasting glucose predicted the development of these conditions (p<0.001). Increasing fasting glucose by 1 mmol/l increased the risk for heart failure by 14% (p=0.04) after adjusting for IHD, BMI and other risk factors for CVD. There was a strong association between diabetes and heart failure, OR 3.0 (2.3-4.0), and abnormal glucose regulation and heart failure, OR 1.8 (1.5-2.3). Diabetes and heart failure were, however, not independent predictors of each other.

INTERPRETATION

There was an independent relationship between increases in fasting glucose and development of heart failure. BMI was a strong predictor of heart failure. Although fasting glucose and BMI were significant risk factors for glucose disturbances and heart failure the conditions themselves did not independently predict each other.

Population-based incidence of type 2 diabetes in northern Spain: the Asturias Study

OBJECTIVE

The aim of this study was to define the incidence of type 2 diabetes in a low-risk Caucasian population in northern Spain and its association with various risk factors.

RESEARCH DESIGN AND METHODS

The Asturias Study is a prospective, population-based survey of diabetes and cardiovascular risk factors. The baseline examination was carried out during 1998-1999 when 1,034 individuals, aged 30-75 years, were randomly selected to determine the prevalence of type 2 diabetes and pre-diabetes in the Principality of Asturias (northern Spain). In 2004-2005, these same subjects were invited for a follow-up examination; 700 participated. This study includes only those individuals who did not have diabetes at baseline. We used the World Health Organization 1999 criteria to classify glucose metabolism at both baseline and follow-up.

RESULTS

The incidence of diabetes adjusted for the age and sex structure of Asturias was 10.8 cases/1,000 person-years (95% CI 8.1-14.8). The incidence rates were 5 cases/1,000 person-years in individuals with normoglycemia, 21 cases/1,000 person-years in individuals with isolated impaired glucose tolerance (IGT), 34.7 cases/1,000 person-years in individuals with isolated impaired fasting glucose (IFG), and 95.2 cases/1,000 person-years in individuals with combined IFG-IGT. Stepwise multiple logistic regression analysis showed that, together with fasting plasma glucose (FPG) and 2-h plasma glucose, which were the strongest predictors of diabetes, triglycerides and BMI were also independently associated with progression to diabetes.

CONCLUSIONS

In this 6-year prospective population-based study, we found an incidence of type 2 diabetes of 10.8 cases/1,000 person-years. Both FPG and 2-h plasma glucose were strongly predictive of diabetes, and their effect was additive.

Infant feeding patterns and midlife erythrocyte sedimentation rate

AIM

To assess the erythrocyte sedimentation rate (ESR), and other coronary heart disease (CHD) risk factors in adults who were either breast- or bottle-fed in early infancy.

METHODS

Subjects were 3614 men and women born 1914-1935. Information on infant feeding patterns was gathered from original midwife's birth records. Adult ESR, triglycerides, total cholesterol, blood pressure, fasting glucose, weight and height were measured.

RESULTS

The number of subjects bottle-fed in early infancy was 186 (5.2%). The geometric mean of ESR was 15.9% (95% CI 1.8%-31.8%) higher in those who were bottle-fed compared with those breastfed, p = 0.026, when adjusting for age and gender. Those who had been breastfed in early infancy had on average 2.9% higher BMI in adulthood (p = 0.012). The hazard ratio for event of CHD for bottle-fed persons versus breastfed was 1.18 (95% CI 0.88-1.57), adjusting for potential confounding factors.

CONCLUSIONS

Higher adult ESR, a moderate risk factor for CHD, among those bottle-fed compared to those breastfed in early infancy might indicate a long term anti-inflammatory influence of breast milk.

Age, Gene/Environment Susceptibility-Reykjavik Study: multidisciplinary applied phenomics

In anticipation of the sequencing of the human genome and description of the human proteome, the Age, Gene/Environment Susceptibility-Reykjavik Study (AGES-Reykjavik) was initiated in 2002. AGES-Reykjavik was designed to examine risk factors, including genetic susceptibility and gene/environment interaction, in relation to disease and disability in old age. The study is multidisciplinary, providing detailed phenotypes related to the cardiovascular, neurocognitive (including sensory), and musculoskeletal systems, and to body composition and metabolic regulation. Relevant quantitative traits, subclinical indicators of disease, and medical diagnoses are identified by using biomarkers, imaging, and other physiologic indicators. The AGES-Reykjavik sample is drawn from an established population-based cohort, the Reykjavik Study. This cohort of men and women born between 1907 and 1935 has been followed in Iceland since 1967 by the Icelandic Heart Association. The AGES-Reykjavik cohort, with cardiovascular risk factor assessments earlier in life and detailed late-life phenotypes of quantitative traits, will create a comprehensive study of aging nested in a relatively genetically homogeneous older population. This approach should facilitate identification of genetic factors that contribute to healthy aging as well as the chronic conditions common in old age.

Evolutionary origins of insulin resistance: a behavioral switch hypothesis

BACKGROUND

Insulin resistance, which can lead to a number of diseases including type 2 diabetes and coronary heart disease, is believed to have evolved as an adaptation to periodic starvation. The "thrifty gene" and "thrifty phenotype" hypotheses constitute the dominant paradigm for over four decades. With an increasing understanding of the diverse effects of impairment of the insulin signaling pathway, the existing hypotheses are proving inadequate.

PRESENTATION OF THE HYPOTHESIS

We propose a hypothesis that insulin resistance is a socio-ecological adaptation that mediates two phenotypic transitions, (i) a transition in reproductive strategy from "r" (large number of offspring with little investment in each) to "K" (smaller number of offspring with more investment in each) and (ii) a transition from "stronger to smarter" or "soldier to diplomat" i.e. from relatively more muscle dependent to brain dependent lifestyle. A common switch could have evolved for the two transitions since the appropriate environmental conditions for the two transitions are highly overlapping and interacting.

TESTING THE HYPOTHESIS

Gestational insulin resistance diverts more energy through the placenta, resulting in increased investment per offspring. On the other hand, insulin resistance is associated with reduced ovulation. The insulin signaling pathway is also related to longevity. Insulin resistance diverts more nutrients to the brain as compared to muscle. Also, hyperinsulinemia has direct positive effects on cognitive functions of the brain. The hypothesis gets support from known patterns in human clinical data and recent research on the molecular interactions in the insulin signaling pathway. Further we state many predictions of the hypothesis that can be tested experimentally or epidemiologically.

IMPLICATIONS OF THE HYPOTHESIS

The hypothesis can bring about a significant change in the line of treatment as well as public health policies for the control of metabolic syndrome.

[Incidence of type 2 diabetes and its diagnosis process in the decade 1991-2000 in a primary health care centre]

BACKGROUND AND OBJECTIVE

To determine the annual incidence and reasons for diagnosing type 2 diabetes mellitus (T2DM) from 1991 to 2000.

PATIENTS AND METHOD

We performed a retrospective, longitudinal study. The clinical records of all new cases of T2DM registered in an urban primary care center over a 10-year period were reviewed. The annual incidence and prevalence in the population aged more than 14 years old were calculated. Statistical analyses of temporal trends and periodicity (monthly, seasonal and annual) were performed with ARIMA models (Box-Jenkins), Poisson parametrical regression and semiparametrical (GAM) models.

RESULTS

There were 598 true new cases of T2DM (mean age [SD]: 59.7 [11.4] years; 51.3% women). The most frequent associated cardiovascular risk factors were obesity (58.5%) and hypertension (68.2%). The main reasons for diagnosing T2DM were the presence of previous hyperglycemia (64.7%) and the application of protocols for other cardiovascular risk factors (12.4%).The annual incidence was 37.9 per 10,000 persons (95% CI, 34.9-40.9) with no differences between sexes. The prevalence of T2DM at the beginning and end of the study period was 4.4 (95% CI, 2.0-4.8) and 5.5% (95% CI, 5.2-5.9) (25% relative increase). There was no significant temporal trend in the incidence of T2DM over the years.

CONCLUSIONS

The observed incidence of T2DM is high compared with that reported in other studies. The increase in prevalence was not related to a progressive increase in the incidence. The most frequent reasons for diagnosing T2DM were previous hyperglycemia and the application of protocols for other cardiovascular risk factors. This finding seems to be related to an early diagnosis and could benefit these patients.

Screening compliance and visual outcome in diabetes

PURPOSE

To study the relationship between screening compliance and visual outcome in a screening programme for diabetic eye disease.

METHODS

A retrospective case control study. The screening compliance of all the diabetes patients (n = 22) listed at the Icelandic National Registry for the Blind (visual acuity <0.3) was compared to a matched group of 44 non-blind diabetes patients (visual acuity > or =0.3) who participated in the same screening programme for diabetic retinopathy. Glycaemic control (HbA1c), office blood pressure and cholesterol levels were assessed.

RESULTS

The study group had a significantly lower level of compliance with the screening programme (27% +/- 38% [mean +/- SD] versus 77% +/- 26% [mean +/- SD]; p < 0.0001). Macular oedema or proliferative diabetic retinopathy was found in 60% (13/22) of the study group when entering the screening programme, compared to 7% (3/44) in the control group. Blood pressure (except diastolic BP among type 1 diabetes mellitus), blood glucose and cholesterol levels were identical. The prevalence of blindness and low vision amongst diabetes patients in Iceland is about 0.5%.

CONCLUSIONS

There was a significant relationship between screening compliance and visual outcome in diabetes patients in our screening programme.

n-3 long-chain polyunsaturated fatty acids in type 2 diabetes: a review

Historically, epidemiologic studies have reported a lower prevalence of impaired glucose tolerance and type 2 diabetes in populations consuming large amounts of the n-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) found mainly in fish. Controlled clinical studies have shown that consumption of n-3 LC-PUFAs has cardioprotective effects in persons with type 2 diabetes without adverse effects on glucose control and insulin activity. Benefits include lower risk of primary cardiac arrest; reduced cardiovascular mortality, particularly sudden cardiac death; reduced triglyceride levels; increased high-density lipoprotein levels; improved endothelial function; reduced platelet aggregability; and lower blood pressure. These favorable effects outweigh the modest increase in low-density lipoprotein levels that may result from increased n-3 LC-PUFA intake. Preliminary evidence suggests increased consumption of n-3 LC-PUFAs with reduced intake of saturated fat may reduce the risk of conversion from impaired glucose tolerance to type 2 diabetes in overweight persons. Reported improvements in hemostasis, slower progression of artery narrowing, albuminuria, subclinical inflammation, oxidative stress, and obesity require additional confirmation. Expected health benefits and public health implications of consuming 1 to 2 g/day n-3 LC-PUFA as part of lifestyle modification in insulin resistance and type 2 diabetes are discussed.

Omega-3 fatty acid supply from milk associates with lower type 2 diabetes in men and coronary heart disease in women

BACKGROUND

Omega-3 fatty acids may prevent type 2 diabetes and coronary heart disease (CHD). We investigated these fatty acids in Nordic cow's milk and whether their supply from milk associates with type 2 diabetes prevalence and CHD mortality in the Nordic countries.

METHODS

Samples (N = 84) of consumers' milk were collected in five Nordic countries four times during 1 year. Fatty acids were analyzed using gas chromatography. Fatty acids supply from milk fat was calculated using national food balance sheets.

RESULTS

The omega-3 fatty acids content was higher and omega-6 fatty acid content was lower in Icelandic milk when compared with milk from other Nordic countries. Type 2 diabetes prevalence in men correlated inversely with the supply of omega-3 fatty acids and eicosapentaenic acid, but positively with omega-6/omega-3 ratio in milk. CHD mortality in women correlated inversely with the supply of eicosapentaenic acid but positively with the omega-6/omega-3 ratio.

CONCLUSIONS

Milk fatty acids content can depend upon the origin of the milk. The higher supply of omega-3 fatty acids from milk might explain the lower type 2 diabetes prevalence and CHD mortality in Iceland compared to the other Nordic countries.

Increased levels of triglycerides, BMI and blood pressure and low physical activity increase the risk of diabetes in Swedish women. A prospective 18-year follow-up of the BEDA study

AIM

To investigate risk factors for the development of diabetes in middle-aged women.

METHODS

A random population sample of 1351 women without prior diabetes or cardiovascular disease, aged 39-65 years, took part in a screening study in 1979-1981 with questionnaires, physical examination and blood sampling. Development of diabetes up to 1998 was identified at a second examination in 1997-1998.

RESULTS

Seventy-three women (5.4%) were diagnosed with diabetes during follow-up. As expected, obesity resulted in a rising age-adjusted risk with hazards ratio 3.2 [95% confidence interval (CI) 1.3, 8.1] at body mass index (BMI) 24-27 kg/m(2), and 8.3 (3.5, 19.7), at BMI > or = 27, compared with BMI < 22 kg/m(2). S-triglycerides (TG) carried a steeply increasing age-adjusted risk with hazards ratio 4.0 (95% CI 2.1, 7.6) already at s-TG 1.0-1.4 mmol/l, 7.1 (3.6, 14.0) at s-TG 1.5-1.9 mmol/l and 9.3 (4.3, 20.2) at s-TG > or = 2.0 mmol/l compared with s-TG < 1.0 mmol/l. Increasing systolic blood pressure (SBP) to 130-144, 145-159 and > or = 160 mmHg escalated the hazards ratio of diabetes to 1.6 (0.8, 3.3), 3.6 (1.7, 7.4) and 5.6 (2.7, 11.4), respectively, compared with SBP < 130 mmHg. Also, low physical activity predicted diabetes, with hazards ratio 2.1 (1.3, 3.3) for sedentary compared with non-sedentary activity. Smoking was not associated with increased risk of diabetes. After adjustment for BMI, SBP and physical activity, increasing TG level remained a strong and significant risk factor for diabetes [hazards ratio 3.0 (1.6, 5.7), 3.7 (1.8, 7.7) and 4.5 (2.0, 10.0), P < 0.001].

CONCLUSIONS

Among middle-aged Swedish women even very slightly elevated s-TG resulted in a considerably enhanced risk of developing diabetes, which was independent of age, BMI, blood pressure and physical activity.

Localization of a susceptibility gene for type 2 diabetes to chromosome 5q34-q35.2

We report a genomewide linkage study of type 2 diabetes (T2D [MIM 125853]) in the Icelandic population. A list of type 2 diabetics was cross-matched with a computerized genealogical database clustering 763 type 2 diabetics into 227 families. The diabetic patients and their relatives were genotyped with 906 microsatellite markers. A nonparametric multipoint linkage analysis yielded linkage to 5q34-q35.2 (LOD = 2.90, P=1.29 x 10(-4)) in all diabetics. Since obesity, here defined as body mass index (BMI) > or =30 kg/m(2), is a key risk factor for the development of T2D, we studied the data either independently of BMI or by stratifying the patient group as obese (BMI > or =30) or nonobese (BMI <30). A nonparametric multipoint linkage analysis yielded linkage to 5q34-q35.2 (LOD = 3.64, P=2.12 x (10)-5) in the nonobese diabetics. No linkage was observed in this region for the obese diabetics. Linkage analysis conditioning on maternal transmission to the nonobese diabetics resulted in a LOD score of 3.48 (P=3.12 x 10(-5)) in the same region, whereas conditioning on paternal transmission led to a substantial drop in the LOD score. Finally, we observed potential interactions between the 5q locus and two T2D susceptibility loci, previously mapped in other populations.

Size at birth and coronary artery disease in a population with high birth weight

BACKGROUND

Epidemiologic studies suggest a link between fetal and childhood growth and later coronary artery disease (CAD). The influence of adult body size on the relation between birth size and CAD has not been thoroughly studied.

OBJECTIVE

We investigated the association between birth and adult sizes and CAD within a population with higher birth weight and a lower incidence of and mortality rate from CAD than those seen in other Scandinavian populations.

DESIGN

Fatal or nonfatal CAD was ascertained in 2399 men and 2376 women born in the Greater Reykjavik area between 1914 and 1935. Birth size was obtained from the National Archives. Anthropometric measurements in adults were obtained from the randomized prospective Reykjavik Study.

RESULTS

CAD was inversely related to birth length (P for trend = 0.029) in men but was not significantly related to birth weight or ponderal index (kg/m(3)). In men who were born short (< or = 50.5 cm) and who became tall adults (either 175-180.5 or > 180.5 cm), the odds ratios (95% CI) for CAD were 1.9 (1.1, 3.1) and 2.2 (1.2, 4.0), respectively, when compared with men in the reference group (those born 52.5-54.0 cm long). A U-shaped relation between birth size and CAD was found for women.

CONCLUSIONS

Size at birth has an effect on CAD, but the effect is modified by adult body size. This confirms that environmental factors operate in both the prenatal and postnatal periods with regard to the development of CAD. The large birth size seen among Icelanders may explain the lower incidence and mortality rate of CAD in Iceland than are seen in other white populations.

Prediction of mortality from coronary heart disease among diverse populations: is there a common predictive function?

OBJECTIVES

To examine the generalisability of multivariate risk functions from diverse populations in three contexts: ordering risk, magnitude of relative risks, and estimation of absolute risk.

DESIGN

Meta-analysis of prospective cohort studies.

PATIENTS

Participants from various epidemiological studies.

MAIN OUTCOME MEASURE

Death from coronary heart disease (CHD).

RESULTS

The analysis included 105 420 men and 56 535 women 35-74 years of age and free of CHD at baseline from 16 observational studies with a total of 27 analytical groups. The area under the receiver operating characteristic curve (AUC) was used to judge the ability of the multivariate risk function to order risk correctly. AUCs ranged from 0.60 to 0.80. The AUCs differed significantly between the studies (p < 0.01) but were very similar for different risk functions applied to the same population, indicating similar ability to rank risk for different models. The magnitudes of the relative risks associated with major risk factors (age, systolic blood pressure, serum total cholesterol, smoking, and diabetes) varied significantly across studies (p < 0.05 for homogeneity). The prediction of absolute risk was not very accurate in most of the cases when a model derived from one study was applied to a different study.

CONCLUSIONS

When considered qualitatively, the major risk factors are associated with CHD mortality in a diverse set of populations. However, when considered quantitatively, there was significant heterogeneity in all three aspects: ordering risk, magnitude of relative risks, and estimation of absolute risk.

Diabetes trends in Europe

Estimates and projections suggest an epidemic expansion of diabetes incidence and prevalence in Europe. To evaluate trends in type 1 and type 2 diabetes in seven European countries (Finland, Denmark, the UK, Germany, France, Spain, and Italy), a variety of information is available, including population-based studies on small or large cohorts of subjects representative of the general population in a particular country, European co-operative studies, and sales figures for insulin and oral hypoglycemic agents that allow extrapolation of the number of pharmacologically treated diabetic patients. The incidence of type 1 diabetes in young people is increasing in most European countries, as is its prevalence in all age groups. Type 2 diabetes is the major contributor to the epidemic rise in diabetes. From 1995 to 1999, the prevalence of type 2 diabetes increased considerably, particularly in the UK, Germany, and France. Costs of ambulatory and in-hospital diabetic care (including antidiabetic, antihypertensive, and hypolipidemic agents) have increased even more rapidly than has the number of affected patients. Diabetes trends in Europe are alarming; health care professionals involved in diabetes care must be made aware of these detrimental trends, and health care delivery to patients with diabetes must be improved.

Size at birth and glucose intolerance in a relatively genetically homogeneous, high-birth weight population

BACKGROUND

The results of epidemiologic studies have linked birth size to adult glucose intolerance.

OBJECTIVE

We investigated this association in a genetically homogeneous population with higher birth weights and a lower prevalence of type 2 diabetes than previously studied.

DESIGN

The subjects were 2362 men and 2286 women aged 33-65 y. Size at birth was obtained from the National Archives of Iceland. Data for adult anthropometry, fasting blood glucose, and blood glucose after an oral glucose load came from the randomized prospective Reykjavík Study.

RESULTS

Postchallenge glucose concentrations were inversely related to birth weight and length in men and inversely related to birth weight and ponderal index in women (P < 0.001). This association was mainly found among those within the highest one-third of adult body mass index values. In men, the prevalence of dysglycemia was lower with increasing weight (P = 0.04) and length (P = 0.003) at birth but there was no relation of dysglycemia to ponderal index. For women, there was no linear trend for dysglycemia in relation to size at birth but the relation with birth length was U shaped.

CONCLUSIONS

Greater birth weight and length appear to offer a protective effect against glucose intolerance. Adult overweight or obesity enhances the risk associated with low birth weight and length. Because the population studied has higher birth weights and a lower prevalence of type 2 diabetes than are found in neighboring countries, it is possible that decreasing the number of low-birth weight infants might help to stem the increasing prevalence of type 2 diabetes worldwide.

Diabetes and impaired glucose tolerance in Aboriginal Australians: prevalence and risk

The prevalence and risk of having impaired glucose tolerance (IGT) and diabetes was estimated relative to body mass index (BMI) among Australian Aboriginal people. A stratified analysis was undertaken of community screening data. Measures included fasting and 2-h glucose concentrations, and BMI (five strata: <22, 22-24.9, 25-29.9, 30-34.9 and >/=35 kg/m(2)). Age was stratified into three groups: 15-34.9, 35-44.9, and >/=45 years. Participants were men and women, ages 15-94 years (n=2626). The prevalence of IGT and diabetes, respectively, adjusted for age and BMI, was 139 and 142 cases/1000 persons among men, and 157 and 152 cases/1000 persons among women. Odds ratios (95% CI) for IGT and diabetes for increasing BMI strata >/=22 kg/m(2) ranged from 1.7 (1.0 to 2.9) to 5.1 (2.4-10.5) for IGT, and from 2.0 (1.2-3.5) to 6.1 (3.3-11.1) for diabetes. For IGT and diabetes, across genders, the population attributable risk percentages (95% CI) for BMI >/=22 kg/m(2) were 34.1% (26.2-41.9%) for IGT, and 46.4% (38.5-54.5%) for diabetes. Diabetes and IGT have reached epidemic proportions among Australian Aboriginal people. An urgent need exists for programmes to reduce the prevalence of diabetes risk factors, especially BMI of 22 kg/m(2) or more, a limit lower than advocated for Euro-American populations.

[Epidemiology of diabetes and its non-coronary complications]

Diabetes mellitus is among the diseases with great impact on health and society, not only for its high prevalence but also for its chronic complications and high mortality. The most precise method to investigate the prevalence of diabetes is by oral glucose tolerance testing. In Spain, the prevalence of diabetes in the 30-65 year-old population is estimated to be 6.5% among 30-to-65- year old, and 10.3% among the 30-to-89 year-old population. The ratio of known to unknown diabetes ranges from 1:3 to 2:3. The incidence of diabetes mellitus type 2 in Spain is 8/1000 persons per year, and the incidence of type 1 is 11 to 12 cases per 100,000 persons per year. The prevalence of chronic complications varies according to type of diabetes, time since onset and degree of metabolic control: neuropathy 25%, retinopathy 32% and nephropathy 23%. Diabetes is one of the most important causes of death in Spain, occupying third place for women and seventh for men.

[Significant incidence of type 2 diabetes on high-risk Spanish population. The IGT Study (2)]

BACKGROUND

Our purpose was to estimate the incidence of type 2 diabetes among a high risk population with or without impaired glucose tolerance (IGT), analysing the progression to diabetes.

PATIENTS AND METHOD

Multicenter cohort study on high risk individuals without diabetes (WHO-85 criteria) in primary health care. Subjects underwent an oral glucose tolerance test measuring fasting plasma glucose (FPG) and plasma glucose at 2 hours (2hPG). Mean follow-up was 37.2 months (4.3-69.7). Phenotypic features, diagnostic variation, diabetes incidence and predictive factors (multivariate analysis and Cox proportional hazards model) were assessed.

RESULTS

We included 243 individuals (148 females), aged 59.7 (10) years, with FPG < 7.8 mM and 2hPG < 11.1 mM. 137 IGT subjects (56.4%) and 106 (43.6%) normal glucose tolerance (NGT) subjects with a similar risk factor impact were evaluated. After the study was closed, 63 (25.9%) subjects developed diabetes: 43 (31.4%) with baseline IGT and 20 (18.9%) with NGT. Overall diabetes incidence increased over time but not proportionally. Mean annual incidence was 9.2% and it dropped to 4.6% when FPG was used as the unique diagnosis criterion (ADA-97). Male under 65 years with both overweight and IGT reported the highest incidence. HbA1c, FPG and 2hPG were independent predictors. Increased HDL cholesterol showed a protective effect on diabetes incidence. The IGT diagnosis interval was a much better predictor [OR = 2.06 (1.56-2.72)] of diabetes development than the impaired FPG diagnosis interval [OR = 1.37 (0.93-2.04)].

CONCLUSIONS

FPG predicted but undervalued diabetes incidence in high risk population. The IGT (2hPG) diagnosis interval predicted diabetes development better than the impaired fasting plasma glucose diagnosis interval. Increased diabetes incidence in high risk Spanish population, particularly with regard to IGT, means that primary preventive resources should be increased.

The Poole Diabetes Study: how many cases of Type 2 diabetes are diagnosed each year during normal health care in a defined community?

We have investigated the incidence of newly diagnosed Type 2 diabetes in the Poole area and extrapolated it to the rest of the UK.

METHODS

this prospective observational study used a surveillance programme in primary and secondary care. We identified all cases of newly diagnosed Type 2 diabetes mellitus occurring from 1st May 1996 to 30th June 1998 through the normal health care process without any active screening in 186889 people registered with 24 primary care practices in the Poole area.

RESULTS

the 1996 prevalence of diagnosed Type 2 diabetes in this population was 1.59 (95% CI 1.53-1.65%)%. During the first 24 months of the study, 706 new cases of Type 2 diabetes mellitus, 382 men and 324 women, were identified. The crude annual incidence of newly diagnosed Type 2 diabetes, thus was 1.93/1000 (95% CI 1.73-2.13%) and age/sex adjusted incidence was 1.67/1000 (95% CI 1.49-1.84%). The age-adjusted incidence was higher in men, 1.86/1000 (95% CI 1.60-2.13), than in women, 1.48/1000 (95% CI 1.25-1.71%), relative risk 1.26 (95% CI 0.997-1.527%), but this difference did not reach statistical significance. Mean HbA1c at diagnosis was 10.8 (S.D. 2.9%)%. Men were younger at diagnosis than women (mean age, 62.9 vs. 65.9%, P<0.01).

CONCLUSION

in UK, prior to the change in the WHO diagnostic criteria for diabetes, we estimate that over 98000 new cases of Type 2 diabetes were diagnosed each year.

Epidemiology of Dupuytren's disease: clinical, serological, and social assessment. The Reykjavik Study

Dupuytren's disease or palmar fibromatosis is a common disabling hand disorder, mainly confined to Caucasians of northwestern European origin. The prevalence of Dupuytren's disease and possible risk factors related to the disease were evaluated in a random sample of 1297 males and 868 females, aged 46 to 74 years. Blood samples were collected and biochemical parameters were evaluated. The possible relation between the disease and clinical, social, and biochemical parameters were estimated with age-adjusted univariate logistic regression analysis. Altogether 19.2% of the males and 4.4% of the female participants had clinical signs of Dupuytren's disease. The prevalence increased with age, from 7.2% among males in the age group 45-49 years up to 39.5% in those 70-74 years old. The more severe form of the disease, finger contractures, was found in 5.0% of the men and 1.4% had required operation, while this was rarely seen among women. In men elevated fasting blood glucose (P < 0.04), low body weight, and body mass index were significantly correlated with the presence of the disease (P < 0.001). Dupuytren's disease was common among heavy smokers (P = 0.02) and those having manual labor as occupation (P = 0.018). These results show that Dupuytren's disease is common in the Icelandic population and occupation and lifestyle seem to be related to the disease.

Evaluation of diabetic retinopathy by fluorophotometry. European concerted action on ocular fluorometry

BACKGROUND

Fluorophotometric variables (permeability of the blood-retinal barrier (BRB) and blood-aqueous barrier (BAB), corneal autofluorescence, and lenticular light transmittance) are reported to correlate with the severity of diabetic retinopathy. This preliminary multicenter study was performed to measure these variables simultaneously in patients with type 2 diabetes mellitus and to assess which of these variables could be of help in evaluating diabetic retinopathy.

METHODS

Eighty-two patients with type 2 diabetes and diabetic retinopathy were recruited in seven European university clinics. Each patient was investigated three times, at intervals of about one year. The investigations included fluorophotometric determination of corneal autofluorescence, lenticular light transmittance, and permeability of the BRB and BAB. Retinopathy was classified into four grades, using a simplified evaluation system based on the Modified Airlie House retinopathy classification and applied to color fundus slides of standard fields 1 and 2.

RESULTS

Multiregression analyses revealed that only corneal autofluorescence and BRB permeability were correlated with the severity of diabetic retinopathy (P < 0.05). Corneal autofluorescence and BRB permeability as single variables were found to be indicative of severe nonproliferative retinopathy and proliferative retinopathy (sensitivity 100% and 86%, respectively, and specificity 65% and 85%, respectively). Combination of both variables increased specificity to 92%.

CONCLUSIONS

This preliminary multicenter study shows that fluorophotometric variables can be measured simultaneously and reliably in patients with diabetes and that corneal autofluorescence and BRB permeability (individually or in combination) could be of help in detecting severe non-proliferative retinopathy and proliferative retinopathy.

The epidemiology of Type 2 diabetes and its current measurement

Type 2 diabetes is globally increasing in prevalence and is widely recognized as a major cause of morbidity and mortality, as well as being a burden to the health-care services. Planning for current and future diabetes services requires up-to-date prevalence information. The enumeration of Type 2 diabetes is, however, surprisingly difficult. Large numbers of people are undiagnosed, and those known cases have variable loci of care. Traditional techniques include cross-sectional diagnostic surveys, postal or house-to-house surveys and cohort surveys. All are time-consuming and expensive, and may potentially undercount. The use of multiple patient lists (e.g. hospital clinic data, general practitioner (GP) lists, prescribing information, etc.) can, however, increase accuracy and, if the data are computerized, may be rapid and inexpensive. A new and potentially exciting tool to utilize multiple lists in Type 2 diabetes prevalence assessment is known as 'capture-recapture'. In this, statistical models are used to estimate prevalence from the degree of overlap between lists. Capture-recapture is emerging as a valuable tool in the epidemiological assessment of Type 2 diabetes.

Coronary heart disease mortality amongst non-insulin-dependent diabetic subjects in Iceland: the independent effect of diabetes. The Reykjavik Study 17-year follow up

OBJECTIVES

The main aim of this study was to estimate the independent risk for coronary heart disease (CHD) death associated with non-insulin dependent (Type 2) diabetes (NIDDM) and effect on life expectancy.

DESIGN AND SETTING

The Reykjavik Study is a prospective cardiovascular population study which started in 1967. A randomized selection procedure identified individuals for invitation to participate, based on their year and date of birth. Participants were examined in the years 1967-91 in one research clinic in Reykjavik.

SUBJECTS AND METHODS

The population in this survey were Icelandic Caucasian males and females, born 1907-35 and therefore 34-79 years old when their examination was performed. Altogether 9139 males and 9773 females attended, and of those 267 males and 210 female were NIDDM as defined by a questionnaire or an oral glucose tolerance test. Other factors measured in the study included systolic and diastolic blood pressure, fasting total cholesterol, triglycerides, uric acid, smoking habits, height, and weight. The causes of death were determined by a review of all death certificates. Results. The relative risk of death from CHD (95% confidence limits), independently associated with NIDDM, was 2.0 (1.5-2.6) for males and 2.4 (1.6-3.6) for females. The relative risk of death from all causes was 1.9 (1.6-2.3) and 1.7 (1.3-2.1), respectively, for male and female diabetic patients.

CONCLUSIONS

Non-insulin dependent diabetes mellitus carried twice the risk of CHD death in both sexes, independently of other risk factors. The diagnosis of NIDDM at the age 55 years reduced an individual's life expectancy by about five years, mostly because of increased CHD death rate.