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软之戚
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1 NSC B

2 -- Incidence and Associated Risk Factors for Diabetes Mellitus Tainan Prospective Cohort Study NSC B % 1.8% 2.5% 1.2% (1638 ) ( ) 2

3 tolerance test suggested by WHO as a golden standard in diagnosing diabetes mellitus from June 1998 to January Subjects also will receive many other 20 mass index, waist-to-hip ratio, blood 1.8%( 17.8) drinking status and physical activity. Of the 1490 eligible people, 1038 (69.7%) examinations include serum lipids, body pressure, uric acid, smoking status, participated in the follow-up study. Abstract Introduction: Since diabetic subjects have higher risk to have cardiovascular diseases, and the prevalence of diabetes mellitus is increased year by year, we are interested in investigating the incidence of diabetes mellitus. The objectives of this study proposal are: (a) to understand the incidence of diabetes mellitus in Tainan city, and (b) to investigate the associated risk factor for progression to diabetes among subjects with normal glucose tolerance and impaired glucose tolerance. We expect the result will be benefit for our health- related department in planning public health policy and health care. Methods: The study is a prospective cohort design. We used the subjects whom we used in a cross-sectional study in All subjects except who had diabetes known in the last study were included. Total study subjects are 1490 (normal glucose tolerance 1261 and impaired glucose tolerance 229). They received a standard oral glucose Results: The incidence of diabetes mellitus was 1.8% per year (2.5% men and 1.2% women) or 17.8 cases per 1000 person-years (25.1 men and 11.7 women). Except in the age groups of 70 and over, the incidence of diabetes mellitus increased with age for both genders. There was no new diabetic subject in the age groups of The diabetic subjects has a higher mean age, body mass index, weight to hip ratio, triglyceride, high-density cholesterol, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, and 2-h plasma glucose levels than non-diabetic subjects. The diabetic subjects also had a higher prevalence of male sex, married marital status, lower educational status, drinking habit, and having family history of ischemic heart disease. The best multiple logistic regression model was fitted with a stepwise-forward strategy. The independent variables were age, gender, family history of diabetes mellitus, family history of hypertension, family history of ischemic heart disease, total cholesterol, triglyceride, fasting plasma glucose, 2-h plasma glucose, 3

4 educational status, socioeconomic status, smoking, drinking, body mass index and weight to hip ratio. According to the final model, the significant factors associated with new diabetes were fasting plasma glucose, 2-h plasma glucose, weight to hip ratio, and cholesterol. Conclusion: The incidence of diabetes in Tainan was 1.8% (or 17.8 cases per 1000 person-years). The significant factors associated with new diabetes were fasting plasma glucose, 2-h plasma glucose, weight to hip ratio, and cholesterol. (3) % 15.5% 5(2) (2) (3-6) (7-8 ) (9-10) (1261 (17-19) 4

5 ) (229 ) cc (20) 7. ( (GOT, 8. GPT) (BUN, Creatinine)) (Radioimmunoassay) (20) 9. (HbA1C) HPLC (low density lipoprotein, LDL) ETECTO (very low density 3. (BMI) ( lipoprotein, VLDL) ) ( ) leads Minnesota code 13. JNC VI (25) (21) (DINAMAP, model 1846SX, Johnson & Johnson company) (22) 5 11.

6 gm 140 mg/dl 200 mg/dl < 140 mg/dl mg/dl < 140 mg/dl (26) DBASE III+ SPSS for windows DBASE III ( ) ( ) ( )

7 % 2.5% 1.2% %( 17.8 ) ( ) (28) %

8 southern Taiwan. Diabetic Med 15: Butler WJ, Ostrander LD, Carman WJ, Lamphiear DE. Diabetes mellitus in Tecumseh, Michigan: prevalence, incidence, and associated conditions. Am J Epidemiol 1982;116: Medalie JH, Papier CM, Glodbourt MA, Herman JB. Major factors in the development of diabetes mellitus in 10,000 men. Arch Intern Med 1975;135: Harlan LC, Harlan WR, Land, 1. King H, Rewers M, WHO Ad Hoc Diabetes Reporting Group. Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Care 1993;16: Department of Health: Health and Vital Statistics. I. General Health Statistics. Taipei, Republic of China, Department of Health, Executive Yuan, Feng-Hwa Lu, Yi-Ching Yang YC, Jin-Shang Wu, Chih-Hsing Wu CH, Chih-Jen Chang 1998: A population-based study of the prevalence and associated factors of diabetes mellitus in 8 Goldstein NG. Factors associated with glucose tolerance in adults in United States. Am J Epidemiol 1987;126: Kannel WH, McGee DL. Diabetes and cardiovascular risk factors: the Framingham Study. Circulation 1979;59: Grarcia MJ, McNamara PM, Gordon T, Kannel WB. Morbidity and mortality in diabetics in the Framingham population: Sixteen-year followup study. Diabetes 1974;23: Criqui MH, Barrett-Connor E, Holdbrook MJ. Clustering ov CVD risk factor. Prev Med 1980;9: Wingard DL, Barett-Connor E,

9 Criqui MH. Clustering of heart disease risk factors in diabetic compared to non-diabetic adults. Am J Epidemiol 1983;117: Li G, Hu Y, Pan X. Prevalence and incidence of NIDDM in DaQing City. Chin Med J- Beijing 1996;109(8): Chou P, Li CL, Wu GS, Tsai ST. Progression to type 2 diabetes among high-risk groups in Kin- Chen, Kinmen. Diabetes Care 1998;21(7): Saad MF, Knowler WC, Pettitt DJ, Nelson RG, Mott DM, Bennett PH. The natural history of impaired glucose tolerance in Pima Indians. New Engl J Med 1988;319: Motala AA, Omar MAK, Gouws E. High risk of progression to NIDDM in South-African Indians with impaired glucose tolerance. Diabetes 1993;42: Reaven GM, Bernstein R, Davis B, Olefsky JM. Non-ketotic diabetes mellitus: insulin deficiency or insulin resistance. Am J Med 1976;60: Porte D. β-cells in type II diabetes mellitus. Diabetes 1991;40: Chou P, Chen HH, Hsiao KJ. Community-based epidemiological study on diabetes in Pu-Li, Taiwan. Diabetes Care 1992;15: Chou P, Liao MJ, Kuo HS, Hsiao KJ, Tsai ST. A population survey on the prevalence of diabetes in Kin-Hu, Kinmen. Diabetes Care 1994;17(9): Lin JD, Shieh WB, Huang MJ, Huang HS. Diabetes mellitus and hypertension based on the family history and 2-h postprandial blood sugar in the Ann-Lo district (Northern Taiwan). Diabetes Research and Clinical Practice 1993;20: WHO Study Group on Diabetes Mellitus. Diabetes Mellitus. WHO Technical Report Series 727. Geneva: WHO, 1985: Seidell JC, Cigolini M, Charzewska J, Ellisinger BM, Biase GD, Bjorntorp P, Hautwast JGAJ, Contaldo F, Szostak V, Scuro LA. Androgenicity in relation to body fat distribution and metabolism in 38-year-old women--the European fat distribution study. J Clin epidemiol 1990;43: Frohlich ED, Grim C, Labarthe DR. Recommendations for human blood pressure determination by sphygmomanometers: report of a 9

10 task force appointed by the Steering Committee, American Heart Association. Hypertension 1988;11:209A-22A. 23. Nobbs BT, Smith JM, Wallar AW. Enzymatic determination of plasma cholesterol on discrete automatic analyzers. Clin Chem Acta 1977;79: Bucolo G, David H. Quantitative determination of serum triglycerides by the use of enzymes. Clin Chem 1973;19: National Institutes of Health. The Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) NIH publication No Classification and diagnosis of diabetes mellitus and other categories of glucose tolerance. Diabetes 1979;28: The Expert Panel. Report of the National Cholesterol Education Program: expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Arch Intern Med 1988;148: Hara H, Egusa G, Yamakido M. Incidence of non-insulin-dependent diabetes mellitus and its risk factors in Japanese-Americans living in Hawaii and Los Angeles. Diabetic Medicine 1996;13:S133-S Akazawa Y. Prevalence and incidence of diabetes mellitus by WHO criteria. Diabet Res Clin Pract 1994;24 Suppl:S23-S National Diabetes Data Group. 10

11 Table 1. The results of diabetic status after 2.6 years follow-up among subjects without diabetes mellitus ~ study OGTT Total Normal IGT DM ~ study No.(%) No.(%) No.(%) No.(%) Normal 881(100) 736(83.5) 126(14.3) 19(2.2) IGT 157(100) 64(40.8) 64(40.8) 29(18.5) Total 1038(100) 800(77.1) 190(18.3) 48(4.6) OGTT: oral glucose tolerance test; IGT: impaired glucose tolerance; DM: diabetes mellitus Table yr incidence of diabetes mellitus by age, and sex in Tainan, Taiwan Total Men Women Age IR IR IR groups no. n (%) no. n (%) no. n (%) (0.0) 92 0(0.0) 116 0(0.0) (1.6) 116 3(2.6) 133 1(0.8) (4.7) 113 9(8.0) 145 3(2.1) (10.2) 73 11(15.1) 94 6(6.4) (12.4) 51 7(13.7) 54 6(11.1) (3.9) 35 1(2.9) 16 1(6.3) Total (4.6) (6.5) (3.0) IR: incidence rate; DM: diabetes mellitus 11

12 Table 3. Comparisons of clinical characteristics of non-diabetic, and newly diagnosed diabetic subjects Variables Non-diabetics New DM p value No Age (yr) 42.4± ± BMI (kg m -2 ) 23.3± ± WHR.840± ± Cholesterol (mg/dl) 194.1± ± Triglyceride (mg/dl) 118.0± ± High density cholesterol(mg/dl) 52.3± ± Low density cholesterol(mg/dl) 122.2± ± Systolic blood pressure (mmhg) 109.3± ± Diastolic blood pressure (mmhg) 69.4± ± Fasting plasma glucose (mg/dl) 91.2± ± h plasma glucose (mg/dl) 106.6± ± HbA1C 5.0±.6 5.5± Physical activity (MET-hrs week-1) 68.9± ± Sex.011 Male 449(45.4) 31(64.6) Female 541(54.6) 17(35.4) Marriage.004 Unmarried 215(21.7) 1(2.1) Married 692(69.9) 43(89.6) Others 83(8.4) 4(8.3) Education.010 None 71(7.2) 7(14.6) Primary 201(20.3) 15(31.3) Junior 124(12.6) 8(16.7) Senior 277(28.0) 13(27.1) University & higher 315(31.9) 5(10.4) Socioeconomic status.034 Low 586(59.2) 36(75.0) High 404(40.8) 12(25.0) Smoking.058 No 749(75.7) 30(62.5) Yes 241(24.3) 18(37.5) Drinking.007 No 843(85.2) 33(68.8) Yes 147(14.8) 15(31.3) Family history of DM.251 No 811(81.9) 36(75.0) Yes 179(18.1) 12(2.0) Family history of ischemic heart disase.024 No 869(87.8) 36(75.0) Yes 121(12.2) 12(25.0) Family history of hypertension.648 No 618(62.4) 32(66.7) t test or χ 2 test 12

13 Table 4. Multiple logistic regression analysis on the newly diagnosed diabetes mellitus in Tainan, Taiwan Variables Odd Ratio 95% C.I. Age (year) Sex Family history of DM Fasting plasma glucose (mg/dl) h plasma glucose (mg/dl) WHR Cholesterol (mg/dl) Triglyceride (mg/dl) - NS SBP (mmhg) - NS DBP (mmhg) - NS Physical activity (MET-hrs wk -1 ) - NS Smoking (no/yes) - NS Drinking (no/yes) - NS Dependent variable is newly diagnosed diabetes vs. nondiabetes. Independent variables are age, sex, family history of DM, body mass index (BMI), fasting plasma glucose, 2-h plasma glucose, systolic blood pressure (SBP), diastolic blood pressure (DBP), physical activity, triglyceride, cholesterol, smoking, drinking, and waist-to-hip ratio (WHR) 13

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untitled http://www.medicine-on-line.com 预防糖尿病 : 页 1/7 糖尿病的预防作者 : 张志伟医学博士, 加拿大皇家内科学院院士附属单位 : 香港中文大学翻译 : 张舒吉林大学白求恩医学部糖尿病简介糖尿病被称为尿中含糖的疾病血中升高