The epidemiology of complications.

Abstract

This is the seventh in a series of reports on the American Diabetes Association (ADA) 61st Scientific Sessions held in Philadelphia, PA, in June 2001. It covers topics related to the treatment of type 2 diabetes. John Fuller, London, U.K., gave the Kelly West lecture on the epidemiology and prevention of diabetic complications. Data from the World Health Organization (WHO) multinational study of vascular disease in diabetes showed interesting discrepancies between national groups in rates of nephropathy and cardiovascular disease (CVD). Mortality rates increase with increasing cigarette use, blood pressure, and cholesterol; proteinuria, triglyceride, and fasting blood glucose are additional risk factors. Studies with electron beam computerized tomography (EBCT) show increased calcium levels in the coronary arteries of both men and women with diabetes, correlating with the duration of diabetes, systolic blood pressure, BMI, and total/HDL cholesterol ratio (1,2). Patients with diabetes have a 2.5- to 5-fold greater risk than those without diabetes of having an increased coronary artery calcification (CAC) score. The EURODIAB study in 31 centers in 16 countries in Europe followed 3,250 patients with type 1 diabetes beginning in the late 1980s. Coronary heart disease (CHD) incidence rates of 10 and 12 per 1,000 patient-years were seen in men and in women, with age and albuminuria independent risk factors in both sexes, the waist-to-hip ratio (WHR) an additional risk factor in men, and systolic blood pressure an additional risk factor in women. Using baseline assessment in 1988–1991, of 1,134 patients with normoalbuminuria, 12.6 and 1.7% developed micro- and macroalbuminuria (3). Risk factors for worsening albuminuria are HbA1c, baseline albuminuria level, triglyceride, and BMI. Among normo-, micro-, and macroalbuminuric patients, CHD event rates were 7, 12, and 22%, respectively. There was a 56% incidence of new retinopathy over 7.5 years for those without retinopathy …