Changes In Prevalence Of Diabetes Research Articles

1409-P: Association between Population Level Social Risk Factors and Prevalence of Diabetes

Background: The goal of this study was to evaluate the independent effect of population social risk on the crude prevalence of diabetes. Methods: We combined census tract level data including diabetes prevalence from the CDC PLACES 2019 database and social risk factor data from the Opportunity Insights database. A multiple linear regression model was run with diabetes prevalence as the outcome and incarceration, poverty, housing, education, employment, job environment, economic mobility, and healthcare access as independent correlates, adjusting for US population in 2020 and state fixed effects. Results: The final analytic sample consisted of 11,457 census tracts within 157 counties in 38 states. Mean prevalence of diabetes was 11.8% +/- 4.9%. All indicator variables were significantly associated with crude prevalence of diabetes and explained 89.2% of the variance in diabetes prevalence at the national level. In the fully adjusted model, with every standard deviation (SD) increase in proportion with an annual check-up, crude prevalence increased by 0.7 SD. For every SD increase in proportion uninsured, crude prevalence increased by 0.5 SD. For every SD increase in income below the poverty line, crude prevalence increased by 0.1 SD. For every SD increase in average rent for a two-bedroom apartment, crude prevalence decreased by 0.1 SD. For every SD increase in proportion of residents with a college degree, crude prevalence decreased by 0.1 SD. For every SD increase in proportion incarcerated, crude prevalence increased by 0.05 SD. In addition, in the fully adjusted model, the crude prevalence of diabetes varied significantly across states. Conclusions: Population level social risk factors were significantly associated with changes in prevalence of diabetes at the national level. The strongest drivers of this relationship were healthcare access, insurance, income, housing, education, and incarceration. Disclosure L.E.Egede: None. R.J.Walker: None. S.Linde: None. Funding National Institutes of Health (R01DK118038, R01DK120861, R01MD013826)

The influence of diabetes on temporal trends in lower extremity revascularisation and amputation for peripheral artery disease: A population-based repeated cross-sectional analysis.

To describe the influence of diabetes on temporal changes in rates of lower extremity revascularisation and amputation for peripheral artery disease (PAD) in Ontario, Canada. In this population-based repeated cross-sectional study, we calculated annual rates of lower extremity revascularisation (open or endovascular) and amputation (toe, foot or leg) related to PAD among Ontario residents aged ≥40 years between 2002 and 2019. Annual rate ratios (relative to 2002) adjusted for changes in diabetes prevalence alone, as well as fully adjusted for changes in demographics, diabetes and other comorbidities, were estimated using generalized estimating equation models to model population-level effects while accounting for correlation within units of observation. Compared with 2002, the Ontario population in 2019 exhibited a significantly higher prevalence of diabetes (18% vs. 10%). Between 2002 and 2019, the crude rate of revascularisation increased from 75.1 to 90.7/100,000 person-years (unadjusted RR=1.10, 95% CI=1.07-1.13). However, after adjustment, there was no longer an increase in the rate of revascularisation (diabetes-adjusted RR=0.98, 95% CI=0.96-1.01, fully-adjusted RR=0.94, 95% CI=0.91-0.96). The crude rate of amputation decreased from 2002 to 2019 from 49.5 to 45.4/100,000 person-years (unadjusted RR=0.78, 95% CI=0.75-0.81), but was more pronounced after adjustment (diabetes-adjusted RR=0.62, 95% CI=0.60-0.64; fully-adjusted RR=0.58, 95% CI=0.56-0.60). Diabetes prevalence rates strongly influenced rates of revascularisation and amputation related to PAD. A decrease in amputations related to PAD over time was attenuated by rising diabetes prevalence rates.

Environmental factors associated with changes in county-level diabetes prevalence in the United States, 2004-2017

BACKGROUND AND AIM: The prevalence of diabetes among adults in the United States (US) has increased steadily in recent years. Although individual risk factors and diagnostic and treatment changes are important, evidence suggests that contextual risk factors have contributed to these increases. We hypothesize that poor environmental quality might also explain increases in diabetes prevalence in the US. METHODS: We obtained age-adjusted estimates of diabetes prevalence among adults from the CDC for all US counties for 2004-2017 and examined changes in these estimates over time within four county strata using the US Department of Agriculture’s Rural Urban Continuum Codes (RUCC) classifications: RUCC1 (metropolitan urbanized), RUCC2 (non-metro urbanized), RUCC3 (less urbanized), and RUCC4 (thinly populated). We obtained estimates of the county-level environmental quality index (EQI) from the US EPA representing 2006-2010, reflecting five domains: air, water, land, sociodemographics, and built environment. Analysis of changes in diabetes prevalence using growth mixture modeling is in progress; we will compare latent classes of county-level diabetes prevalence trajectories with EQI measures. RESULTS:A total of 3,137 counties were included in this analysis (RUCC1 n = 1166, RUCC2 n = 306, RUCC3 n = 1026, RUCC4 n = 639). Mean (SD) percentage change in age-adjusted diabetes prevalence between 2004-2017 was: 6.8 (23)% (RUCC1), 10.8 (25)% (RUCC2), 12.6 (32)% (RUCC3), and 5.4 (34)% (RUCC4); each RUCC strata included counties where diabetes prevalence decreased. Except for RUCC4 (thinly populated) counties, mean EQI values were higher among counties that had a net decrease in diabetes prevalence compared to those with an increase between 2004-2017. CONCLUSIONS:There was substantial heterogeneity in the percent change in age adjusted diabetes prevalence across all RUCC strata between 2004-2017. Environmental quality may be related to this increase. KEYWORDS: environmental epidemiology; obesity and metabolic disorders

Geographic disparities and temporal changes of diabetes prevalence and diabetes self-management education program participation in Florida.

BackgroundAlthough Diabetes Self-Management Education (DSME) programs are recommended to help reduce the burden of diabetes and diabetes-related complications, Florida is one of the states with the lowest DSME participation rates. Moreover, there is evidence of geographic disparities of not only DSME participation rates but the burden of diabetes as well. Understanding these disparities is critical for guiding control programs geared at improving participation rates and diabetes outcomes. Therefore, the objectives of this study were to: (a) investigate geographic disparities of diabetes prevalence and DSME participation rates; and (b) identify predictors of the observed disparities in DSME participation rates.MethodsBehavioral Risk Factor Surveillance System (BRFSS) data for 2007 and 2010 were obtained from the Florida Department of Health. Age-adjusted diabetes prevalence and DSME participation rates were computed at the county level and their geographic distributions visualized using choropleth maps. Significant changes in diabetes prevalence and DSME participation rates between 2007 and 2010 were assessed and counties showing significant changes were mapped. Clusters of high diabetes prevalence before and after adjusting for common risk factors and DSME participation rates were identified, using Tango’s flexible spatial scan statistics, and their geographic distribution displayed in maps. Determinants of the geographic distribution of DSME participation rates and predictors of the identified high rate clusters were identified using ordinary least squares and logistic regression models, respectively.ResultsCounty level age-adjusted diabetes prevalence varied from 4.7% to 17.8% while DSME participation rates varied from 26.6% to 81.2%. There were significant (p≤0.05) increases in both overall age-adjusted diabetes prevalence and DSME participation rates from 2007 to 2010 with diabetes prevalence increasing from 7.7% in 2007 to 8.6% in 2010 while DSME participation rates increased from 51.4% in 2007 to 55.1% in 2010. Generally, DSME participation rates decreased in rural areas while they increased in urban areas. High prevalence clusters of diabetes (both adjusted and unadjusted) were identified in northern and central Florida, while clusters of high DSME participation rates were identified in central Florida. Rural counties and those with high proportion of Hispanics tended to have low DSME participation rates.ConclusionsThe findings confirm that geographic disparities in both diabetes prevalence and DSME participation rates exist. Specific attention is required to address these disparities especially in areas that have high diabetes prevalence but low DSME participation rates. Study findings are useful for guiding resource allocation geared at reducing disparities and improving diabetes outcomes.

Temporal changes in diabetes prevalence and achievement of care goals in urban South Asia from 2010 to 2016 - The Center for Cardio-metabolic Risk Reduction in South Asia Study.

Achievement of treatment targets among individuals with diabetes remains suboptimal in many parts of the globe. We aimed to assess changes in diabetes prevalence and achievement of diabetes care goals in South Asia using two consecutive cross-sectional population-based surveys. Two representative samples of South Asian adults were recruited using identical methods from Chennai, Delhi, and Karachi in 2010-11 (n=16,288; response rate-94.7%) and 2015-16 (n=14,587; response rate-94.0%) through the Center for Cardio-metabolic Risk Reduction in South Asia (CARRS) Study. Quality of care goals were defined as HbA1c <53mmol/mol (7.0%), blood pressure (BP) control: <140/90mmHg, lipid control: LDL cholesterol <2.56mmol/l (100mg/dl), and self-reported non-smoking. Weighted prevalence of self-reported diabetes increased by 9.0% [13% (95%CI: 13-14) to 15% (14-15)] while that of newly diagnosed diabetes decreased by 16% [6.1% (5.7-6.6) to 5.1% (4.6-5.6)]. There were improvements in achieving glycaemic (25% to 30%, p=0.002) and lipid (34% to 45%, p<0.001) goals, but no notable improvements in BP control or smoking status. The proportion of individuals with self-reported diabetes meeting more than one target also increased. Diabetes prevalence continues to grow among urban South Asians and large gaps still exist in the attainment of treatment targets. Concerted policy, systemic, clinical and individual efforts are needed to close these care gaps.

Changes in prevalence of diabetes over 15 years in a rural Australian population: The Crossroads Studies

AimsSecular trends in diabetes prevalence vary globally. We compared the prevalence of diabetes in two surveys 15 years apart in rural Australia. MethodTwo cross-sectional household surveys and clinics (biomedical assessments including oral glucose tolerance tests (OGTTs)) in 2001–2003 (Crossroads) and 2016–2018 (Crossroads-II).Setting: Four rural Victorian towns.Participants: Residents of randomly selected households (Crossroads (n = 5258), Crossroads-II (n = 2649)) with nested clinic assessments for randomly selected participants (n = 1048 and 736 respectively). Response rate 61%.Main outcome measures: Self-reported diagnosed diabetes, screening history, and diabetes defined by OGTT. ResultsThe age standardised prevalence of diagnosed diabetes increased from 5.0(4.4–5.7)% to 7.7(6.7–8.6)%, with crude prevalence increasing overall (5.4 to 10.4% p < 0.001), in the smaller towns (5.4 to 11.1% p = 0.001) and, the regional centre (4.1 to 7.3% p < 0.001). Screening for diabetes over the previous two years increased (rural towns 49.8 to 63.8%; regional centre 44.9 to 63.6%; both p < 0.001). The proportion of undiagnosed diabetes was 23.2% in 2003 and 13.7% in 2018. The age and sex adjusted change in total diabetes was (1.15(0.84–1.59)). Central obesity (adjusted odd ratio 1.28(1.00–1.64)) but not overall obesity (adjusted odd ratio 1.17(0.95–1.46)) increased over time. ConclusionsOver 15 years, the crude prevalence of diagnosed diabetes increased while the age and sex adjusted total diabetes prevalence did not change significantly. The epidemic may be slowing in some settings.

Changes in diabetes prevalence and corresponding risk factors - findings from 3- and 6-year follow-up of PURE Poland cohort study

BackgroundDiabetes mellitus (DM) is one of the greatest challenges for public health worldwide. The aim of the study was the analysis of diabetes development in participants with normoglycemia and Impaired Fasting Glucose (IFG) in 3-year and 6-year follow-up of PURE Poland cohort study.MethodsThe analysis was conducted in Polish cohort enrolled into Prospective Urban and Rural Epidemiology (PURE) Study. The following study presents results of 1330 participants that have partaken both in the baseline study, in 3-year and in the 6-year follow up. The analysis of the impact of risk factors on diabetes development was performed using multivariate Cox frailty analysis. Population Attributable Risk (PAR) was computed individually for every risk factor.ResultsDiabetes prevalence increased from 17.7% at baseline to 23.98% in 3-year- and 28.27% in 6-year follow-up. The risk of diabetes was higher in participants with obesity [HR = 5.7, 95%Cl 2,56-12,82], overweight [HR = 3.4, 95%Cl 1,56-7,54] and IFG [HR = 2.7, 95%Cl 1,87-3,85]. The risk of diabetes development was almost 2-fold higher in men than in women [HR = 1.826; 95%CI =1,24 - 2,69]. In 6 years, diabetes developed in 23.8% of participants with IFG and 7.9% of participants with normoglycemia. According to PAR, overweight and obesity accounted for 80.8%, hypertension for 67.6% and IFG for 38.3% of diabetes cases in our population.ConclusionsOur study reveals alarming increase in prevalence of diabetes during 6 years of observation. In our population, most diabetes cases can be attributed to overweight, obesity, hypertension and IFG. Findings add strong rationale to implement targeted preventive measures in population of high risk.

Does the Association of Diabetes With Stroke Risk Differ by Age, Race, and Sex? Results From the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

Given temporal changes in diabetes prevalence and stroke incidence, this study investigated age, race, and sex differences in the diabetes-stroke association in a contemporary prospective cohort, the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. We included 23,002 non-Hispanic black and white U.S. adults aged ≥45 years without prevalent stroke at baseline (2003-2007). Diabetes was defined as fasting glucose ≥126 mg/dL, random glucose ≥200 mg/dL, or use of glucose-lowering medication. Incident stroke events were expert adjudicated and available through September 2017. The prevalence of diabetes was 19.1% at baseline. During follow-up, 1,018 stroke events occurred. Among adults aged <65 years, comparing those with diabetes to those without diabetes, the risk of stroke was increased for white women (hazard ratio [HR] 3.72 [95% CI 2.10-6.57]), black women (HR 1.88 [95% CI 1.22-2.90]), and white men (HR 2.01 [95% CI 1.27-3.27]) but not black men (HR 1.27 [95% CI 0.77-2.10]) after multivariable adjustment. Among those aged ≥65 years, diabetes increased the risk of stroke for white women and black men, but not black women (HR 1.05 [95% CI 0.74-1.48]) or white men (HR 0.86 [95% CI 0.62-1.21]). In this contemporary cohort, the diabetes-stroke association varied by age, race, and sex together, with a more pronounced effect observed among adults aged <65 years. With the recent increase in the burden of diabetes complications at younger ages in the U.S., additional efforts are needed earlier in life for stroke prevention among adults with diabetes.

Workload impact of the Quality and Outcomes Framework for patients with diabetes: an interrupted time series in general practice.

There are substantial concerns about GP workload. The Quality and Outcomes Framework (QOF) has been perceived by both professionals and patients as bureaucratic, but the full impact of the QOF on GP workload is not well known. To assess the impact of the QOF on GP consultation rates for patients with diabetes mellitus. This study used interrupted time series of 13 248 745 general practice consultations for 37 065 patients with diabetes mellitus in England. Clinical Practice Research Datalink general practice data were used from 2000/2001 to 2014/2015, with introduction of the QOF (1 April 2004) as the intervention, and mean annual GP consultation rates as the primary outcome. Mean annual GP clinical consultation rates were 8.10 per patient in 2000/2001, 6.91 in 2004/2005, and 7.09 in 2014/2015. Introduction of the QOF was associated with an annual change in the trend of GP clinical consultation rates of 0.46 (95% confidence interval [CI] = 0.23 to 0.69, P = 0.001) consultations per patient, giving a post-QOF trend increasing by 0.018 consultations per year. Introduction of the QOF was associated with an immediate stepped increase of 'other' out-of-hours and non-clinical encounters, and trend change of 0.57 (95% CI = 0.34 to 0.81, P<0.001) per year, resulting in a post-QOF trend increasing by 0.27 other encounters per year. Introduction of the QOF was associated with a modest increase in clinical GP consultation rates and substantial increase in other encounters for patients with diabetes independent of changes in diabetes prevalence. National prevalence of diabetes increased by 90.7% from 2004/2005 to 2014/2015, which, combined with this study's findings, means GPs would have provided nearly double the number of consultations for patients with diabetes over this timescale.

Health Care Spending on Diabetes in the U.S., 1996-2013.

Health care spending on diabetes in the U.S. has increased dramatically over the past several decades. This research describes health care spending on diabetes to quantify how that spending has changed from 1996 to 2013 and to determine what drivers are increasing spending. Spending estimates were extracted from the Institute for Health Metrics and Evaluation's Disease Expenditure 2013 database. Estimates were produced for each year from 1996 to 2013 for each of 38 age and sex groups and six types of care. Data on disease burden were extracted from the Global Burden of Disease 2016 study. We analyzed the drivers of spending by measuring the impact of population growth and aging and changes in diabetes prevalence, service utilization, and spending per encounter. Spending on diabetes in the U.S. increased from $37 billion (95% uncertainty interval $32-$42 billion) in 1996 to $101 billion ($97-$107 billion) in 2013. The greatest amount of health care spending on diabetes in 2013 occurred in prescribed retail pharmaceuticals (57.6% [53.8-62.1%] of spending growth) followed by ambulatory care (23.5% [21.7-25.7%]). Between 1996 and 2013, pharmaceutical spending increased by 327.0% (222.9-456.6%). This increase can be attributed to changes in demography, increased disease prevalence, increased service utilization, and, especially, increases in spending per encounter, which increased pharmaceutical spending by 144.0% (87.3-197.3%) between 1996 and 2013. Health care spending on diabetes in the U.S. has increased, and spending per encounter has been the biggest driver. This information can help policy makers who are attempting to control future spending on diabetes.

Carbon dioxide emissions and change in prevalence of obesity and diabetes in the United States: An ecological study

Recent studies suggest that increasing levels of the greenhouse gas, carbon dioxide (CO2), may influence weight gain and thus may play a role in rising trends in obesity and diabetes. We conducted an ecological study to examine the associations between CO2 emissions from fossil fuel combustion and changes in the prevalence of obesity and diabetes in the United States. County-level data on CO2 emissions, prevalence of obesity and diagnosed diabetes, other sociodemographic factors and neighborhood characteristics related to urbanicity, and fine particles (PM2.5) between 2004 and 2008 were obtained from the Vulcan Project, Centers for Disease Control and Prevention, and American Community Survey. Linear mixed effect modeling of 3019 counties for the associations between average CO2 emissions and changes in diabetes and obesity prevalence between 2004 and 2008 was performed. The average obesity and diabetes prevalence increased between 2004 and 2008 by 3.65% (SD: 1.88%) and 1.65% (SD: 1.70%), respectively. A marginally significant positive association between CO2 emission and changes in obesity prevalence was found with adjustment for sociodemographic factors, indicators of urbanicity and spatial autocorrelation (p-trend=0.06). The association became weaker and nonsignificant with further adjustment for PM2.5 (p-trend=0.17). There was a significant positive association between CO2 emission and changes in diabetes prevalence before controlling for PM2.5 (p-trend=0.05) but the association became null after controlling for PM2.5 (p-trend=0.49), suggesting that PM2.5 is a critical confounder in the association between CO2 emission and changes in diabetes prevalence. This study does not support the hypothesis that CO2 emissions, a leading driver of climate change, may be linked to increasing trends in obesity and diabetes, though there was an indication of possible link between CO2 and obesity.

Trend analysis of diabetic prevalence and incidence in a rural area of South Korea between 2003-2008.

Aims/Introduction: This study determined the change in prevalence of diabetes and prediabetes over a period of 5 years in South Korea. The incidence of diabetes and prediabetes and risk factors associated with the development of diabetes were also investigated. The Dalseong population-based cohort survey recruited 1806 subjects who were over 20-years-old in 2003. Five years later, 1287 of the original subjects were re-evaluated and 187 new subjects were added to the study. All participants completed a questionnaire, were given a physical examination, and provided blood samples for analysis including 2 h oral glucose tolerances. Age-adjusted prevalence of diabetes rose from 6.7% in 2003 to 9.1% in 2008. The prevalence of prediabetes also increased from 18.5% in 2003 to 28.4% in 2008. The incidence rates of diabetes and prediabetes were 18.3 per 1000 person-years and 55.4 per 1000 person-years, respectively. The development of diabetes was associated with impaired fasting glucose (IFG) (odds ratio [OR] 5.661), impaired glucose tolerance (IGT) (OR: 6.013), age (OR 1.013), and waist-to-hip ratio (OR 1.513). After excluding the IFG and IGT, systolic blood pressure (OR 1.023), high-sensitivity C-reactive protein (hsCRP; OR 1.097), triglyceride (OR 1.002) and waist-to-hip ratio (OR 1.696) were statistically significant risk factors in a multivariate logistic regression analysis. A significant rise in the prevalence of diabetes and prediabetes was observed between 2003 and 2008. In addition, this study newly demonstrated that waist-to-hip ratio and hsCRP were associated with the development of diabetes after adjusting for several confounding factors. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00045.x, 2010).

Evaluating the impact of a national pilot screening programme for type 2 diabetes in deprived areas of England

A pilot programme designed to systematically screen for type 2 diabetes was introduced in 24 general practices in England selected for their high levels of socio-economic deprivation and multi-ethnic populations. To evaluate the impact of screening on the prevalence of type 2 diabetes. A prospective audit of screening activity in pilot practices and comparison of the change in prevalence of diabetes in pilot and comparison practices were conducted. Of 41,400 individuals invited for screening from a population of 165,828 in pilot practices, 25,356 (61%) were screened. Three hundred and fifty-eight (0.22%) new cases of diabetes were detected among those screened. Only 69% of those with a positive screening test had diagnostic testing recorded and only 19% had a record of an oral glucose tolerance test. The absolute increase in the prevalence of diagnosed diabetes was 0.53% in pilot practices and 0.42% in comparison practices. The 'real world' nature of the programme and dependence on routine data collection systems makes results more difficult to interpret but also enabled problems with implementation, not evident from previous research, to be identified. It is likely that the low diagnostic yield was largely due to a high level of ad hoc screening activity outside the pilot protocol and inadequate access to diagnostic testing after a positive screening test. In particular, implementation of screening for diabetes in primary care should not be undertaken without robust assessment of the resources required for diagnostic testing and follow-up and adequate clinical audit.

Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India.

The rural Indian population is undergoing lifestyle transition due to socio-economic growth. This study was done to determine the temporal changes in prevalence of diabetes and IGT that could have occurred in a rural population in India as a result of the lifestyle transition. A cross-sectional study of 1213 Asian-Indian subjects aged 20 years or over was done to look for the prevalence of diabetes and IGT using the 1999 WHO criteria. The temporal changes were assessed in comparison with a similar study conducted 14 years previously. The factors associated with the temporal changes were also analysed. Nearly a three-fold increase in age- and sex-adjusted prevalence of diabetes (from 2.20% to 6.36%) was seen in 2003 when compared with a similar study done 14 years before. Prevalence of IGT did not change significantly (7.44% in 1989 vs 7.18% in 2003). Improvement in living conditions had occurred during the period, occupational changes were seen, the number of manual labourers had decreased and economic conditions had improved. BMI and waist circumference had increased. After correcting for age, sex and differences in time periods, waist circumference and physical inactivity showed significant associations with the increased prevalence of diabetes. Demographic transition due to improved living conditions in rural India was associated with a three-fold increase in the prevalence of diabetes. Increased upper body adiposity and physical inactivity showed significant association with this phenomenon.

Increasing prevalence of diabetes mellitus and impaired glucose tolerance among 60-year-old Danes.

The age-specific prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was estimated in 60-year-old individuals in 1996/97 and compared to the prevalence in 1974/75. The study also examined whether or not the change in prevalence of diabetes and IGT could be explained by changes in body mass index (BMI) and physical activity. Diabetes and IGT were diagnosed by a standardized oral glucose tolerance test (OGTT) in two Danish population-based, age-specific, birth cohorts. The prevalence of diabetes in 1996/97 was 12.3% among 60-year-old men and 6.8% among women, representing an increase in diabetes of 58% in men and 21% in women compared to 1974/75. The prevalence of IGT was 15.9% among men and 13.1% among women, representing increases of 109 and 16%, respectively. A concurrent increase in BMI in the 22-year period between the two studies explained the increase found in the prevalence of diabetes and IGT. A marked increase in the prevalence of diabetes and IGT among 60-year-old individuals over a 22-year period was observed - especially in men. The increase was fully explained by a concurrent increase in BMI.

Reduced prevalence of impaired glucose tolerance and no change in prevalence of diabetes despite increasing BMI among Aboriginal people from a group of remote homeland communities.

To examine trends in glucose tolerance and coronary risk among Aboriginal people from a group of homeland communities in central Australia during a 7-year follow-up period. Community-based screenings of adult volunteers were performed in 1988 (n = 437; 93% response rate) and in 1995 (n = 424; 85% response rate). A health promotion intervention program commenced after the 1988 survey that focused on the benefits of exercise and appropriate diet. Mean (95% CI) BMI increased significantly from 22.8 kg/m2 (22.3-23.2) to 24.2 kg/m2 (23.8-24.7) during the follow-up period (P < 0.001). This increase was similar for men and women and across all age-groups. The increase in BMI was greater among subjects residing adjacent to a store compared with those residing in communities located far from a store (P < 0.001). Decreases were evident in the prevalence of impaired glucose tolerance (IGT) (from 22.5 to 10.1% among women, P < 0.001; from 12.2 to 6.5% among men, P = 0.074) and hypercholesterolemia (from 36.7 to 25.8% among women, P < 0.01; from 52.4 to 44.0% among men, P = 0.147), but no change was evident in the prevalence of diabetes. Smoking remained rare among women (<4%) and decreased among men (from 52.9 to 40.8%, P < 0.05). The trends in glucose intolerance were clearly better than have been observed in other Aboriginal communities. The institution of an intervention program corresponded with reductions in the prevalence of IGT, hypercholesterolemia, and smoking. The prevalence of diabetes remained unaltered despite a significant increase in mean BMI, possibly because of the promotion of increased physical activity levels.

Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote Australian Aboriginal community

ObjectiveTo assess the sustainability and effectiveness of a community-directed program for primary and secondary prevention of obesity, diabetes and cardiovascular disease in an Aboriginal community in north-west Western Australia. MethodEvaluation of health outcomes (body mass index, glucose tolerance, and plasma insulin and triglyceride concentrations) in a cohort of high-risk individuals (n=49, followed over two years) and cross-sectional community samples (n=200 at baseline, 185 at two-year and 132 at four-year follow-ups), process (interventions and their implementation) and impact (diet and exercise behaviour). ResultsFor the high-risk cohort, involvement in diet and/or exercise strategies was associated with protection from increases in plasma glucose and triglycerides seen in a comparison group; however, sustained weight loss was not achieved. At the community level, significant reductions were observed in fasting insulin concentration but no change in prevalence of diabetes, overweight or obesity. Weight gain remained a problem among younger people. Sustainable improvements were observed for dietary intake and level of physical activity. These changes were related to supportive policies implemented by the community council and store management. ConclusionsCommunity control and ownership enabled embedding and sustainability of program, in association with social environmental policy changes and long-term improvements in important risk factors for chronic disease. ImplicationsDevelopmental initiatives facilitating planning, implementation and ownership of interventions by community members and organisations can be a feasible and effective way to achieve sustainable improvements in health behaviours and selected health outcomes among Aboriginal people.

Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data

Objective : To evaluate the impact of the revised diagnostic criteria for diabetes mellitus adopted by the American Diabetes Association on prevalence of diabetes and on classification of patients. For...

Influence of Castration, Alone or Combined with Thymectomy, on the Development of Diabetes in the Nonobese Diabetic Mouse*

The nonobese diabetic (NOD) mouse is a recognized model for studying immunologically-mediated insulin-dependent diabetes mellitus. The disease appears with a greater preponderance in females than in males. Castration at weaning led to a significant increase in the prevalence of diabetes in NOD males, whereas a tendency to a decreased prevalence was observed in NOD females. Castration combined with thymectomy was found to further increase the prevalence of diabetes in NOD males, whereas in females castration reversed the effect of thymectomy. These results on changes in diabetes prevalence were corroborated by the degree of lymphocytic infiltration directed toward the pancreatic islets of Langerhans. Taken together these results indicate a direct relationship between the endocrine and immune systems, whereby orchidectomy has a deleterious effect on the immunopathogenesis of diabetes. In addition, we examined whether the distribution of lymphocyte subpopulations, mitogen reactivity, lymphokine production, and in vivo response to a thymus-dependent antigen, such as sheer red blood cell, were dependent or independent of the sex steroid environment.