Female Diabetes Mellitus Research Articles

Abstract 18714: Predictors of Incident Abdominal Aortic Aneurysm in The Elderly: Insights from the Southern Community Cohort Study

Background: Abdominal aortic aneurysm (AAA) is a leading cause of death in the United States, with high prevalence in the elderly population. We sought additional insight into the incidence and predictors of AAA among elderly persons with documented lifestyle and socioeconomic characteristics. Methods: Among 11,013 elderly (≥ 65 years) participants in the Southern Community Cohort Study who were also Medicare recipients from 1999-2008, we calculated age-adjusted incidence rates (IR) of AAA. We assessed the predictors of incident AAA using Cox proportional hazards regression analysis, adjusting for demographic, lifestyle, socioeconomic factors, and medical history. Participants with prevalent AAA at baseline were excluded from this analysis. Results: Overall, 198 incident AAA cases were identified during the study period. Age-adjusted IR (per 100,000) were 528, 1267, 247 and 590 among black men, white men, black women and white women, respectively. After adjusting for known risk factors, women had lower risk for AAA compared with men (Hazard ratio (HR) 0.59, 95% CI 0.43-0.81; Table) and blacks had lower risk compared with whites (HR 0.42, 95% CI 0.31-0.59). Smoking remained the strongest risk factor overall (former: HR 2.14, 95% CI 1.40-3.30; current: HR 5.09, 95% CI 3.25-7.95), and this association was most pronounced among women. Hypertension and myocardial infarction or coronary artery bypass surgery were each positively associated with AAA incidence among men (respective HR 1.84, 95% CI 1.13-2.99 and 1.68, 95% CI 1.06-2.66). Interestingly, the presence of diabetes mellitus (DM) was inversely associated with incident AAA (overall HR 0.68, 95% CI 0.47-0.99). Conclusion: Smoking and HTN were independent predictors of increased risk of incident AAA in this cohort, while female sex, black race, and DM confers protective effects. The underlying mechanism(s) for these protective effects remain incompletely understood and warrant further evaluation.

Atherosclerotic Effects of Smoking and Excess Weight

Background: Metabolic syndrome is a systemic atherosclerotic cascade terminating with multi-organ failures. Methods: Consecutive patients with Coronary Heart Disease (CHD) were studied. Results: Study included 1,620 females and 1,240 males. Prevalences of CHD were similar in both sexes (3.8% versus 4.4%, respectively, p>0.05). Mean ages of CHD cases were 61.5 versus 63.5 years in both sexes, respectively (p>0.05). Smoking and Chronic Obstructive Pulmonary Disease (COPD) were higher in males with CHD (54.5% versus 9.6%, p 0.05 for both) probably due to small sample sizes of the groups. Whereas low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) were higher in females with CHD, significantly (132.6 versus 115.6 mg/dL, p=0.008 and 250.3 versus 150.1 mg/dL, p=0.002, respectively). Similarly, hypertension (HT) and diabetes mellitus (DM) were also higher in females with CHD, significantly (58.0% versus 30.9%, p<0.001 and 51.6% versus 38.1%, p<0.05, respectively). Conclusion: Metabolic syndrome is a systemic atherosclerotic process exaggerated by some metabolic disorders. Smoking and excess weight may be the major triggering causes of the syndrome, and they come with similar degree of clinical severity in front. Smoking and COPD were higher in males with CHD against the higher BMI, WCH, LDL-C, TG, HT, and DM in females, resulting with similar prevalences of CHD in both sexes.

Risk factors for mortality in diabetic peritoneal dialysis patients

It is well established that the survival rate of diabetic end-stage renal disease patients remains the lowest among all primary diagnoses probably because of higher prevalence of cardiovascular diseases (CVD) associated with diabetes. This study was designed to evaluate the impact of CVD and other risk factors individually or in combination on mortality in diabetic peritoneal dialysis (PD) patients. In a retrospective study, 213 incident PD patients [118 had diabetes mellitus (DM), 94 were female, mean age 55 ± 13 years] underwent initial assessment of nutritional status, comorbid disease (CMD) survey, residual renal function (RRF), dialysis adequacy and peritoneal transport characteristics at a mean of 9 days (range, 3-24 days) after start of PD and were then followed for 30 ± 24 months (range, 3-115 months). Of 213 patients, 154 patients were reassessed after a mean of 11 months (range, 6-19 months). Nutritional status was assessed by subjective global assessment and other methods. CMD was graded by Davies index and included DM, CVD, liver disease and respiratory disease. On Kaplan-Meier analysis, patient survival was significantly lower in female DM patients compared to other groups. The 3-year patient survival rate was 46, 70, 82 and 83% for female DM, male DM, male non-DM and female non-DM, respectively (P = 0.003). On Cox proportional hazards multivariate analysis including all patients, old age, presence of CVD or protein-energy wasting (PEW), low serum albumin concentration and low RRF were independent predictors of mortality but not DM per se or female gender. In DM patients, old age, female gender, presence of CVD or PEW and low RRF were independent predictors of mortality while old age was the only risk factor in non-DM patients. After adjustment for age, gender and RRF, DM patients with both CVD and PEW had a risk of mortality that was 3.3 times that of DM patients without CVD and PEW. In DM patients without CVD and PEW, patient survival was not different from that of non-DM patients without CVD and PEW. DM per se was not a risk factor for mortality in this group of PD patients. Instead, the higher mortality rate in diabetic PD patients, in particular among female patients, was mainly attributable to concurrent morbidity such as CVD and PEW, together with low RRF.

Fração da carga global do diabetes mellitus atribuível ao excesso de peso e à obesidade no Brasil

To estimate the global burden of diabetes mellitus (DM) in 2002-2003 and to calculate the fraction of diabetes attributable to excess weight and obesity for Brazil and its regions. The prevalence of excess weight and obesity according to sex and age (> 20 years) and the relative risks for the development of DM (derived from international studies) attributable to excess weight and obesity were used to calculate the global burden of DM. The prevalence of excess weight and obesity for Brazil and its regions was obtained from the Family Budget Survey (Pesquisa de Orçamento Familiar). Disability-adjusted life years (DALY) were calculated for DM based on the sum of two components: years of life lost (YLL) and years lived with disability (YLD). Of the total DALY estimated for DM in Brazil, YLD accounted for 70%. For Brazil as a whole, 61.8% and 45.4% of DM in females was attributable to excess weight and obesity, respectively. Among males, the proportions were 52.8% and 32.7%. The largest excess weight/obesity-attributable fractions were observed in the South, Southeast, and Midwest regions and in the 35-44-year-old age groups. A large fraction of the burden of DM is attributable to preventable individual risk factors. Measures targeting prevention and control of risk factors such as excess weight and obesity must be included in the Brazilian public health agenda.

Opium consumption in men and diabetes mellitus in women are the most important risk factors of premature coronary artery disease in Iran

We performed this study to compare of CAD risk factors in young male and female in Iran. In an analytic cross-sectional study, two groups of patients were evaluated with and without Coronary artery disease. The result of study suggests that there is a relationship between CAD and diabetes mellitus, increasing level of LDL and lipoprotein A in women, While CAD in men had more relation with smoking and opium use. High prevalence and uncontrolled diabetes mellitus in females and relatively high prevalence of opium consumption in males result in different premature CAD patterns.

Increased Arterial Stiffness in Elderly Female Diabetic Peritoneal Dialysis Patients

Background: Arterial stiffness is a major risk factor for cardiovascular and all-cause mortality in patients with end-stage renal disease. It has been reported that female and elderly diabetes mellitus (DM) patients treated with peritoneal dialysis (PD) had a higher risk of death. However, the underlying mechanism remains unknown. The present study tried to investigate whether older female DM patients have increased arterial stiffness. Methods: One hundred and eighty-one continuous ambulatory PD patients in a single center were enrolled. On enrollment, demographic data were collected. Carotid-femoral pulse wave velocities (PWV) were checked at the same time. Results: As expected, age had a significant impact on PWV both in DM and non-DM patients. There was no significant difference in PWV between male and female patients under the age of 50. No significant difference in PWV was found between male and female non-DM patients over the age of 50. However, the comparison of PWV reached statistical significance between male and female DM patients over the age of 50 (12.44 ± 1.83 m/s vs. 13.56 ± 1.86 m/s, p < 0.05). Conclusions: Our study showed that female DM patients over the age of 50 had the highest PWV as compared to other patient groups. Increased arterial stiffness might have contributed to the worst outcome of this population on PD treatment.

Phospholipase, proteinase and haemolytic activities of Candida albicans isolated from oral cavities of patients with type 2 diabetes mellitus

The aim of this study was to biotype and characterize phospholipase, proteinase and haemolytic activities of oral Candida albicans isolates from 210 Chinese patients with type 2 diabetes mellitus (DM) and 210 age- and sex-matched healthy controls. Seventy-six and 50 C. albicans isolates were obtained from type 2 DM patients and controls, respectively, using the oral rinse technique. The isolates were characterized with a biotyping system based on enzyme profiles, carbohydrate assimilation patterns and boric acid resistance of the yeasts, and the isolates were further tested for in vitro phospholipase, proteinase and haemolytic activities. The major biotypes of C. albicans isolates from the type 2 DM and control groups were A1R (42.1 %) and J1R (36.0 %), respectively. Significantly higher proteinase and haemolytic activities were found in the isolates from the type 2 DM group (P<0.05). Proteinase activity was higher in isolates from patients with > or =10 years of DM history than those with <10 years (P<0.05). Haemolytic activity was significantly higher in isolates from female DM patients than in those from male counterparts (P<0.05). These data provide evidence of increased extracellular enzyme activity in Candida isolates taken from DM patients.

Authors?? Response

To the Editor: We thank Lamm et al1 for responding to our article.2 They recalculated our data only for the period 1980–2000 (excluding 1971–1979) and this led to an estimate of similar significant negative slope for diabetes mellitus (DM) standardized mortality ratios (SMRs) for males and females. They dispute our conclusion that there is a gender difference in temporal pattern (only during the 1980s and 1990s). Because inorganic arsenic has been reported to be associated with an increased mortality from DM, it is logical to expect that a reduction of arsenic exposure through improvement in the water supply system would lead to a decrease in mortality rates from DM in both males and females living in the Blackfoot disease (BFD) endemic areas. We feel that their argument, however, provides further evidence that the association between arsenic exposure and DM was causal. Their point of criticism regarding the use of DM listed on the death certificate as the underlying cause of death has already been addressed in the discussion section of our article. We agree with Lamm et al that small numbers of DM deaths will provide much less stability to the analysis, particularly during the 1970s. To minimize this statistical variability, the 3-year moving averages of the SMR were calculated for this study. Lamm et al argue that fluorescent compounds (humic substances) in the artesian well water are a potential causative agent for BFD; thus, the decline in diabetes mortality may be the consequence of withdrawal of a water-borne factor, but whether arsenic is that factor is not clear. In our opinion, in the BFD endemic areas, the main exposure to inorganic arsenic is through ingestion of artesian well water containing high concentrations of arsenic. Physical and chemical characteristics of drinking water have been intensively studied in both BFD endemic and nonendemic areas.3 In artesian well water, the only chemical component exceeding the daily maximum allowable limit was arsenic. Although fluorescent compounds, known as humic substances, have been suggested to exert an initiator role in the development of BFD,4,5 there has been no epidemiologic evidence to show a correlation between exposure to humic substances and development of DM. The association between humic substances and BFD might be due to the confounding effect of an association between BFD and arsenic exposure.6 Thus, the reduction in DM mortality in the study area may result from the withdrawal of arsenic exposure through improvements in the water supply system as reflected by a change in water source. Hui-Fen Chiu, PhD Department of Pharmacology College of Medicine Kaohsiung Medical University Kaohsiung, Taiwan Chih-Ching Chang, MD, PhD Institute of Public Health College of Health Sciences Kaohsiung Medical University Kaohsiung, Taiwan Shang-Shyue Tsai, PhD Department of Healthcare Administration I-Shou University Kaohsiung County, Taiwan Chun-Yuh Yang, PhD, MPH Institute of Public Health College of Health Sciences Kaohsiung Medical University Kaohsiung, Taiwan

Evaluation of awareness of Diabetes Mellitus and associated factors in four health center areas

Objective As in all chronic diseases, providing patients with necessary information about Diabetes Mellitus (DM) and educating them are the best method of control of DM and preventing further complication. The aim of this study was to investigate the awareness of DM and related factors in diabetics. Methods This cross-sectional study was conducted in four health centre areas of Ankara ( n = 96,348) between 1997 and 2000. In these areas, the researches were visited every home and detected the total of 2136 diagnosed patients with DM. 62.5% of diabetics (1334) participated in the study in which a face-to-face interview was conducted to fill in a questionnaire followed by eye examination and fasting blood glucose level testing. Chi-square test and logistic regression analyses were performed to investigate the relationships between factors. Results Statistical analysis has shown that mean age of respondents was 57.4 ± 10.9 years and majority were female (67.9%) and older onset DM (96.6%). Mean duration of DM was 7.8 ± 6.5 years. Only 28.6% of patients ( n = 382) have had informed about DM. The main information resource was found to be hospitals (76.4%), then media 19.1% and primary health care centers (PHCC) 3.9%. Patients who graduated from university were 13.5 times; who were under 50 years of age were 1.92 times; who have had prior eye examination were 1.84 times and who had co-morbidities were 1.52 times more likely to have informed about DM than the other groups. Conclusion Awareness of DM amongst diabetics is very low and mainly determined by their education levels. The PHCC play a very small role in dissemination of information towards diabetics. Practice implications Results from this study have implications for patient education efforts. Accurately, clinicians need to strive to improve overall levels of patients’ awareness and knowledge of their specific conditions, regardless of their literacy. Many opportunities exist for raising diabetic's awareness of their disease and linking diabetic's growing health awareness with those health promoting behaviors known to reduce morbidity and mortality.

Factor VII Activity Is an Independent Predictor of Cardiovascular Mortality in Elderly Women of a Sicilian Population: Results of an 11-year Follow-up

The aim of the Epidemiological project "Ventimiglia di Sicilia" is to identify the cardiovascular risk factors in a Sicilian population with a low risk profile and healthy nutritional habits. The risk of cardiovascular mortality in older subjects (over 60 years of age) is presented for an 11 year follow-up. Females showed higher prevalence of diabetes mellitus, hypertension, obesity and higher levels of total, LDL and HDL cholesterol, factor VII activity and fibrinogen compared to males. Cardiovascular mortality was related to hypertension and obesity in males, to high factor VII activity, obesity and diabetes mellitus in females. In a Logistic Regression model the same variables were independently correlated to cardiovascular mortality with the exception of obesity. In conclusion, these findings suggest that in a population with a low risk profile, other factors, such as factor VII activity, may emerge as predictors of cardiovascular mortality.

Influence of Sex and Age at Onset on Autoantibodies against Insulin, GAD65 and IA2 in Recent Onset Type 1 Diabetic Patients

Methods: Autoantibodies against insulin (IAA), glutamic acid decarboxylase (GADA) and tyrosine phosphatase IA2 (IA2A) were measured in sera from 448 recent onset patients with type 1 diabetes mellitus (DM) subdivided according to sex (194 female and 254 male) and age at onset (134 patients diagnosed before 10 years, 187 between 10 and 20 years, 66 between 20 and 30 years and 61 over 30 years. Results: Autoantibodies were more frequent in female DM patients (93.8 vs. 86.6%, p = 0.013) due to an increased prevalence of both GADA (86.1 vs. 70.1%) and IA2A (59.3 vs. 49.2%), with GADA levels also significantly higher in women (0.24 vs. 0.18 U, p = 0.0003). When age groups were compared, there was a reduction in prevalence in patients over 20 years for both IAA (70% for patients diagnosed under 20 and 36% for older patients) and IA2A (65 and 25%, respectively). These differences also affected IAA levels, with the highest antibody titres in the youngest group (1,214.1 nU/ml in children under 10 compared to 546.9, 345.6 and 341.1 nU/ml in the subsequent groups; p < 10^–4). GADA prevalence did not differ significantly between age groups but, nevertheless, autoantibody levels were highest among the oldest type 1 DM patients (0.327 U compared to 0.216, 0.197 and 0.176 U in the decreasing age groups; p < 10^–4). Conclusion: There are sex- and age-related differences affecting the presence and/or titres of β cell autoantibodies. We speculate that these differences could reflect the severity and specificity of the autoimmune attack against the endocrine pancreas and might influence the rate of progression to type 1 DM or the risk of developing other autoimmune diseases.

診断マーカーの最近の進歩 Ｉｎｓｕｌｉｎ ｌｉｋｅ ｇｒｏｗｔｈ ｆａｃｔｏｒ‐Ｉ（ＩＧＦ‐Ｉ）測定の臨床的意義

Serum insulin-like growth factor-I (IGF-I) measured by newly developed ELISA with monoclonal antibody (27 E 10) which recognizes the epitope on the c-chain of IGF-I. Total IGF-I (tIGF-I) values were obtained from serum after acid-ethanol treatment. Direct IGF-I (dIGF-I) values were obtained directly from serum before treatment. Indirect IGF-I (iIGF-I) values were caliculated by subtracting dIGF-I from tIGF-I. Each IGF-I values in the serum samples from the patients with Diabetes Mellitus (DM), Osteoporosis were compared with those from the control samples. In the mean value of dIGF-I, female control were higher than male control, DM were higher than control in both gender, and female DM were higher than male DM. In the mean values of tIGF-I, statistical significance was shown only in comparing female DM with female control. No statistical significance was detected among the values of iIGF-I. Above data suggest that the dIGF-I are more valuable than tIGF-I in clinical use. We conclude that the measurement of IGF-I become more useful with increasing utility of recombinant IGF-I, and the further investigations about the sense of dIGF-I are needed.

The protection against gentamicin nephrotoxicity in the streptozotocin-induced diabetic rat is not related to gender

Since gender can influence the renal toxicity of a drug in a given species, the present study was undertaken to evaluate the role of sex in the protection against gentamicin (G)-induced nephrotoxicity afforded by diabetes mellitus (DM) in the rat. We have compared the effects of administration of G (40 mg/kg/day, for 14 days) on male and female DM Sprague-Dawley rats. Non-diabetic animals of both sexes receiving identical doses of G served as controls. At the end of the experiment on day 14, both female (F) and male (M) control groups had similar and marked evidence of nephrotoxicity: elevation of plasma creatinine (F 1.7±0.7; M 2.8±0.6 mg/dl), decrease in endogenous 24-h creatinine clearance (Ccr) (F 0.3±0.1; M 0.2±0.1 ml/min/100 g BW), and histological evidence of severe acute tubular necrosis. In marked contrast, the DM rats showed no functional or morphological evidence of renal damage throughout the study regardless of their gender (day 14: plasma creatinine: F 0.2±0.02; M 0.2±0.02; Ccr: F 1.2±0.1; M 1.6±0.1 ml/min/100 g BW), and they also accumulated less G in their kidney cortex than the C rats. The male controls exhibited higher renal cortex accumulation of G than the female controls (p <0.05), whereas the opposite occurred in the DM groups (p <0.01). Because the validity of using Ccr for the evaluation of GFR changes in experimental nephrotoxicity has been questioned, we have compared, in a separate experiment, three different methods of estimation of GFR (simulataneous short clearances of inulin and Ccr, and 24-h Ccr) in conscious female Sprague-Dawley rats undergoing the same treatment with G described above. At no time during the study did the method used for estimation of the GFR influence the results. We conclude that male and female Sprague-Dawley rats with diabetes are functionally and morphologically equally protected against G. Furthermore, no gender-related differences in the magnitude of G-induced nephrotoxicity was demonstrated in the non-diabetic control animals.

Lymphocyte potassium and magnesium concentrations as prognostic factors after acute myocardial infarction.

215 patients admitted with acute myocardial infarction were prospectively evaluated for prognostic factors. When lymphocyte potassium concentration increased by up to twofold of normal, a high lymphocyte magnesium concentration was associated with a good prognosis. However, when the increase in lymphocyte potassium concentration was greater than twofold, the presence of a high lymphocyte magnesium made no difference to mortality. Age, the female sex, anterior wall infarction, high serum enzymes, heart failure, diabetes mellitus in females and serious arrhythmias were all bad prognostic signs.