Incidence Of Non-insulin-dependent Diabetes Mellitus Research Articles

What are the health risks? The medical consequences of obesity and its health risks.

It is important to establish what the medical view of obesity should be. An important step is the development of a standardised definition of obesity. The World Health Organisation (WHO) has proposed body mass index (BMI) as a simple measure of obesity. Whereas BMI has great clinical utility, it should be remembered that calculation of a raised BMI does not automatically indicate a high degree of adiposity. This is because BMI does not distinguish between weight due to excess fat, and weight due to a large mass of muscle or bone. Gender and age also have to be considered when evaluating BMI measurements. Obesity is related to many disorders, most of which are metabolic in origin. For example, hypertension and the adverse lipid profile associated with obesity increases the risk of coronary heart disease (CHD). There is also a profound association between obesity, particularly intra-abdominal adiposity, and the development of non-insulin dependent diabetes mellitus (NIDDM). Obesity has reached epidemic proportions. This is paralleled by an increasing incidence of NIDDM. There is no doubt that weight gain and obesity are major clinical problems, which need to be prevented and managed more effectively. This is essential, given the role of obesity in many of the chronic health problems affecting westernised societies.

Vascular Calcification in Dialysis Patients

The risk factors for vascular calcification (VC) in dialysis patients include duration of dialysis, diabetes mellitus, aging, hyperphosphatemia, hyperparathyroidism, and calcium or vitamin D supplementation. This study was performed to evaluate the prevalence of and risk factors for VC in our dialysis population. Methods One hundred twenty-nine chronic dialysis patients underwent plain x-rays of the hands for VC. Patients were grouped as either positive (PVC) or negative (NVC) for VC. Age, gender, duration of dialysis, presence of non–insulin-dependent diabetes mellitus (NIDDM), oral calcium, and 1α-hydroxyvitamin D 3 supplement, serum levels of calcium (Ca), phosphorus (P), calcium phosphorus product (CaxP), alkaline phosphates (ALP) and intact parathyroid hormone (iPTH) were compared between the two groups. Results Thirty-four patients (26.35%) showed VC. There were no differences between PVC and NVC patients for duration of dialysis (38.4 ± 27.7 for PVC and 34.6 ± 31.2 months for NVC, P = .80), levels of serum Ca ( P = .26), P ( P = .19), CaxP ( P = .33), ALP ( P = .89), or iPTH ( P = .24). Similarly, oral calcium and 1α-hydroxyvitamin D 3 intake were not different between the two groups ( P = .971 and P = .3710 respectively). Compared to NVC patients, PVC patients were older (56.3 ± 10.4 versus 47.5 ± 16.1 years, P = .008) and had a greater incidence of NIDDM (17/34 PVC and diabetic versus 20/95 NVC, P = .001). In conclusion, for patients with a medium length of dialysis, the duration of dialysis as well as the doses of calcium salts and of 1α-hydroxyvitamin D 3 were not significantly associated with vascular calcifications, but it was not possible to exclude a role for these and other factors in patients with longer dialysis.

Diminished β-cell replication contributes to reduced β-cell mass in fetal sheep with intrauterine growth restriction

Human fetuses with severe intrauterine growth restriction (IUGR) have less pancreatic endocrine tissue and exhibit beta-cell dysfunction, which may limit beta-cell function in later life and contribute to their increased incidence of noninsulin-dependent diabetes mellitus. Three factors, replication, apoptosis, and neoformation, contribute to fetal beta-cell mass. We studied an ovine model of IUGR to understand whether nutrient deficits lead to decreased rates of fetal pancreatic beta-cell replication, increased rates of apoptosis, or lower rates of differentiation. At 90% of term gestation, IUGR fetal and pancreatic weights were 58% and 59% less than pair-fed control, respectively. We identified a selective impairment of beta-cell mass compared with other pancreatic cell types in IUGR fetuses. Insulin and insulin mRNA contents were less than other pancreatic endocrine hormones in IUGR fetuses, as were pancreatic insulin positive area (42%) and beta-cell mass (76%). Pancreatic beta-cell apoptosis was not different between treatments. beta-cell capacity for cell cycling, determined by proliferating cell nuclear antigen (PCNA) immunostaining, was not different between treatment groups. However, the percentage of beta-cells actually undergoing mitosis was 72% lower in IUGR fetuses. These results indicate that in utero nutrient deficits decrease the population of pancreatic beta-cells by lengthening G1, S, and G2 stages of interphase and decreasing mitosis near term. Diminished beta-cell mass in IUGR infants at birth, if not adequately compensated for after birth, may contribute to insufficient insulin production in later life and, thus, a predisposition to noninsulin-dependent diabetes.

Use of Antioxidant Nutrients in the Prevention and Treatment of Type 2 Diabetes

Type 2 diabetes, or non-insulin dependent diabetes mellitus (NIDDM), is increasingly common throughout the world. The World Health Organization has predicted that between 1997 and 2025, the number of diabetics will double from 143 million to about 300 million. The incidence of NIDDM is highest in economically developed nations, particularly the U.S., where approximately 6.5% of the population (17 million people) have either diagnosed or undiagnosed diabetes. The two most important factors contributing to the development of NIDDM are obesity and physical inactivity. The leading cause of mortality and morbidity in people with NIDDM is cardiovascular disease caused by macro- and microvascular degeneration. Current therapies for NIDDM focus primarily on weight reduction. Indeed, several investigations indicate that 65% to 75% of cases of diabetes in Caucasians could be avoided if individuals in this subgroup did not exceed their ideal weight. The success of this approach has been, at best, modest. An alternate approach to the control of Type 2 diabetes is to arrest the progress of the pathology until a cure has been found. To this end, some investigators suggest that dietary antioxidants may be of value. Several studies in humans and laboratory animals with NIDDM indicate that vitamin E and lipoic acid supplements lessen the impact of oxidative damage caused by dysregulation of glucose metabolism. In this brief review, we discuss the incidence, etiology, and current therapies for NIDDM and further explore the usefulness of dietary antioxidants in treating this disorder.

Overtime, psychosocial working conditions, and occurrence of non-insulin dependent diabetes mellitus in Japanese men.

OBJECTIVES: To ascertain the effects of overtime and psychosocial job conditions on the occurrence of non-insulin dependent diabetes mellitus (NIDDM) in Japan. DESIGN: An eight year prospective cohort study. SETTING:...

Non-Insulin Dependent Diabetes Mellitus in African-American Youths of Arkansas

Non-insulin dependent diabetes mellitus (NIDDM) occurs more frequently in certain adult populations, including African-Americans. Recently an increase in the incidence of NIDDM has been observed among African-American youths in Arkansas. Clinical presentations among these youths vary from asymptomatic to severe diabetic ketoacidosis. From a chart review, data were examined to determine which physical, biochemical, and autoimmune characteristics were most helpful in appropriate classification of NIDDM vs insulin dependent diabetes mellitus (IDDM). It is apparent that several diagnostic and treatment issues need to be addressed to improve the management of African-American youths with NIDDM.

Cost-Effectiveness of the Primary Prevention of Non-Insulin Dependent Diabetes Mellitus

Non-insulin dependent diabetes mellitus (NIDDM) is a chronic disease, with increasing prevalence widely reported. NIDDM is associated with high rates of morbidity and premature mortality and is the cause of high health service use. There is clinical, epidemiological and scientific evidence that NIDDM is potentially preventable through weight loss, enhanced fitness and nutrition modification. The research question addressed in this article is whether the prevention of NIDDM is costeffective compared with other possible uses of our health care resources and whether some approaches to NIDDM prevention are more cost-effective than others. Program types analysed are surgery, group behavioural program, media campaign, general practitioner (family physician) lifestyle advice, and intensive diet and behavioural programs. Target groups include seriously obese persons, women with previous gestational diabetes, overweight men and all adults. Expected diabetes years and life years were modelled for hypothetical intervention and control cohorts and used, with information on program cost, to derive estimates of cost-effectiveness, expressed as cost per diabetes year avoided and cost per life year gained. Markov modelling was used to track states of normal glucose tolerance, impaired glucose tolerance (IGT) and NIDDM for intervention and control cohorts. Expected life years were calculated through application of age and gender specific mortality vectors, adjusted for diabetic state and weight loss. Expected savings in health care costs from NIDDM prevention were based on estimated annual cost of NIDDM management and were used to derive net cost-effectiveness ratios. The group program for overweight men and media programs were identified as extremely worthwhile, generating estimated net savings in health care resources, while reducing diabetes incidence and extending life expectancy. The behavioural/diet programs for high risk groups were found to be highly cost-effective relative to other health care programs, at an estimated net cost per life year saved of between A$1000 (US$720) and A$2600 (US$1900). Surgery performed poorest, but still well at A$4600 (US$3300) net cost per life year saved, if targeted at persons with IGT. We conclude that the primary prevention of NIDDM can be highly cost-effective. The development and funding of pilot programs for NIDDM prevention is recommended to test these findings and address the increasing incidence of NIDDM.

Exercise in the management of non-insulin-dependent diabetes mellitus.

The incidence of non-insulin-dependent diabetes mellitus (NIDDM) has increased worldwide during the last decades, despite the development of effective drug therapy and improved clinical diagnoses. NIDDM is one of the major causes of disability and death due to the complications accompanying this disease. For the well-being of the patient, and from a public healthcare perspective, the development of effective intervention strategies is essential in order to reduce the incidence of NIDDM and its resulting complications. For the patient, and for society at large, early intervention programmes are beneficial, especially from a cost-benefit perspective. Physical activity exerts pronounced effects on substrate utilisation and insulin sensitivity, which in turn potentially lowers blood glucose and lipid levels. Exercise training also improves many other physiological and metabolic abnormalities that are associated with NIDDM such as lowering body fat, reducing blood pressure and normalising dyslipoproteinaemia. Clearly, regular physical activity plays an important role in the prevention and treatment of NIDDM. Since physical activity has been shown in prospective studies to protect against the development of NIDDM, physical training programmes suitable for individuals at risk for NIDDM should be incorporated into the medical care system to a greater extent. One general determinant in a strategy to develop a preventive programme for NIDDM is to establish a testing programme which includes VO2max determinations for individuals who are at risk of developing NIDDM. Before initiating regular physical training for people with NIDDM, a complete physical examination aimed at identifying any long term complications of diabetes is recommended. All individuals above the age of 35 years should perform an exercise stress test before engaging in an exercise programme which includes moderate to vigorously intense exercise. The stress test will identify individuals with previously undiagnosed ischaemic heart disease and abnormal blood pressure responses. It is important to diagnose proliferative retinopathy, microalbuminuria, peripheral and/or autonomic neuropathy in patients with NIDDM before they participate in an exercise programme. If any diabetic complications are present, the exercise protocol should be modified accordingly. The exercise programme should consist of moderate intensity aerobic exercise. Resistance training and high intensity exercises should only be performed by individuals without proliferative retinopathy or hypertension. Once enrolled in the exercise programme, the patient must be educated with regard to proper footwear and daily foot inspections. Fluid intake is of great importance when exercising for prolonged periods or in warm and humid environments. With the proper motivation and medical supervision, people with NIDDM can enjoy regular physical exercise as a means of enhancing metabolic control and improving insulin sensitivity.

Insulin signaling and glucose transport in insulin resistant skeletal muscle. Special reference to GLUT4 transgenic and GLUT4 knockout mice.

Glucose homeostasis is impaired in patients with non-insulin dependent diabetes mellitus (NIDDM) and this defect in due in part, to defects in glucose transport in skeletal muscle. Intense interest is now focused on whether reduced insulin-mediated glucose transport in muscle from NIDDM patients results from alterations in the insulin signal transduction pathway or from alterations in traffic and/or translocation of GLUT4 to the plasma membrane. Recently, potential targets for impaired traffic/translocation of GLUT4 have been reported to include defective phosphorylation of IRS-1 and reduced PI-3 kinase activity. In addition to insulin signaling defects, impaired glucose transport may result from a defect(s) in the activation or functional capacity of GLUT4. Because GLUT4 is dysregulated in skeletal muscle from NIDDM patients, it is an attractive target for gene therapy. Overexpression of GLUT4 in muscle results in increased glucose uptake and metabolism, and protects against the development of insulin resistance in transgenic mice. Genetic ablation of GLUT4 results in impaired insulin tolerance and defects in glucose metabolism in skeletal muscle. Because impaired muscle glucose transport leads to reduced whole body glucose uptake and hyperglycemia, understanding the molecular regulation of glucose transport in skeletal muscle is necessary to develop effective strategies to prevent or reduce the incidence of NIDDM.

Incidence of NIDDM and the effects of gender, obesity and hyperinsulinaemia in Taiwan.

Our aim is to determine non-insulin-dependent diabetes mellitus (NIDDM) incidence in Taiwan and examine its relation to obesity and hyperinsulinaemia in Chinese men and women. A total of 995 men and 1195 women aged 35-74 years free from diabetes in two townships in Taiwan were followed up with a second examination. At baseline general and metabolic data were recorded, and detailed anthropometric parameters and plasma glucose and insulin were assessed. World Health Organisation (WHO) criteria of fasting glucose 7.8 mmol/l or greater was utilized for defining diabetes. The age-standardized incidence rate based on the United States population in 1970 was 9.3/1000 (CI 5.8-12.8) in men and 9.3/1000 (CI 6.2-12.4) in women and the based on the WHO population in 1976 was 8.9/1000 (CI .5-12.3) in men and 8.9/1000 (CI 5.9-11.9) in women for the Chinese who had a mean BMI slightly greater than 24 (kg/m2). The predictability of the plasma glucose level was greater than that of the insulin level and the obesity indices. NIDDM incidence increased approximately threefold with each 0.67 mmol/l increase in plasma glucose level in men and women. The present study demonstrated the essential relationship of not only BMI but also central obesity indices (such as subscapular and waist circumference) to the incidence of NIDDM among men and women and a stronger relationship between NIDDM incidence and obesity in women than in men. The predictive effects of obesity indices and fasting plasma insulin values on NIDDM risk were independent of each other in men. Obesity and hyperinsulinaemia each without the presence of the other can lead to an increased risk of NIDDM. In women the NIDDM incidence increased more than additively in those with both obesity and hyperinsulinaemia compared to those with single obesity or hyperinsulinaemia. A slightly higher incidence of NIDDM in Taiwan than in western countries was found. The importance of obesity is indicated for predicting NIDDM in the community. Hyperinsulinaemia was found to play a significant role in predicting NIDDM incidence independent of obesity in men and synergistically with obesity in women.

Cardiovascular risk factors prior to the development of non-insulin-dependent diabetes mellitus in persons with impaired glucose tolerance: The Hoorn study

The aim of the study was to analyze cardiovascular risk factors as predictors for developing non-insulin-dependent diabetes mellitus (NIDDM) in people with impaired glucose tolerance. A cross-sectional survey of glucose tolerance was conducted in people, aged 50–74, who were randomly selected from the registry of the middle-sized town Hoorn (The Netherlands). Based on the mean values of two oral glucose tolerance tests, people were classified in glucose tolerance categories according to the WHO criteria. The mean follow-up time was 36 months (range 13–55 months). The cumulative incidence of NIDDM was 34% (95% CI 16.9–45.1). In multiple logistic regression analysis, cardiovascular risk factors at baseline did not predict the conversion from impaired glucose tolerance to NIDDM, in contrast with the two-hour plasma glucose level (odds ratio 3.56, p < 0.001) and the fasting proinsulin level, as one of the determinants of beta-cell dysfunction (Odds ratio 2.1, p < 0.05). The baseline HDL-cholesterol level, one of the components of the insulin resistance syndrome, was associated with the conversion from impaired glucose tolerance to normal glucose tolerance (Odds ratio 1.58, p < 0.05). The results of our study seem to support the hypothesis that conversion from impaired glucose tolerance to normal glucose tolerance depends on insulin resistance and the development of NIDDM from impaired glucose tolerance depends on beta-cell dysfunction.

Strategies and methods for implementing a community-based diabetes primary prevention program in Sweden

Non-insulin-dependent diabetes mellitus (NIDDM) is the most common type of diabetes with a prevalence of at least 4% in Sweden. There is convincing evidence that, besides a genetic predisposition, exogenous factors such as poor dietary habits (high fat, low fibre content), low physical activity and obesity are serious risk factors for NIDDM. Steps have been taken to develop a primary prevention program for NIDDM in Stockholm, Sweden. The program aims to reduce the incidence of NIDDM by 25% over a 10-year period, by influencing the risk factors in the populations of three intervention municipalities. The intervention will be developed through two approaches: ‘community intervention’, and ‘intervention within community’. Evaluation of the program will be performed by monitoring the prevalence and incidence of diabetes in the target population and by assessing the effects of strategies designed to increase physical exercise and improve diet. Furthermore, changes in awareness, knowledge, attitudes and practices related to prevention of diabetes, will be investigated. For this purpose, a baseline study is carried out in the three intervention municipalities and two selected control municipalities. The baseline study includes a sample of about 3200 men and the same number of women, aged 35—54 years, from intervention and control populations. A follow-up study after 5 and 10 years will be made.

Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses' Health Study.

Obesity is an established risk factor for non-insulin-dependent diabetes mellitus (NIDDM). Anthropometric measures of overall and central obesity as predictors of NIDDM risk have not been as well studied, especially in women. Among 43,581 women enrolled in the Nurses' Health Study who in 1986 provided waist, hip, and weight information and who were initially free from diabetes and other major chronic diseases, NIDDM incidence was followed from 1986 to 1994. After adjustment for age, family history of diabetes, smoking, exercise, and several dietary factors, the relative risk of NIDDM for the 90th percentile of body mass index (BMI) (weight (kg)/height (m)2) (BMI = 29.9) versus the 10th percentile (BMI = 20.1) was 11.2 (95% confidence interval (CI) 7.9-15.9). Controlling for BMI and other potentially confounding factors, the relative risk for the 90th percentile of waist: hip ratio (WHR) (WHR = 0.86) versus the 10th percentile (WHR = 0.70) was 3.1 (95% CI 2.3-4.1), and the relative risk for the 90th percentile of waist circumference (36.2 inches or 92 cm) versus the 10th percentile (26.2 inches or 67 cm) was 5.1 (95% CI 2.9-8.9). BMI, WHR, and waist circumference are powerful independent predictors of NIDDM in US women. Measurement of BMI and waist circumference (with or without hip circumference) are potentially useful tools for clinicians in counseling patients regarding NIDDM risk and risk reduction.

Hypertension, diabetes mellitus, and insulin resistance: the role of intracellular magnesium.

Magnesium is one of the most abundant ions present in living cells and its plasma concentration is remarkably constant in healthy subjects. Plasma and intracellular magnesium concentrations are tightly regulated by several factors. Among them, insulin seems to be one of the most important. In fact, in vitro and in vivo studies have demonstrated that insulin may modulate the shift of magnesium from extracellular to intracellular space. Intracellular magnesium concentration has also been shown to be effective on modulating insulin action (mainly oxidative glucose metabolism), offset calcium-related excitation-contraction coupling, and decrease smooth cell responsiveness to depolarizing stimuli, by stimulating Ca2+-dependent K+ channels. A poor intracellular magnesium concentration, as found in non-insulin-dependent diabetes mellitus (NIDDM) and in hypertensive (HP) patients, may result in a defective tyrosine-kinase activity at the insulin receptor level and exaggerated intracellular calcium concentration. Both events are responsible for the impairment in insulin action and a worsening of insulin resistance in non-insulin-dependent diabetic and hypertensive patients. By contrast, in NIDDM patients daily magnesium administration, restoring a more appropriate intracellular magnesium concentration, contributes to improve insulin-mediated glucose uptake. Similarly, in HP patients magnesium administration may be useful in decreasing arterial blood pressure and improving insulin-mediated glucose uptake. The benefits deriving from daily magnesium supplementation in NIDDM and HP patients are further supported by epidemiological studies showing that high daily magnesium intake to be predictive of a lower incidence of NIDDM and HP. In conclusion, a growing body of studies suggest that intracellular magnesium may play a key role on modulating insulin-mediated glucose uptake and vascular tone. We further suggest that a reduced intracellular magnesium concentration might be the missing link helping to explain the epidemiological association between NIDDM and hypertension.

Effects of smoking on the incidence of non-insulin-dependent diabetes mellitus. Replication and extension in a Japanese cohort of male employees.

The effects of smoking on the 8-year (1984-1992) incidence of non-insulin-dependent diabetes mellitus (NIDDM) were investigated in a cohort of 2,312 male employees of an electrical company in Japan. The incidence rate was 2.2/1,000 person-years. After controlling for other known risk factors for NIDDM, a proportional hazards regression analysis indicated that those who were currently smoking 16-25 cigarettes per day had a 3.27 times higher risk of developing NIDDM during the follow-up period than never smokers (p < 0.05); the hazard ratio was similar (3.21) for those who were currently smoking > or = 26 cigarettes per day. Among ever smokers, proportional hazards regression analysis also indicated that younger age at starting smoking was associated with an increased risk of NIDDM (p for trend = 0.09). These findings suggest that number of cigarettes smoked per day is important in the relation between smoking and NIDDM incidence, although the risks did not increase above a given amount of smoking. Starting smoking at a younger age also might be independently associated with an increased risk of NIDDM.

Ten-year follow-up study on the relation between the development of non-insulin-dependent diabetes mellitus and occupation.

To investigate the relation between occupation and the development of non-insulin-dependent diabetes mellitus (NIDDM), we undertook a 10-year follow-up survey of male employees of a zipper and aluminum sash factory in Japan. Of 1,218 employees we followed 1,087 subjects. We classified the subjects into five occupations: managers, technical workers, clerical workers, workers in transport, and laborers. NIDDM incidence was 3.1% for 10 years. The age-adjusted incidence of the workers in transport was the highest and that in laborers was the lowest. We used a multiple logistic analysis for adjustment with baseline characteristics such as age, BMI, fasting plasma glucose, and family history of diabetes mellitus. Adjusted relative risk of the workers in transport compared with the laborers was significantly high (3.95). Our work suggests that occupation is related to the development of NIDDM.

The potential for lifestyle change to influence the progression of impaired glucose tolerance to non-insulin-dependent diabetes mellitus.

Impaired glucose tolerance (IGT) is well recognized as a risk factor for the development of non-insulin-dependent diabetes mellitus (NIDDM). Detecting IGT offers a unique opportunity for targeting intervention to reduce the incidence of NIDDM. This article reviews current evidence for the efficacy of lifestyle intervention programmes involving people with IGT.

Incidence of Non‐insulin‐dependent Diabetes Mellitus and Its Risk Factors in Japanese‐Americans Living in Hawaii and Los Angeles

The incidence of non-insulin-dependent diabetes mellitus (NIDDM) and its risk factors were analysed from data of a follow-up study conducted on Japanese-Americans living in Hawaii and Los Angeles areas known to have a high prevalence of NIDDM. There were 1144 Japanese-Americans aged 40 years or more (mean (+/- SD) age: 60.7 +/- 10.1) available for follow-up, and who were non-diabetic based on glucose tolerance test (GTT) results conducted at the time of the initial examination. During the study period (6.3 +/- 3.2 yr), 124 cases of NIDDM occurred with an incidence rate as high as 10.8% or 17.2 persons per 1000 person-years. The incidence of NIDDM was 1.25 times higher in males than in females, and the rate increased with age. The incidence in obese people (body mass index: BMI > or = 25) was approximately twice that in the non-obese, the rate increasing with the level of obesity. Using Cox's proportional hazards model, the risk factors for NIDDM were analysed after adjusting for sex and age. Significant risk factors were the serum glucose (SG) level (fasting, 1-h, 2-h), the serum immuno-reactive insulin (IRI) level (1-h, 2-h) during GTT, BMI, serum triglycerides, high density lipoprotein (HDL)-cholesterol, serum uric acid, diastolic blood pressure, systolic blood pressure, serum total protein, and delta IRI/delta SG (0-30 min) level. In particular the hyperinsulinaemia was a significant risk factor even after adjusting for sex, age, and obesity. The incidence of NIDDM in the sub-group whose delta IRI/delta SG (0-30 min) level was under 0.3 was higher than that of the over 0.8 sub-group by a factor of approximately 12. Likewise, after dividing the subjects into five sub-groups according to the fasting or 2 h IRI level, the incidence of NIDDM was higher in the highest quintile than in the lowest quintile sub-group by a factor of approximately 3 and 7, respectively. The results of the GTT of the subjects who developed NIDDM during the follow-up period were analysed longitudinally and compared with the results obtained 8 years before occurrence of NIDDM. An increase in the 2-h serum IRI was observed initially, followed by an increase in the 2-h serum glucose level, preceding the appearance of NIDDM. 1. A high incidence of NIDDM is clearly observed in the population of Japanese-Americans, who are genetically indistinguishable from native Japanese; causes of this increase, from the survey results, are suspected to include westernization of lifestyle, particularly the reduction in the level of physical activity, conversion to a diet containing markedly more animal fat, simple carbohydrates, and less complex carbohydrates. 2. In the Japanese-Americans, diminished early insulin release to an oral glucose challenge and increased insulin resistance characterized by hyperinsulinaemia are suspected to be some of the important risk factors for NIDDM. Consequently, this study strongly suggested the possibility that the development of NIDDM in Japanese persons may be influenced by environmental factors.

Increased incidence of non-insulin-dependent diabetes mellitus among adolescents

To determine whether a rise in the diagnosis of non-insulin- dependent diabetes mellitus (NIDDM) has accompanied the rise in obesity in the pediatric population, as it has among adults. Medical records of 1027 consecutive patients from birth to age 19 years with a diagnosis of diabetes from 1982 to 1995 at a regional, university-affiliated pediatric diabetes referral center were reviewed and classified according to criteria of the National Diabetes Data Group. The number of patients with a diagnosis of NIDDM rose from approximately 4% of new diagnoses of diabetes in patients from birth to age 19 years before 1992, to 16% in 1994. Among patients 10 to 19 years of age, NIDDM accounted for 33% of diagnoses of diabetes in 1994. The incidence of adolescent NIDDM in Greater Cincinnati increased tenfold, from 0.7/100,000 per year in 1982 to 7.2/100,000 per year in 1994. The mean (+/- SD) age and body mass index at presentation were 13.8 +/- 1.9 years and 37.7 +/- 9.6 kg/m2, respectively. The overall female/male ratio was 1.7:1, and female patients were seen 1 year earlier than male patients (p < 0.01). Male subjects had a higher body mass index than female subjects (p < 0.05). A first-degree relative with NIDDM was identified for 65% of patients. At presentation, 21% of the patients had had a diagnosis of at least one other condition associated with obesity. There is an increasing incidence of NIDDM among adolescents in Greater Cincinnati, accompanying the national rise in adolescent obesity. Obesity and strong family histories of NIDDM are important risk factors. Because NIDDM leads to long-term morbidity, the prevention of obesity as well as early identification of overt disease, is critical.

Exercise training has a long-lasting effect on prevention of non—insulin-dependent diabetes mellitus in Otsuka-Long-Evans-Tokushima fatty rats

Exercise training has been shown to be effective in preventing the development of non—insulin-dependent diabetes mellitus (NIDDM) in a model rat (Otsuka-Long-Evans-Tokushima Fatty [OLETF]). For determination of how long a preventive effect of exercise training against the development of NIDDM lasts in this model, six male OLETF rats each were assigned to training (1) for a whole experimental period, from 7 to 28 weeks of age (E—E); (2) for the first half of the period, from 7 to 15 weeks of age (E—S); and (3) for the second half of the period, from 16 to 28 weeks of age (S—E). In addition, eight male OLETF rats were given no exercise during the experimental period (S—S). At 28 weeks of age, E—E, E—S, S—E, and S—S rats, weighed averages of 514, 542, 557, and 669 g and had abdominal fat deposits of 13.9, 21.3, 38.2, and 76.0 g, respectively. At 28 weeks of age, the cumulative incidence of NIDDM in S—S was 100%, while none of the trained rats were diabetic. The glucose infusion rate (GIR) during a hyperinsulinemic euglycemic clamp test, an index of insulin sensitivity, in the E—E group was significantly greater than that in the S—S group. The values in the E—S and S—E groups were slightly, but not significantly, less than that in the E—E group. Morphologic studies on the pancreas of E—E rats and S—E rats showed minimal changes of islets, whereas sections of islets from E—S rats appeared slightly enlarged and fibrotic, although significantly less than those of islets of S—S rats. These results demonstrate that the preventive effect of exercise training against the development of NIDDM lasts for at least 3 months after the cessation of exercise in this model.