Lifetime Risk Of Diabetes Research Articles

Early prediction of the impact of public health policies on obesity and lifetime risk of type 2 diabetes: A modelling approach.

Help public health decision-making requires a better understanding of the dynamics of obesity and type 2 diabetes and an assessement of different strategies to decrease their burdens. Based on 97,848 individual data, collected in the French Health, Health Care and Insurance Survey over 1998-2014, a Markov model was developed to describe the progression of being overweight to obesity, and the onset of type 2 diabetes. This model traces and predicts 2022-2027 burdens of obesity and type 2 diabetes, and lifetime risk of diabetes, according to different scenarios aiming at minimum to stabilize obesity at 5 years. Estimated risks of type 2 diabetes increase from 0.09% (normal weight) to 1.56% (obesity II-III). Compared to the before 1995 period, progression risks are estimated to have nearly doubled for obesity and tripled for type 2 diabetes. Consequently, over 2022-2027, the prevalence of obesity and type 2 diabetes will continue to increase from 17.3% to 18.2% and from 7.3% to 8.1%, respectively. Scenarios statibilizing obesity would require a 22%-decrease in the probability of move up (scenario 1) or a 33%-increase in the probability of move down (scenario 2) one BMI class. However, this stabilization will not affect the increase of diabetes prevalence whereas lifetime risk of diabetes would decrease (30.9% to 27.0%). Combining both scenarios would decrease obesity by 9.9%. Only the prevalence of obesity III shows early change able to predict the outcome of a strategy: for example, 6.7%-decrease at one year, 13.3%-decrease at two years with scenario 1 stabilizing obesity at 5 years. Prevalences of obesity and type 2 diabetes will still increase over the next 5 years. Stabilizing obesity may decrease lifetime risks of type 2 diabetes without affecting its short-term prevalence. Our study highlights that, to early assess the effectiveness of their program, public health policy makers should rely on the change in prevalence of obesity III.

Do diabetes phenotypes in US women differ by race/ethnicity? A population-based cluster analysis

ObjectiveUS women exhibit racial disparities in the lifetime risk of diabetes and related outcomes. Identifying heterogeneity in clinical presentation may assist with reducing racial disparities in diabetes outcomes. We identified clinical phenotypes of diabetes and examined their racial and ethnic distribution in US women. Research design and methodsWe conducted cluster analysis based on five factors in US women with diagnosed diabetes assessed in the National Health and Nutrition Examination Surveys 1999–2018 (n = 825). Multinomial logistic regression analysis was performed to identify racial and ethnic differences in the distribution of phenotypes. ResultsWe identified four distinct clinical phenotypes. Two phenotypes, mild age-related and severe insulin-deficient diabetes, each included approximately a third of women. Mild insulin-resistant and severe insulin-resistant diabetes phenotypes accounted for 19.9% and 13.7%, respectively. The distribution of clusters did not differ by race and ethnicity. ConclusionsThe prevalence of four clinically distinct diabetes phenotypes identified in US women did not differ by race and ethnicity.

1143-P: Lifetime Risk, Life Expectancy, and Years of Life Lost to Type 2 Diabetes in a Global Modelling Study of Six Countries

Lifetime risk, life expectancy and years of life lost provide a meaningful perspective on the burden of type 2 diabetes to guide public health interventions. We estimated these metrics using population datasets from six high income countries, for two time-points five years apart per country in the period 2009-2019. We included 96,718,000 person-years and 448,1incident diabetes cases in life-table models. Each life-table simulated progression of a cohort of 20-year-olds free of diabetes, followed until death or age 100. Poisson regression was used to estimate incidence and mortality rates for each single year of age in males and females. Using microsimulation, 95% uncertainty intervals around lifetime risk, life expectancy and years of life lost were produced. Lifetime risk of diabetes decreased for both sexes in all countries (Table) , most notably in Israeli females from 58.1% (57.0 - 59.1) in 2010-to 45.9% (44.7 - 47.1) in 2015-16. Life expectancy for people with diabetes increased for both sexes in all countries, generally in line with the increase seen in those without diabetes. Years of life lost to diabetes at age 20 varied from 2.4 (1.4 - 3.4) in Latvian males in 2015-16 to 8.6 (8.3 - 8.9) in Israeli males in 2015-16. These findings show declining lifetime risk of type 2 diabetes in many countries, however, years of life lost to the disease remains substantial for the average person with diabetes. Disclosure D.Tomic: None. S.Pildava: None. J.E.Shaw: Advisory Panel; Abbott Diagnostics, AstraZeneca, Eli Lilly and Company, Pfizer Inc., Roche Diagnostics, Research Support; AstraZeneca, Boehringer Ingelheim International GmbH, Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Novo Nordisk, Sanofi. D.J.Magliano: None. L.Chen: None. J.I.Morton: None. E.W.Gregg: None. M.E.Pavkov: None. M.Arffman: None. Y.J.Cheng: None. K.Ha: None. D.Kim: None.

P-P28 Long term follow-up after pancreatico-duodenectomy for chronic pancreatitis; are we compliant with NICE guidelines

Abstract Background Patients with chronic pancreatitis experience malnutrition, osteoporosis, pancreatic exocrine insufficiency and have a 80% lifetime risk of diabetes (1). These are progressive consequences and require proactive surveillance for detection and optimisation of treatment. The NICE pancreatitis guidelines recommend long-term follow up for patients with chronic pancreatitis (1). European guidelines recommend regular assessment of bone density, biochemical assessment of micronutrient status and a comprehensive nutritional assessment (2). The aim of this survey was to assess compliance with the NICE guidelines by analysing current practice in patients with chronic pancreatitis after pancreaticoduodenectomy. Methods A UK wide electronic survey was developed using Qualtrics® software (SAP America Inc. USA) to capture all the nutritional aspects of follow-up thought to be relevant in the long term. Markers of endocrine failure and malnutrition (weight, nutritional assessment and biochemical, vitamin and mineral screens), smoking and alcohol cessation advice and the use of dual energy x-ray absorptiometry (DEXA) scans were included. The survey was piloted on 5 staff locally prior to being circulated through a professional network – the Pancreatic Society of Great Britain and Ireland (PSGBI). Data were analysed using Chi-Square tests in SPSS (Version 26). Results One hundred and one (23% response rate) clinicians completed the survey, with 83 useable data sets. Eighty eight percent worked in tertiary centres. Lifelong follow up was only offered in tertiary centres (n = 12) and was only provided by surgeons or dietitians (p = 0.03). The duration of follow up did not vary by region (p = 0.463). Patients in the South of England were more likely to undergo a micronutrient screen (p = 0.027). Only 26% of all patients were offered a DEXA scan. Clinicians with more than 10-years’ experience were more likely to assess weight (p = 0.039), glucose and HbA1c (p = 0.035) and assess symptoms (p = 0.031). Conclusions This survey demonstrated a need to improve the provision of long-term follow up for patients with chronic pancreatitis. Lack of clarity on the format and who within the clinical team should take responsibility may explain the lack of structured follow-up in this patient group. The importance of long-term assessment needs to be included in training programmes for junior clinicians, to standardise management, improve nutritional screening and improve access to bone mineral density scanning and diabetes screening. Responsibility for follow up should be agreed between primary, secondary and tertiary care.

BMI and diabetes risk in low-income and middle-income countries

Diabetes is a growing public health problem in all countries, but this increase has been much faster in low-income and middle-income countries (LMICs) 1 Seiglie JA Marcus M-E Ebert C et al. Diabetes prevalence and its relationship with education, wealth, and BMI in 29 low- and middle-income countries. Diabetes Care. 2020; 43: 767-775 Crossref PubMed Scopus (34) Google Scholar , 2 NCD Risk Factor Collaboration (NCD-RisC) – Africa Working GroupTrends in obesity and diabetes across Africa from 1980 to 2014: an analysis of pooled population-based studies. Int J Epidemiol. 2017; 46: 1421-1432 Crossref PubMed Scopus (120) Google Scholar than in high income countries (HICs) 3 Narayan KMV Boyle JP Thompson TJ Gregg EW Williamson DF Effect of BMI on lifetime risk for diabetes in the U.S. Diabetes Care. 2007; 30: 1562-1566 Crossref PubMed Scopus (303) Google Scholar over the past three decades. 4 Zhou B Lu Y Hajifathalian K et al. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet. 2016; 387: 1513-1530 Summary Full Text Full Text PDF PubMed Scopus (2067) Google Scholar Concomitantly, the paucity of robust and representative data has prevented improved characterisation of the risk factors underlying this sharp increase in the burden in LMICs, which is needed to build more efficient diabetes screening and prevention policies than the current standard. Reliance on diabetes screening and diagnostic criteria based largely on data from HICs 5 WHOScreening for type 2 diabetes: report of a World Health Organization and International Diabetes Federation meeting. https://apps.who.int/iris/bitstream/handle/10665/68614/WHO_NMH_MNC_03.1.pdf?sequence=1&isAllowed=yDate: 2003 Date accessed: April 19, 2021 Google Scholar , 6 American Diabetes Association2. Classification and diagnosis of diabetes: standards of medical care in diabetes - 2021. Diabetes Care. 2021; 44: S15-S33 Crossref PubMed Scopus (502) Google Scholar has therefore substituted for these deficiencies, and tailoring diabetes screening strategies to cutoffs of measurable risk factors derived from data from representative cohorts in LMICs has been a long-term challenge. Body-mass index and diabetes risk in 57 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 685 616 adultsThe association between BMI and diabetes risk in LMICs is subject to substantial regional variability. Diabetes risk is greater at lower BMI thresholds and at younger ages than reflected in currently used BMI cutoffs for assessing diabetes risk. These findings offer an important insight to inform context-specific diabetes screening guidelines. Full-Text PDF

Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria

IntroductionPre-diabetes, a status conferring high risk of overt diabetes, is defined differently by the American Diabetes Association (ADA) and the WHO. We investigated the impact of applying definitions of pre-diabetes...

1537-P: Lifetime Risk of Diabetes in Metropolitan India: Striking in All BMI Groups

Background: To our knowledge, no estimates of lifetime risk of diabetes have been produced for India, a country with a high propensity to developing diabetes and a low overall body weight compared to high-income countries. Data: We estimated the lifetime risk of diabetes in metropolitan India, and its variation by sex, age and BMI. We used government mortality statistics, diabetes prevalence from the Indian Council for Medical Research INdia DIABetes study (2008-15) and incidence from the Centre for Cardiometabolic Risk Reduction in South Asia (2010-2018). We limited estimates Indians aged 20 or more years. Results: Overall lifetime risk of diabetes in women in metropolitan cities aged 20 was 74.7% (95%CI: 65.4-83.3%), and 69.0% (95%CI: 58.9-78.7%) in men. Remaining risk is highest among the obese (92.9% (95%CI: 88.0-96.0%) in women and 92.4% (95%CI: 86.6-96.1%) in men aged 20) and is lowest among underweight/normal weight people (56.4% (95%CI: 46.9-66.3%) in women and 54.2% (95%CI: 44.5-64.6%) in men). Lifetime risk declines with age (to 67.3% (95%CI: 57.4-77.1%) in women aged 40 to 42.5% (95%CI: 33.8-52.9%) at age 60). Conclusion: In metropolitan India, 1 in 2 underweight/normal weight, and 9 in 10 obese, people aged 20 are projected to develop diabetes during their life. This portends a serious epidemic and indicates what may develop elsewhere in India in the absence of urgent action. Table. Lifetime risk of diabetes by sex, age and BMI Disclosure S. Luhar: None. S. Kinra: None. V. Mohan: None. D. Kondal: None. R. Anjana: None. S.A. Patel: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. D. Prabhakaran: None. N. Tandon: None. K. Narayan: None. Funding Economic and Social Research Council (ES/J500021/1)

103-OR: Change in Lifetime Risk for Diabetes in the United States, 1997-2015

Lifetime risk (LR), a cumulative incidence estimate, is a key metric of disease burden that reflects the impact of baseline prevalence, incidence, and mortality risk. Previous studies in developed countries estimated LR of diabetes (DM) to be ∼35%. Since 2008 both DM incidence and mortality in persons with DM have decreased. The impact of those changes on LR of DM and years of potential life lost (YPLL) to DM is not known. We used data from 558,225 participants aged ≥20 years from the National Health Interview Survey to estimate LRs and YPLLs up to age 80 years by period: 1997-2000, 2001-2005, 2006-2010, and 2011-2015. The age-specific incidence of diagnosed DM and mortality by DM were estimated using Poisson regression. Multistate difference equation accounting for competing risk was used to model LR and YPLL. Age-sex-race adjusted DM incidence (%) for the four periods was 0.6, 0.7, 0.8, and 0.7, respectively (overall P < .001). LR followed the change in incidence and decreased significantly during last period (Figure); YPLL steadily decreased from 12.0 (11.8-12.2) in 1997-2000 to 8.9 (8.7-9.1) in 2011-2015. In 2011-2015, LR (%) and YPLL (years) were 36.6 (95% CI 36.2-37.0) and 9.7 (9.5-9.9) for men, and 36.5 (36.0-36.9) and 8.2 (8.0-8.4) for women, 32.3 (32.0-32.8) and 8.4 (8.2-8.6) for whites, and 46.8 (46.1-47.4) and 10.6 (10.3-11.0) for blacks. In the United States, LR and YPLL have declined, but disparities still persist. Disclosure Y.J. Cheng: None. E.W. Gregg: None. R. Brinks: None. S.H. Saydah: None. A.L. Albright: None. G. Imperatore: None.

Diabetes prevalence, incidence and mortality in First Nations and other people in Ontario, 1995-2014: a population-based study using linked administrative data.

Diabetes mellitus is an established health concern in First Nations communities and is associated with complex influences of colonization. This study, a partnership between First Nations and academic researchers, was undertaken to determine patterns of diabetes prevalence, incidence and mortality in Ontario. Using health services and population data from Ontario for 1995 to 2014, linked with the federal Indian Register, we calculated age- and sex-adjusted annual estimates of diabetes prevalence, incidence and mortality for First Nations people (living within and outside First Nations communities) and other people in Ontario. We also examined age- and sex-specific crude diabetes prevalence. Between 1995 and 2014, the prevalence of diabetes increased and the incidence decreased somewhat in all populations. Both prevalence and incidence were substantially higher among First Nations people than among other people in Ontario. In particular, First Nations women had higher prevalence than other women (4.2% v. 1.6% for ages 20-34 yr and 17.6% v. 6.0% for ages 35-49 yr). The lifetime risk of diabetes was higher among First Nations people than among other people in Ontario (57.0%, 95% confidence interval [CI] 56.3%-57.6% v. 44.5%, 95% CI 44.4%-44.6%). Over time, all-cause mortality for those with diabetes declined but remained consistently higher for First Nations people than for other people in Ontario. Diabetes is more common among First Nations people than among other people in Ontario, particularly at younger ages and in women. First Nations-led approaches to address the high prevalence of diabetes in younger First Nations women have the potential to improve metabolic health across generations.

Abstract P065: Lifetime Risk of Developing Type 2 Diabetes by Levels of Adiposity in the US Population

Introduction: Prior estimates of lifetime risk (LTR) for developing type 2 diabetes (diabetes) among US adults have been derived using Markov modeling, thus were not based on longitudinal data. We use pooled data from several US community-based cohorts to estimate the LTR of diabetes according to age, sex and body mass index (BMI). Hypothesis: Higher BMI is associated with higher LTR of diabetes irrespective of the index age; and men have a higher LTR of diabetes compared to women. Methods: We pooled individual-level data from 7 US-based cohorts: Framingham Heart Study; Framingham Offspring Heart Study; Coronary Artery Risk Development in Young Adults (CARDIA); Atherosclerosis Risk in Communities (ARIC); Cardiovascular Health Study (CHS); Multi-Ethnic Study of Atherosclerosis (MESA); and Jackson Heart Study (JHS). Participants were free of diabetes (fasting blood glucose ≥126 mg/dl or use of medications) at index age, and were categorized by BMI (normal weight [<25 kg/m 2 ], overweight [25-29 kg/m 2 ] and obese (BMI≥30 kg/m 2 )]. The LTR of diabetes, at index age 55, was derived modified Kaplan-Meier estimator adjusting for competing risk of death free from diabetes. Results: Our sample consisted of 14139 Black and White participants (56% female). At index age 55 years, the 25-year adjusted risk for diabetes was 5.3% (95% confidence interval: 4.1-6.6%) in men and 2.8% (2.2-3.5%) in women with normal weight (Figure). The corresponding risks for diabetes among overweight participants were 11.0% (9.7-12.3%) in men and 8.5% (7.3-9.7%) in women. In obese individuals, the 25-year risk for diabetes was 24.3% (21.9- 26.6%) in men, and 20.4% (18.6-22.2%) in women. Conclusions: In this sample of middle-aged US adults , long-term risk for diabetes was substantially higher in overweight and obese participants. These data strongly suggest that lowering the population burden of obesity is critical for lowering the population burden of diabetes.

The feasibility and utility of a protein sparing modified fast (PSMF) in obese endometrial cancer survivors: A pilot study.

170 Background: Endometrial cancer affects 50,000 women a year. Obesity plays a significant role in the pathogenesis of endometrial cancer. Obese endometrial cancer survivors (ECS) are at significant lifetime risk of diabetes, cardiovascular disease (CVD), recurrence and death. There are no prospective studies examining the role of diet only in attempting to achieve weight loss in obese ECS. Protein sparing modified fast (PSMF), an approach to rapid weight loss, has been used to treat obesity in a safe manner. A pilot study is underway to investigate the feasibility of a PSMF for weight loss in this high risk population. Methods: To date, seven obese (BMI > 30kg/m^2) ECS have been placed on a PSMF under the supervision of a physician and dietitian. Patients provided demographic information and Obesity Quality of Life (OQOL) questionnaire. Comprehensive metabolic panel with lipid panel and biomarkers of inflammation were drawn. Patients were instructed to eliminate carbohydrate containing foods and to augment with 1.2g/kg of protein per obesity-adjusted ideal body weight. Primary objectives are: total weight loss, subject retention, compliance, side effects, QOL and alterations in markers of obesity and inflammation. Results: The median age of the patient group was 56 years. Median baseline weight was 292.4 pounds (185.9-369). Median BMI was 44.5 kg/m2 (37.5-61.4). Mean baseline leptin level was 54.3 ng/ml (normal: 2.5-21.8). Mean baseline C-reactive protein level, a strong marker for CVD, was 4.574 (high risk for CVD > 3). At 4 weeks median percent body weight lost was -6.48% (5.19%-7.00%). At 3 months the median loss nearly doubled to -13% (8.31%-14.11%). Significant reduction in CRP and leptin occurred in 2 patients: mean decrease was 3.9 and 28 points respectively. Conclusions: Our early data demonstrate that significant weight loss in obese endometrial cancer survivors is achievable in a standard outpatient gynecologic oncology practice. While long term follow up data and elucidation of the true significance of improvement in serum inflammatory markers are needed, we do know that even a 5-10% loss of body weight can lead to substantial improvement in CVD and diabetes risk.

Undiagnosed Diabetes and Pre-Diabetes in Health Disparities.

Globally half of all diabetes mellitus is undiagnosed. We sought to determine the extent and characteristics of undiagnosed type 2 diabetes mellitus and pre-diabetes in Mexican Americans residing in the United States. This disadvantaged population with 50% lifetime risk of diabetes is a microcosm of the current pandemic. We accessed baseline data between 2004 and 2014 from 2,838 adults recruited to our Cameron County Hispanic Cohort (CCHC); a two-stage randomly selected ‘Framingham-like’ cohort of Mexican Americans on the US Mexico border with severe health disparities. We examined prevalence, risk factors and metabolic health in diagnosed and undiagnosed diabetes and pre-diabetes. Two thirds of this Mexican American population has diabetes or pre-diabetes. Diabetes prevalence was 28.0%, nearly half undiagnosed, and pre-diabetes 31.6%. Mean BMI among those with diabetes was 33.5 kg/m2 compared with 29.0 kg/m2 for those without diabetes. Significant risk factors were low income and educational levels. Most with diabetes had increased waist/hip ratio. Lack of insurance and access to health services played a decisive role in failure to have diabetes diagnosed. Participants with undiagnosed diabetes and pre-diabetes had similar measures of poor metabolic health similar but generally not as severe as those with diagnosed diabetes. More than 50% of a minority Mexican American population in South Texas has diabetes or pre-diabetes and is metabolically unhealthy. Only a third of diabetes cases were diagnosed. Sustained efforts are imperative to identify, diagnose and treat individuals in underserved communities.

Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985–2011: a modelling study

Diabetes incidence has increased and mortality has decreased greatly in the USA, potentially leading to substantial changes in the lifetime risk of diabetes. We aimed to provide updated estimates for the lifetime risk of development of diabetes and to assess the effect of changes in incidence and mortality on lifetime risk and life-years lost to diabetes in the USA. We incorporated data about diabetes incidence from the National Health Interview Survey, and linked data about mortality from 1985 to 2011 for 598 216 adults, into a Markov chain model to estimate remaining lifetime diabetes risk, years spent with and without diagnosed diabetes, and life-years lost due to diabetes in three cohorts: 1985-89, 1990-99, and 2000-11. Diabetes was determined by self-report and was classified as any diabetes, excluding gestational diabetes. We used logistic regression to estimate the incidence of diabetes and Poisson regression to estimate mortality. On the basis of 2000-11 data, lifetime risk of diagnosed diabetes from age 20 years was 40·2% (95% CI 39·2-41·3) for men and 39·6% (38·6-40·5) for women, representing increases of 20 percentage points and 13 percentage points, respectively, since 1985-89. The highest lifetime risks were in Hispanic men and women, and non-Hispanic black women, for whom lifetime risk now exceeds 50%. The number of life-years lost to diabetes when diagnosed at age 40 years decreased from 7·7 years (95% CI 6·5-9·0) in 1990-99 to 5·8 years (4·6-7·1) in 2000-11 in men, and from 8·7 years (8·4-8·9) to 6·8 years (6·7-7·0) in women over the same period. Because of the increasing diabetes prevalence, the average number of years lost due to diabetes for the population as a whole increased by 46% in men and 44% in women. Years spent with diabetes increased by 156% in men and 70% in women. Continued increases in the incidence of diagnosed diabetes combined with declining mortality have led to an acceleration of lifetime risk and more years spent with diabetes, but fewer years lost to the disease for the average individual with diabetes. These findings mean that there will be a continued need for health services and extensive costs to manage the disease, and emphasise the need for effective interventions to reduce incidence. None.

Support for Benefit of Physical Activity on Satiety, Weight Control, and Diabetes Risk

Dear Editor: Several recent articles in the Journal 1-3 examined different, complementary facets of the relationship between physical activity, dietary choices, obesity risk and risk of diabetes mellitus. We believe that taken together, the articles provide important support for the importance of regular exercise as a short-term influence on satiety and long-term influence on diabetes risk. Tinker and her associates 1 concluded that three randomized controlled diabetes prevention trials reduced diabetes risk whereas the Womens Health Initiative-DMT did not, in part because the three previous trials had included physical activity in the lifestyle intervention wherease the WHT-DMT did not. Why should increasing physical activity make such a difference in the impact of dietary modification on risk of diabetes? One reason is that increased physical activity appears to improve the healthfulness of food preferences, thereby reducing passive overconsumption of energy.4 This is evidenced by the dose-response pattern observed by Palmer and her associates 2 between an increasing proportion of study participants reporting at least 1 hour per week of physical activity and decreasing consumption of sugar-sweetened soda beverages (goodness of fit chi square(2) = 205.4, p < .0001). Total beverage intake usually increases with increasing physical activity; it is therefore striking to see average sugar-sweetened soda beverage consumption actually decrease with increasing proportion of study participants reporting physical activity. Previous research has demonstrated that long bouts of aerobic physical activity increase the perceived sweetness of beverages.4 If we assume that commercial soda beverages have a sweetness optimized for a sedentary population, it is then likely that heavy exercisers will dislike these commercial beverages because of their perceived excessive sweetness. Harding and her associates 3 furthermore reported a dose-response relationship between an increasing proportion of subjects who were physically active and quintile of plasma vitamin C concentration. Plasma vitamin C is a useful biomarker for fruit and vegetable intake because 90% of vitamin C intake derives from fruit and vegetable intake. The intake of minimally processed fruit and vegetables, in turn, is becoming recognized as a sustainable way of increasing satiety with fewer calories,5 thereby leading to the kind of sustained weight loss that should, in turn, reduce risk of diabetes. Intervention trials are needed to confirm the nature and quantity of physical activity needed to motivate adherence to the healthier, high-satiety food choices that these articles have demonstrated can protect healthy adults from lifetime risk of diabetes.

The Danish National Diabetes Register: trends in incidence, prevalence and mortality

The aim of the study was to describe trends in the incidence rate, prevalence and mortality rate for diabetes in Denmark. Healthcare registers at the National Board of Health were used to compile a register of diabetic patients in the Danish population (5.4 million people). Age- and sex-specific prevalence, incidence rates, mortality rates and standardised mortality ratios relative to the non-diabetic part of the population were calculated. The register contains records for about 360,000 persons with diabetes; 230,000 were alive at 1 January 2007, corresponding to an overall prevalence of 4.2%. The prevalence increased by 6% per year. In 2004 the incidence rates were 1.8 per 100,000 at age 40 years and 10.0 per 100,000 at age 70 years. The incidence rate increased 5% per year before 2004 and then stabilised. The mortality rate in the diabetic population decreased 4% per year, compared with 2% per year in the non-diabetic part of the population. The mortality rate decreased 40% during the first 3 years after inclusion in the register. The standardised mortality ratio decreased with age, from 4.0 at age 50 years to 2.5 at age 70 years and just under 2 at age 85 years, identically for men and women. The standardised mortality ratio decreased 1% per calendar year. The lifetime risk of diabetes was 30%. The prevalence of diabetes in Denmark rose in 1995-2006, but the mortality rate in diabetic patients decreased faster than that of the non-diabetic population. The mortality rate decreased markedly just after inclusion in the register. Incidence rates have shown a tendency to decrease during the last few years, but this finding should be viewed with caution.

A new approach of nonparametric estimation of incidence and lifetime risk based on birth rates and incident events

BackgroundIncidence and lifetime risk of diabetes are important public health measures. Traditionally, nonparametric estimates are obtained from survey data by means of a Nelson-Aalen estimator which requires data information on both incident events and risk sets from the entire cohort. Such data information is rarely available in real studies.MethodsWe compare two different approaches for obtaining nonparametric estimates of age-specific incidence and lifetime risk with emphasis on required assumptions. The first and novel approach only considers incident cases occurring within a fixed time window–we have termed this cohort-of-cases data–which is linked explicitly to the birth process in the past. The second approach is the usual Nelson-Aalen estimate which requires knowledge on observed time at risk for the entire cohort and their incident events. Both approaches are used on data on anti-diabetic medications obtained from Odense Pharmacoepidemiological Database, which covers a population of approximately 470,000 over the period 1993–2003. For both methods we investigate if and how incidence rates can be projected.ResultsBoth the new and standard method yield similar sigmoidal shaped estimates of the cumulative distribution function of age-specific incidence. The Nelson-Aalen estimator gives somewhat higher estimates of lifetime risk (15.65% (15.14%; 16.16%) for females, and 17.91% (17.38%; 18.44%) for males) than the estimate based on cohort-of-cases data (13.77% (13.74%; 13.81%) for females, 15.61% (15.58%; 15.65%) for males). Accordingly the projected incidence rates are higher based on the Nelson-Aalen estimate–also too high when compared to observed rates. In contrast, the cohort-of-cases approach gives projections that fit observed rates better.ConclusionThe developed methodology for analysis of cohort-of-cases data has potential to become a cost-effective alternative to a traditional survey based study of incidence. To allow more general use of the methodology, more research is needed on how to relax stationarity assumptions.

Effect of BMI on Lifetime Risk for Diabetes in the U.S.

At birth, the lifetime risk of developing diabetes is one in three, but lifetime risks across BMI categories are unknown. We estimated BMI-specific lifetime diabetes risk in the U.S. for age-, sex-, and ethnicity-specific subgroups. National Health Interview Survey data (n = 780,694, 1997-2004) were used to estimate age-, race-, sex-, and BMI-specific prevalence and incidence of diabetes in 2004. U.S. Census Bureau age-, race-, and sex-specific population and mortality rate estimates for 2004 were combined with two previous studies of mortality to estimate diabetes- and BMI-specific mortality rates. These estimates were used in a Markov model to project lifetime risk of diagnosed diabetes by baseline age, race, sex, and BMI. Lifetime diabetes risk at 18 years of age increased from 7.6 to 70.3% between underweight and very obese men and from 12.2 to 74.4% for women. The lifetime risk difference was lower at older ages. At 65 years of age, compared with normal-weight male subjects, lifetime risk differences (percent) increased from 3.7 to 23.9 percentage points between overweight and very obese men and from 8.7 to 26.7 percentage points for women. The impact of BMI on diabetes duration also decreased with age. Overweight and especially obesity, particularly at younger ages, substantially increases lifetime risk of diagnosed diabetes, while their impact on diabetes risk, life expectancy, and diabetes duration diminishes with age.

Adolescents at Risk for MODY3 Diabetes Prefer Genetic Testing Before Adulthood

Mutations in the hepatocyte nuclear factor (HNF)-1α gene cause an autosomally, dominantly inherited form of diabetes, maturity-onset diabetes of the young (MODY) type 3, which is characterized by poor insulin secretion in response to glucose together with good sensitivity to insulin and sulfonylurea medication and low renal threshold for glucose (1). The lifetime risk of diabetes may be as high as 95% for individuals carrying the most common Pro291fsinsC mutation. Glucose tolerance deteriorates in most cases during the pubertal years (2–5). However, because of fasting normoglycemia, clinical diagnosis is often delayed despite high postprandial glucose concentrations and an increased A1C value. Diabetes complications are common, and proliferative retinopathy has been detected already at diagnosis of diabetes in a 19-year-old carrier (6). On the other hand, while the incidence of diabetes among mutation carriers steeply increases in puberty, at least 20% remain nondiabetic until their 30s (2,4,5). Abnormal glucose tolerance in subjects at risk for MODY3 can be diagnosed with an oral glucose tolerance test. Urine glucose analysis after a large oral glucose load has also been advocated as a noninvasive screening tool in young children (7). Although an aberrant result from these tests has diagnostic value for diabetes and a certain predictive value in identification of probable carriers, they are not specific for MODY, and a normal result cannot exclude future risk. A genetic test seems to be warranted before adulthood, either to confirm carrier status in these prescreened subjects or in all at-risk subjects. A predictive test, whether a clinical or specific gene …

Americans face high lifetime risk of diabetes

Americans face high lifetime risk of diabetes

Can the Glycemic Index (GI) be Used as a Tool in the Prevention and Management of Type 2 Diabetes?

The large increase in type 2 diabetes (T2DM), the considerable lifetime risk of diabetes and the loss of lifetime call for concerted action to prevent T2DM and its complications. Since diabetes is characterized by abnormal glucose metabolism, the question arises of whether a high intake of carbohydrates that are rapidly absorbed as glucose may increase the risk and worsen the course of T2DM. To quantify the impact of carbohydrates on blood glucose the glycemic index (GI) and the glycemic load (GL) have been applied. The GI of a food is a method of ranking carbohydrate rich foods according to their glycemic responses. GI is defined as the incremental area under the blood glucose curve of 50g carbohydrate of a test food expressed as a percentage of the area of the response to an equivalent amount of a reference food (glucose or white bread). In relation to GI/GL and prevention of T2DM there is insufficient information from observational studies to determine whether a positive association exists or not. Only randomized controlled clinical intervention studies will be able to provide the final answer. From meta-analyses of randomised controlled clinical trials comparing low and high GI diets in the treatment of diabetes it has been found that low GI diets improve the glycemic control. Labeling of foods with GI would be helpful for persons with diabetes, but the usefulness for healthy subjects remains to be clarified. At present it seems premature to introduce GI labeling for the entire population.