Prevalence Of Micro Research Articles

Prevalence of micro and macrovascular complications of diabetes detected at single visit screening

Objective: To describe the prevalence of complications of diabetes and to study the relationship between the prevalence of complications and the duration of diabetes in a subset of Sri Lankan population Study design: Cross sectional case analysis of 6765 patients at National Diabetes Centre, Rajagiriya, Sri Lanka. Data analysis: Data was analyzed with SPSS 11. Results: The mean duration of diabetes in the study population was 7.9 years (SD=6.7). The results showed that the prevalence of micro vascular complications increased with increasing duration of diabetes. In patients with diabetes mellitus for less than 1 year, retinopathy prevalence was 6.8% and in those with 16-20 years diabetes duration it rose to 52.6%. Neuropathy prevalence at diagnosis was 11% and at 16- 20 years it was 54.3%. Nephropathy prevalence at diagnosis and at 16-20 years was 18.8% and 23.8% respectively. Conclusions: The study has demonstrated high prevalence of complications at the initial diagnosis. Hence, early screening techniques would be beneficial in order to prevent and retard the progression of the disease and to reduce the associated morbidity and mortality. DOI: http://dx.doi.org/10.4038/sjdem.v2i1.4328 Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2012; 2 : 17-20

The Influence of Risk Factors for Metabolic Syndrome on Vascular Complications

We assessed the influence of metabolic syndrome (MetS) characteristics on vascular complications. The study included 108 patients (72 women and 36 men, age 57.0 ± 8.5 years) with MetS that was diagnosed according to International Diabetes Federation criteria. The prevalence of micro- and macrovascular complications was assessed: vascular changes in the fundus of the eye-72%, ischemic heart disease-54.9%, estimated glomerular filtration rate (eGFR) <90 mL/min-38.9%, diabetic foot-5.55%, and cerebrovascular accident-3.7% of patients. A negative correlation between high-density lipoprotein cholesterol (HDL-C) concentration, creatinine levels, and level of vascular changes in the fundus of the eye was found. Moreover, the level of obesity and fasting glucose level had positive correlation with the intensity of vascular changes in the fundus of the eye. Characteristics of MetS (obesity and fasting glucose level) have high impact on advancing vascular complications in these patients. High level of HDL-C decreases the intensity of vascular changes in patients with MetS.

The elusive type 2 diabetes individual achieving tight blood pressure target: A phenotypic study

Background To describe the characteristics (therapeutic, physical and behavioural) associated with achievement of tight blood pressure (BP) control and its prevalence in type 2 diabetes (T2DM) patients. Methods Cross-sectional observational cohort study. 673 hypertensive patients with T2DM, treated with one or more antihypertensive drugs. Sociodemographic, clinical and laboratory variables compared between patients achieving BP targets (goal-achievers [GAs]) and non-goal-achievers (non-GAs). Results Only 111 patients (16%) achieved BP goals. Markers-factors connected with failure of BP control in non-GAs were: sub-Saharan African ethno-geographical origin, high alcohol consumption and low educational level. Total cholesterol was significantly lower and glycaemic control significantly better in GAs. In addition, prevalence of micro- or macro-albuminuria was clearly lower in GAs. As regards cardiovascular drugs, statins were used to a greater extent by the GAs. Finally, GAs and non-GAs had the same pattern of micro- and macro-vascular diabetic diseases, as well as similar estimated 10-year absolute cardiovascular risk scores. Conclusions This cross-sectional study characterized variables associated with an unmet need in drug-treatment of hypertension in T2DM. One might surmise that using higher dosage and/or number of antihypertensive agents will be required in most T2DM patients in order to reach targets, including new antihypertensive agents.

Prevalence of diabetes complications in first line therapy of type 2 diabetes mellitus in a middle size town of Romania

Aims. We investigated the prevalence of micro and macro-vascular complications and how these patients perform with respect to current treatment goal. Methods. We performed a cross-sectional study in type 2 diabetes subjects treated with biguanides in monotherapy, consecutively attending a standard diabetes outpatient clinic from a middle size town in Romania, during 2008-2009. We used the latest available visit at the Clinic for data regarding demographics, anthropometrics, biochemistry, micro and macrovascular complications of diabetes. Results. We investigated 814 subjects, under biguanides treatment, 463 (56.9%) females, mean age 62.6±10.5 years, age at diabetes onset 60±10.4 years, and a disease duration at study inclusion 2.6±3.9 years. Only 5.2% of females and 17.7% (p<0.01) of males had a waist circumference <80/<94 cm. A fasting plasma glucose <7.21 mmol/l was found in 40.4% of cases. The therapeutic target for blood pressure was achieved in 14.7% of cases for systolic blood pressure (<130 mmHg) and 29.6% for diastolic blood pressure (<80 mmHg). Conclusion. Individuals with type 2 diabetes treated with biguanides in monotherapy are poorly controlled, have a high prevalence of metabolic syndrome components as well as micro and macrovascular complications.

Screening of diabetic patients for microalbuminuria in primary care — The PROSIT-Project

The PROSIT (Proteinuria Screening and Intervention) Project started in1993 in order to obtain data on the prevalence of micro- and macroalbuminuria in diabetic patients treated in primary care, to establish an easy screening programme for microalbuminuria, in which also diabetic patients can participate in self-responsibility, and to implement a specific intervention programme for incipient nephropathy. In 58 representative doctor's offices 647 diabetic patients were included, who performed at home self-tests for microalbuminuria on three days within one week using the early morning urine and a newly developed qualitative immunologic teststrip for microalbuminuria. After storage they returned the same urine samples to their doctors' offices for semiquantitative retesting with the immunologic test-strip Micral-Test® II. In case of positive results the proteinuria dipstick Combur-9-Test® was applied in order to exclude other causes of positive microalbuminuria (e.g. urinary tract infection). Data of 569 patients (6% Type 1, 88% Type 2 and 6% secondary diabetes) could be analysed. Both qualitative self-testing for microalbuminuria at home and semiquantitative retesting in doctors' offices were found to be feasible. Based on semiquantitative retesting the prevalences of microalbuminuria (macroalbuminuria)were 19.6% (0%) in Type I diabetes, 17.2% (10.8%) in Type 2 diabetes and 11.7% (7.8%) in secondary diabetes. Type 2 diabetic patients showed a clear correlation between albuminuria and diabetes duration, HbA1c, serum creatinine, triglycerides as well as micro- and macrovascular complications. 227 patients with micro- or macroalbuminuria were included into the ongoing PROSIT intervention programme.

Screening of diabetic patients for microalbuminuria in primary care--The PROSIT-Project. Proteinuria Screening and Intervention.

The PROSIT (Proteinuria Screening and Intervention) Project started in 1993 in order to obtain data on the prevalence of micro- and macroalbuminuria in diabetic patients treated in primary care, to establish an easy screening programme for microalbuminuria, in which also diabetic patients can participate in self-responsibility, and to implement a specific intervention programme for incipient nephropathy. In 58 representative doctor's offices 647 diabetic patients were included, who performed at home self-tests for microalbuminuria on three days within one week using the early morning urine and a newly developed qualitative immunologic test-strip for microalbuminuria. After storage they returned the same urine samples to their doctors' offices for semiquantitative retesting with the immunologic test-strip Micral-Test II. In case of positive results the proteinuria dipstick Combur-9-Test was applied in order to exclude other causes of positive microalbuminuria (e.g. urinary tract infection). Data of 569 patients (6% Type 1, 88% Type 2 and 6% secondary diabetes) could be analysed. Both qualitative self-testing for microalbuminuria at home and semiquantitative retesting in doctors' offices were found to be feasible. Based on semiquantitative retesting the prevalences of microalbuminuria (macroalbuminuria) were 19.6% (0%) in Type 1 diabetes, 17.2% (10.8%) in Type 2 diabetes and 11.7% (7.8%) in secondary diabetes. Type 2 diabetic patients showed a clear correlation between albuminuria and diabetes duration, HbA1c, serum creatinine, triglycerides as well as micro- and macrovascular complications. 227 patients with micro- or macroalbuminuria were included into the ongoing PROSIT intervention programme.

Vascular complications of black patients with type 2 diabetes mellitus in Southern Brazil

Ethnicity has been shown to be associated with micro- and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro- and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95%CI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.

Vascular complications of black patients with type 2 diabetes mellitus in Southern Brazil

Ethnicity has been shown to be associated with micro- and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro- and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95%CI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.

A lack of increase in high molecular weight-adiponectin in macroalbuminuric subjects with metabolic syndrome may exert renal and atherosclerotic risks

We assessed serum levels of total- and HMW-adiponectin as well as carotid intima–media thickness (IMT) in relation to the levels of albuminuria in subjects with and without metabolic syndrome (MS). Consecutive 291 subjects were enrolled in this study. Waist circumference (WC) was measured and MS was diagnosed according to the Japanese criteria. Urinary albumin/creatinine ratio (ACR) was determined, and then divided into three stages; normo-, micro- and macroalbuminuria. Of all subjects, 95 were defined as having MS (MS+) and the other 196 were not (MS−). There was no significant difference in age between MS+ and MS− groups. The prevalence of micro- and macroalbuminuria was about twice as high in the MS+ than in the MS−. Although there was no difference in the WC among normo-, micro- and macroalbuminuric subjects in both MS+ and MS−, serum HMW-adiponectin levels and the HMW/total-adiponectin ratio in the macroalbuminuric MS− were significantly higher than that in the normo- and microalbuminuric MS−. However, these parameters did not change with an increase in urinary ACR among MS+. IMT was greatest in macroalbuminuric MS+ when compared with other groups. Multiple regression analysis revealed that HMW/total-adiponectin ratio is associated with urinary ACR independent of age, gender and presence of MS. We concluded that increased serum HMW-adiponectin by unknown mechanisms, at abstract least independent of WC, might help protect against renal and atherosclerosis risks in macroalbuminuric MS−.

Microalbuminuria among Type 1 and Type 2 diabetic patients of African origin in Dar Es Salaam, Tanzania

BackgroundThe prevalences and risk factors of microalbuminuria are not full described among black African diabetic patients. This study aimed at determining the prevalence of microalbuminuria among African diabetes patients in Dar es Salaam, Tanzania, and relate to socio-demographic features as well as clinical parameters.MethodsCross sectional study on 91 Type 1 and 153 Type 2 diabetic patients. Two overnight urine samples per patient were analysed. Albumin concentration was measured by an automated immunoturbidity assay. Average albumin excretion rate (AER) was used and were categorised as normalbuminuria (AER < 20 ug/min), microalbuminuria (AER 20–200 ug/min), and macroalbuminuria (AER > 200 ug/min). Information obtained also included age, diabetes duration, sex, body mass index, blood pressure, serum total cholesterol, high-density and low-density lipoprotein cholesterol, triglycerides, serum creatinine, and glycated hemoglobin A1c.ResultsOverall prevalence of microalbuminuria was 10.7% and macroalbuminuria 4.9%. In Type 1 patients microalbuminuria was 12% and macroalbuminuria 1%. Among Type 2 patients, 9.8% had microalbuminuria, and 7.2% had macroalbuminuria. Type 2 patients with abnormal albumin excretion rate had significantly longer diabetes duration 7.5 (0.2–24 yrs) than those with normal albumin excretion rate 3 (0–25 yrs), p < 0.001. Systolic and diastolic blood pressure among Type 2 patients with abnormal albumin excretion rate were significantly higher than in those with normal albumin excretion rate, (p < 0.001).No significant differences in body mass index, glycaemic control, and cholesterol levels was found among patients with normal compared with those with elevated albumin excretion rate either in Type 1 or Type 2 patients.A stepwise multiple linear regression analysis among Type 2 patients, revealed AER (natural log AER) as the dependent variable to be predicted by [odds ratio (95% confidence interval)] diabetes duration 0.090 (0.049, 0.131), p < 0.0001, systolic blood pressure 0.012 (0.003–0.021), p < 0.010 and serum creatinine 0.021 (0.012, 0.030).ConclusionThe prevalence of micro and macroalbuminuria is higher among African Type 1 patients with relatively short diabetes duration compared with prevalences among Caucasians. In Type 2 patients, the prevalence is in accordance with findings in Caucasians. The present study detects, however, a much lower prevalence than previously demonstrated in studies from sub-Saharan Africa. Abnormal AER was significantly related to diabetes duration and systolic blood pressure.

Complications of Type 2 Diabetes Among Aboriginal Canadians

Despite a dramatically increasing burden of type 2 diabetes in Aboriginal Canadian communities (1–5), relatively little information is available regarding the prevalence of, and risk factors for, the complications of type 2 diabetes in this population (6). Although previous studies have documented micro- and macrovascular disease in Aboriginal Canadians with diabetes, the majority of these reports have relied heavily on hospital records, chart reviews, and disease registries (6). These approaches may underestimate the magnitude of the complications burden because only those with the severest disease are included, and standardized methods are infrequently used to document complications. The objective of the present research project was to systematically determine, using validated methods, the prevalence of micro- and macrovascular complications among Aboriginal Canadians who have type 2 diabetes and to identify risk factors that are associated with these conditions. The Sandy Lake Diabetes Complications Study has been presented in detail previously (6). Briefly, all community members known to have type 2 diabetes were invited to participate; 189 of 250 (76%) eligible subjects were enrolled, although the sample size varies given time-limited access to certain equipment. Participants were older than nonparticipants and more likely to be male but did not differ in diabetes treatment. Signed informed consent was obtained from all participants, and the study was approved by the Sandy Lake First Nation Band Council and the Mount Sinai Hospital Ethics Review Committee. We used validated measures to assess retinopathy, neuropathy, nephropathy, and cardiovascular disease risk factors, as described previously (6). Digital fundus photography was performed using a nonmydriatic retinal camera, with …

IRIS II Study: Sensitivity and Specificity of Intact Proinsulin, Adiponectin, and the Proinsulin/Adiponectin Ratio as Markers for Insulin Resistance

This study was performed to compare the specificity and sensitivity of intact proinsulin, adiponectin, and their ratio (proinsulin/adiponectin) in the prediction of insulin resistance as assessed by the homeostasis model assessment (HOMA) score (> or =2 = resistant). Using a cross-sectional approach, 500 orally treated patients with type 2 diabetes (272 women, 238 men; mean +/- SD age, 64.8 +/- 11.6 years; hemoglobin A1c, 7.0 +/- 1.5%; disease duration, 5.8 +/- 6.1 years) were investigated. Various cutoffs for body mass index-adjusted adiponectin and proinsulin/adiponectin were compared with the established cutoff value of 10 pmol/L for fasting proinsulin. Fasting proinsulin correlated more closely with the HOMA score (r = 0.560, P < 0.001) than fasting adiponectin (r = -0.204, P < 0.001) or proinsulin/adiponectin (r = 0.355, P < 0.001). For proinsulin, specificity and sensitivity for insulin resistance in correlation to the HOMA score results were 96% and 70%, respectively. At a comparable specificity level to proinsulin, adiponectin did not reach a comparable sensitivity (14%), while the proinsulin/adiponectin ratio almost reached the same sensitivity (65%). Overall, patients with elevated proinsulin had a higher prevalence of micro- and macrovascular disease [odds ratio 1.47 (adiponectin, 1.08; proinsulin/ adiponectin, 1.48) and 1.34 (adiponectin, 1.32; proinsulin/adiponectin, 1.27), respectively]. Elevation of fasting intact proinsulin seems to be the more specific marker for insulin resistance and increased cardiovascular risk than suppression of fasting adiponectin. Formation of the ratio does not lead to a further increase in the predictive value.

Racial and Ethnic Differences in Microalbuminuria Prevalence in a Diabetes Population

The objective of this study was to determine whether racial or ethnic differences in prevalence of diabetic microalbuminuria were observed in a large primary care population in which comparable access to health care exists. A cross-sectional analysis of survey and automated laboratory data 2969 primary care diabetic patients of a large regional health maintenance organization was conducted. Study data were analyzed for racial/ethnic differences in microalbuminuria (30 to 300 mg albumin/g creatinine) and macroalbuminuria (>300 mg albumin/g creatinine) prevalence among diabetes registry-identified patients who completed a survey that assessed demographics, diabetes care, and depression. Computerized pharmacy, hospital, and laboratory data were linked to survey data for analysis. Racial/ethnic differences in the odds of microalbuminuria and macroalbuminuria were assessed by unconditional logistic regression, stratified by the presence of hypertension. Among those tested, the unadjusted prevalence of micro- or macroalbuminuria was 30.9%, which was similar among the various racial/ethnic groups. Among those without hypertension, microalbuminuria was twofold greater (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.14 to 3.53) and macroalbuminuria was threefold greater (OR 3.17; 95% CI 1.09 to 9.26) for Asians as compared with whites. Among those with hypertension, adjusted odds of microalbuminuria were greater for Hispanics (OR 3.82; 95% CI 1.16 to 12.57) than whites, whereas adjusted odds of macroalbuminuria were threefold greater for blacks (OR 3.32; 95% CI 1.26 to 8.76) than for whites. For most racial/ethnic minorities, hypertriglyceridemia was significantly associated with greater odds of micro- and macroalbuminuria. Among a large primary care population, racial/ethnic differences exist in the adjusted prevalence of microalbuminuria and macroalbuminuria depending on hypertension status. In this setting, racial/ethnic differences in early diabetic nephropathy were observed despite comparable access to diabetes care.

Prevalence of albuminuria in Australia: The AusDiab Kidney Study

Albuminuria is an important predictor of risk of progressive renal disease, cardiovascular disease, and mortality; however, the prevalence in the general population is not well defined. We determined estimates of the population prevalence and associations of microalbuminuria and macroalbuminuria in Australian adults; 11,247 Australians aged > or = 25 years living in 42 randomly selected population clusters were tested for albuminuria (spot urine albumin:creatinine (mg/mmol): normal < 3.4, microalbuminuria 3.4 to 34, macroalbuminuria > 34). Prevalence of micro- and macroalbuminuria were assessed with age, sex, obesity, smoking, hypertension (> or = 140/90 mm Hg or known diagnosis on treatment), glucose metabolism status (WHO criteria according to fasting glucose and oral glucose tolerance test), ischemic heart and cerebrovascular disease, and low glomerular filtration rate (calculated glomerular filtration rate < 60 mL/min/1.73m2). Microalbuminuria and macroalbuminuria proteinuria were present in 6.0% and 0.6% of the population, respectively. The majority of subjects with microalbuminuria (64%) and macroalbuminuria (76%) had hypertension, and approximately half of those with albuminuria had abnormal glucose metabolism. Of all participants with microalbuminuria, 25.9% had normal blood pressure and glucose metabolism, and in this group, alternative associations of microalbuminuria included obesity (13.5%), smoking (20.7%), and low glomerular filtration rate (12.3%). Albuminuria is present in a small percentage of the general adult population, but is highly prevalent in subjects with hypertension and/or abnormal glucose metabolism. The majority of cases of microalbuminuria and macroalbuminuria in the general population are among those with hypertension.

Audit of a shared-care program for persons with diabetes: baseline and 3 annual follow-ups.

In Italy, data on shared-care programs for diabetes are lacking. We described the characteristics of type 2 diabetic population assisted in general practice and evaluated 3 years of follow-up outcomes and performance indicators in a shared-care program in Modena, Italy (1998-2001); only well-controlled diabetic patients were considered. Forty-nine percent of territorial GPs adhered to the project (257 out of 521) and 77% of them sent 6409 paired baseline and follow-up datasheets. Altogether, 97.8% patients had type 2 diabetes, mean age 68.6+/-11.7 years, disease duration 9.6+/-7.5 years, BMI 28.6+/-4.8 kg/m2, HbA(1c) 7.6%+/-1.6%, 16.1% of them were disabled. Among the non-disabled patients, 23.6% had optimal glycemic control (HbA(1c) < or =6.5%); at baseline the prevalence of micro- and macrovascular diabetic complications was: 8.2% microalbuminuria and 2.4% macroalbuminuria plus nephropathy, 11.0% nonproliferative and 3.0% preproliferative retinopathy, 7.0% neuropathy, 1.8% diabetic foot; 8.5% angina, 6.9% TIA or stroke, 6.3% infarction, 5.2% intermittent claudication, 4.1% heart failure. Among the disabled patients 27.9% had optimal glycemic control, but they had more diabetic complications. The performance indicators significantly improved over the 3-year study period: glycemic control indicators increased from 66%-75% to 83%-90% and micro- and macrovascular indicators from 59%-65% to 75%-81%. The outcome indicators also improved: mean HbA(1c) value changed from 7.6%+/-1.6% to 7.3%+/-1.3% and the percentage of people with HbA(1c)< or =6.5% significantly improved over time. Similar trends were observed in both disabled and non-disabled diabetic patients.

CLINICAL, BIOPHYSICAL AND BIOCHEMICAL VARIABLES FROM AFRICAN-HERITAGE SUBJECTS WITH TYPE 2 DIABETES

We compared the metabolic profile of two ethnic populations with type 2 diabetes, one from Bantu (n=23; Ban) and the other from Belgian (n=314) extraction followed at St Luc Hospital. Further comparison with a Belgian sub-cohort (n=64; Be) matched for age (52 yrs) and sex distribution (M/F : 61/39 %) showed no significant difference between Belgian and Bantu subjects with regards to diabetes duration (9 and 11 yrs; Ban and Be respectively), age at diabetes diagnosis (43 and 42 yrs), HbA1c (8.1±1.9 vs. 8.5±1.9 %; NS), and achieved education level. BMI was lower in Ban (29±4 vs. 32±7 in Be; p<0.02), as were body fat (33±12 vs. 37±11 kg; NS) and waist diameter (99±9 vs. 106±16 cm; p<0.02). Forty-eight and 72% of Ban and Be were on metformin (p<0.05), while insulin was given to 39 and 34%. Daily insulin dose was lower in Ban (0.31±0.20 vs. 0.47±0.18 IU.kg-1.24h-1; p<0.001).There was no difference in ß-cell function (%ß; normal : 100%) or insulin sensitivity (%S; normal :100%) as determined with HOMA between groups. %ß (median [perc 25-75]) was 51 [23-119] and 67 [45-84] in Ban and Be, while %S was 32 [29-37] and 37 [27-45]. Smoking (past & current) prevalence was 5 and 47% in Ban and Be (p<0.0001). Prevalence of micro- and macroangiopathy did not differ between groups, although Ban had more macroalbuminuria (29 vs. 9 %; p<0.05), and were more often treated with Ca2+-channel- and ß-blockers than Be subjects (36 and 39 % vs. 16 and 8 %; p= 0.07 and <0.05, respectively).Fasting (F) and interprandial (IP) triglycerides (TG) were lower in Ban : 115 [81-149] vs. 189 [155-325] mg.dL-1 for F-TG and 127 [81-160] vs. 170 [128-305] mg.dL-1 for IP-TG (p<0.0001), as was total cholesterol (201±53 vs. 223±40 mg.dL-1 (p<0.05), despite lower use of hypolipidaemic drug (13 vs. 44%; p<0.01). Africanheritage subjects with type 2 diabetes have similar degree of diabetes control and complications, in the presence of leaner biophysical status, minimal tobacco exposure and lower fasting and interprandial triglycerides.

Past Practice of Sports and Type 2 Diabetes in Later Life

Introduction: Type 2 diabetes mellitus (T2DM) results from 2 combined abnormalities (insulin resistance and pancreatic β-cell dysfunction), which are present in variable proportion. Regular practice of sports improves insulin sensitivity, decreases atherogenic markers, and may even delay the onset of impaired glucose tolerance in at-risk individuals. Since known duration of type 2 diabetes often underestimates the true exposure to hyperglycaemia and to other atherogenic abnormalities, it is plausible to expect that regular practice of sports prior to T2DM diagnosis might favourably modify the spectrum of diabetes-related complications after diagnosis. Methods: We compared 60 male subjects who reported having practised sports on a regular basis prior to being diagnosed with T2DM (EX-group) with 96 control T2DM subjects who never practised sports, and matched for age and known diabetes duration (NEVER-group). Micro- and macro-angiopathic complications were analysed, alongside diabetic and cardiovascular drug use, prevalence of hypertension, and lipid profile. Results: Age (mean ± 1SD) was 59.5 ± 11.0 years, and known diabetes duration 10.4 ± 7.0 years. EX-subjects were aged 40 ± 14 years at the time they interrupted their sports practice, the interval between interruption and T2DM diagnosis amounting to 12 ± 10 years. There were no difference in present-day BMI (29 ± 5 kg.m−2), nor in waist diameter (103 ± 11 cm) or percent body fat (30 ± 7%) between the EX- and NEVER-groups. Metabolic control, assessed by HbA1c, was similar in both groups (8.3 ± 2.0 (EX-) vs. 8.1 ± 2.1% (NEVER-; NS)). High blood pressure (BP) was present in 53 and 58% respectively. There was no difference between groups for BP- or lipid-lowering drug(s) and drug class(es) usage. Systolic and diastolic BP were identical in both groups (145 and 85 mm Hg). Insulin sensitivity (IS) and β-cell function (β) assessed by the HOMA model (1) were similar in both groups. Thus, IS was (median [perc. 25–75]) 36 [27–58] and 37 [28–48]%, while β was 60 [32–90] and 64 [36–109]% respectively in EX- and NEVER-subjects (NS). Prevalence of micro- and macro-angiopathy, including coronary artery disease (CAD) were lower, though not significantly, in EX-subjects: 22 vs. 29% (retinopathy); 18 vs. 26% (microalbuminuria); 26 vs. 40% (peripheral neuropathy); 27 vs. 35% (macro-angiopathy); 15 vs. 25% (CAD). Total cholesterol.HDL-C−1, fasting- and inter-prandial TG were not significantly different between groups, nor was the absolute 10 year CAD excess risk estimated from Coronary Risk Chart: 12 ± 10%. Discussion: Past regular practice of sports in male subjects did not result in a significantly less severe spectrum of diabetes-related complications after a known duration of type 2 diabetes mellitus of 10 years, when compared with subjects matched for age and for diabetes duration. Nevertheless, a non-significant lesser prevalence of micro- and macro-angiopathic manifestations was found associated with past practice of sports prior to diabetes diagnosis.

Determinants of albuminuria in people with Type 2 diabetes mellitus

This study sought to identify determinants of albuminuria in people with Type 2 diabetes. In 335 primary care patients, we assessed albumin–creatinine ratio (ACR) in two 24-h urine samples, and its cross-sectional associations with protein and alcohol intake, cigarette smoking, body weight and height, glycosuria, blood pressure, hypoglycaemic and antihypertensive treatment, gender, age, age at diagnosis, diabetes duration, family history of diabetes and cardiovascular diseases, ethnic origin, and education. The prevalence of micro- or macro-albuminuria (ACR≥2.0 mg/mmol) was 33%. Among these patients, compared to those with normo-albuminuria, there were more men, protein intake (g/kg) estimated from urinary urea as well as systolic blood pressure and glycosuria were higher, there were more smokers, men were shorter, and a family history of diabetes was less prevalent (all P<0.05). In linear and logistic regression ( n=270) albuminuria was independently associated ( P<0.05 unless indicated otherwise) with systolic blood pressure (OR 10 mmHg=1.32), smoking (OR ex/never=2.36, OR current/never=4.89), glycosuria (OR ≥7/<1 g/l=2.41), gender (OR men/women=2.50), age in men (OR 10 year=1.60) ( P<0.10) and, inversely, in women (OR 10 year=0.63) ( P>0.10). On aggregation, the modifiable determinants systolic blood pressure, smoking and glycosuria explained 12% of the variation in albuminuria. These factors thus are, although to a moderate extent only, potential determinants of albuminuria. We also observed an independent, inverse association with body height (OR 0.10 m=0.47). This is in line with the hypothesis that development in utero or during early life influences kidney function in later life.

Cardiovascular disease in cirrhosis--a point-prevalence study in relation to glucose tolerance.

Impaired glucose tolerance or diabetes are frequently observed in cirrhosis. Overt diabetes was reported to affect long term survival of cirrhotic patients by increasing the risk of hepatocellular failure, without increasing the risk of diabetes-associated cardiovascular events. We evaluated the prevalence of cardiovascular disease in 122 patients with cirrhosis, subdivided according to their glucose tolerance. The following parameters were considered: arterial pressure, peripheral vascular disease (ankle to brachial pressure ratio), ischemic heart disease, microalbuminuria, retinopathy. The prevalence of abnormal findings was compared with that observed in 60 randomly selected patients with noninsulin-dependent diabetes and in 40 controls. Noninsulin-dependent diabetic patients and patients with cirrhosis and diabetes were comparable for age, metabolic control, and smoking habits; the duration of diabetes was 5 yr longer for noninsulin-dependent diabetes. In cirrhosis, the prevalence of micro- and peripheral macroangiopathy, as well as coronary heart disease, was not different in relation to glucose tolerance, it was comparable to that of controls, and significantly lower than that observed in non-insulin-dependent diabetes. Cirrhotic patients, even in the presence of overt diabetes, are at low risk of cardiovascular disease. The low prevalence may be related to shorter duration of diabetic disease, also in relation to reduced life expectancy, as well as to liver disease-induced abnormalities protecting the cardiovascular system from atherosclerosis.

Cardiovascular disease in cirrhosis: A point-prevalence study in relation to glucose tolerance

OBJECTIVE: Impaired glucose tolerance or diabetes are frequently observed in cirrhosis. Overt diabetes was reported to affect long term survival of cirrhotic patients by increasing the risk of hepatocellular failure, without increasing the risk of diabetes-associated cardiovascular events. METHODS: We evaluated the prevalence of cardiovascular disease in 122 patients with cirrhosis, subdivided according to their glucose tolerance. The following parameters were considered: arterial pressure, peripheral vascular disease (ankle to brachial pressure ratio), ischemic heart disease, microalbuminuria, retinopathy. The prevalence of abnormal findings was compared with that observed in 60 randomly selected patients with non–insulin-dependent diabetes and in 40 controls. RESULTS: Noninsulin-dependent diabetic patients and patients with cirrhosis and diabetes were comparable for age, metabolic control, and smoking habits; the duration of diabetes was 5 yr longer for noninsulin-dependent diabetes. In cirrhosis, the prevalence of micro- and peripheral macroangiopathy, as well as coronary heart disease, was not different in relation to glucose tolerance, it was comparable to that of controls, and significantly lower than that observed in noninsulin-dependent diabetes. CONCLUSIONS: Cirrhotic patients, even in the presence of overt diabetes, are at low risk of cardiovascular disease. The low prevalence may be related to shorter duration of diabetic disease, also in relation to reduced life expectancy, as well as to liver disease-induced abnormalities protecting the cardiovascular system from atherosclerosis.