Prevention Of Non-insulin-dependent Diabetes Mellitus Research Articles

Effectiveness of comprehensive nursing intervention program (CNIP) on knowledge and practice regarding the prevention of non-insulin-dependent diabetes mellitus (NIDDM) among adults.

There are estimated 72.96 million cases of diabetes in the adult population of India. The prevalence in urban areas ranges between 10.9% and 14.2%, and the prevalence in rural India ranges between 3.0% and 7.8% among the population aged 20 years and above with a much higher prevalence among individuals aged over 50 years. This study aimed to determine the effectiveness of comprehensive nursing intervention program (CNIP) on knowledge and practice regarding the prevention of non-insulin-dependent diabetes mellitus (NIDDM) among adults. A quasi-experimental one-group pretest-posttest design was chosen for the study. Adults were selected using a simple random sampling technique by the lottery method; of 120 eligible adults, 60 were selected to participate in the study. The study was conducted in an urban community, Bangalore, and data were collected from March 25, 2022, to April 23, 2022. CNIP consisted of education, demonstration of exercise, and information booklet. The pretest and posttest were collected using the structured knowledge questionnaire for assessing the level of knowledge and non-observational checklist for assessing the level of practice among adults. Data were analyzed by descriptive and inferential statistics. There was significant improvement in the mean scores of knowledge from 52.3 to 82.2 and practice mean score from 45.5 to 68.4. The paired t-test value of knowledge was 3.88, and practice was 2.97, which was significant at P < 0.05 level. The study concluded that CNIP had a great role in increasing the level of knowledge and practice among adults in the prevention of NIDDM.

Exercise test and glucose homeostasis in rats treated with alloxan during the neonatal period or fed a high calorie diet

Animal models appear well-suited for studies into the role of exercise in the prevention of non-insulin-dependent diabetes mellitus (NIDDM). The aim of the present study was to analyze glucose homeostasis and blood lactate during an exercise swimming test in rats treated with alloxan during the neonatal period and/or fed a high calorie diet from weaning onwards. Rats were injected with alloxan (200 mg/kg, i.p.) or vehicle (citrate buffer) at 6 days of age. After weaning, rats were divided into four groups and fed either a balanced diet or a high-caloric diet as follows: C, control group (vehicle + normal diet); A, alloxan-treated rats fed the normal diet; H, vehicle-treated rats fed the high-caloric diet; and HA, alloxan-treated rats fed the high-caloric diet. Fasting serum glucose levels were higher in groups A and AH compared with the control group. The Homeostatic Model Assessment index varied in the groups as follows: H>A>HA = C. There were no differences in free fatty acids or blood lactate concentrations during the swim test. Alloxan-treated rats fed a normal or high-caloric diet have the potential to be used in studies analyzing the role physical exercise plays in the prevention of NIDDM.

Aminoguanidine prevents arterial stiffening in a new rat model of type 2 diabetes

Formation of advanced glycation end-products (AGEs) on collagen within the arterial wall may be responsible for the development of diabetic vascular injury. This study focused on investigating the role of aminoguanidine (AG), an inhibitor of AGE formation, in the prevention of noninsulin-dependent diabetes mellitus (NIDDM)-derived arterial stiffening and cardiac hypertrophy in rats. The NIDDM was induced in male Wistar rats, which were administered intraperitoneally with 180 mg kg(-1) nicotinamide (NA) 30 min before an intravenous injection of 50 mg kg(-1) streptozotocin (STZ). After induction of diabetes mellitus type 2, animals receiving daily peritoneal injections with 50 mg kg(-1) AG for 8 weeks were compared with the age-matched, untreated, diabetic controls. After exposure to AG, the STZ-NA diabetic rats had improved aortic distensibility, as evidenced by 18.8% reduction of aortic characteristic impedance (P < 0.05). Treatment of the experimental syndrome with AG also resulted in a significant increase in wave transit time (+23.7%, P < 0.05) and a decrease in wave reflection factor (-26.6%, P < 0.05), suggesting that AG may prevent the NIDDM-induced augmentation in systolic load of the left ventricle. Also, the glycation-derived modification on aortic collagen was found to be retarded by AG. The diminished ratio of left ventricular weight to body weight suggested that prevention of the diabetes-related cardiac hypertrophy by AG may correspond to the drug-induced decline in aortic stiffening. Long-term administration of AG to the STZ-NA diabetic rats imparts significant protection against the NIDDM-derived impairment in vascular dynamics, at least partly through inhibition of the AGE accumulation on collagen in the arterial wall.

Glucose tolerance, insulin sensitivity, and insulin secretion in children born small for gestational age.

Intrauterine growth retardation is associated with an increased risk of developing adult diseases, such as noninsulin-dependent diabetes mellitus (NIDDM). NIDDM could result from a decreased insulin sensitivity or a reduced insulin secretion or a combination of both. Glucose tolerance, insulin sensitivity, and insulin secretion were studied in prepubertal children born small for gestational age (SGA). Twenty-nine SGA children with a mean age of 9.1 +/- 1.1 yr and 24 children born appropriate for gestational age (AGA), with a mean age of 9.0 +/- 1.1 yr, were studied. All children were born at term and were prepubertal. Children were studied on two separate days after 12 h of overnight fasting. Day 1: Glucose tolerance was studied with an oral glucose tolerance test. AUC(ins0-120 min)/AUC(gluc0-120 min) was used to estimate beta-cell function in the two groups. Day 2: A hyperinsulinemic euglycemic clamp study was performed to determine insulin sensitivity (M-value). Glucose tolerance and beta-cell function were not different between the two groups. M-value in SGA children was significantly lower than M-value in AGA children: 12.9 +/- 4.0 mg/kg.min vs. 15.6 +/- 2.3 mg/kg.min [P = 0.009; after adjustment for appropriate gestational age body mass index (BMI), P = 0.001]. The M-value tended to be higher in SGA children without catch-up growth compared with SGA children with catch-up growth (15.8 +/- 4.3 vs. 12.3 +/- 3.8 mg/kg.min; P = 0.079) and was comparable to AGA controls (15.6 +/- 2.3 mg/kg.min). The M-value in SGA children who had shown catch-up growth was comparable to AGA children (13.4 +/- 3.4 vs. 15.6 +/- 2.3 mg/kg.min; P = 0.06), provided they had a BMI of 17 kg/m(2) or less. However, the SGA children with catch-up growth and a BMI greater than 17 kg/m(2) were those having the lowest M-values (9.3 +/- 3.4 mg/kg.min). In conclusion, during oral glucose tolerance tests, no differences were found in glucose tolerance and beta-cell function between the SGA and AGA groups. However, the hyperinsulinemic clamp showed a reduced insulin sensitivity in SGA children, which may contribute to the enhanced risk of developing NIDDM in adult life, especially in SGA children with catch-up growth and a high BMI. The implications of our findings in relation to height are unclear, but might be of potential importance when considering GH treatment. In addition, interventions to improve fetal growth and to control obesity in childhood seem to be important factors in the prevention of NIDDM.

Obesity as a risk factor for non-insulin-dependent diabetes mellitus in Korea.

Most Korean patients with non-insulin-dependent diabetes mellitus (NIDDM) have been reported not to be obese, and many of them lost weight significantly during the course of their disease. In this regard, a retrospective cohort study was conducted to determine the relationship between body mass index (BMI, kg/m2) and the risk for NIDDM among Koreans. Subjects who had received a medical examination from 1990 to 1991 and who were available for the detection of NIDDM until September 1999 were included. Subjects who initially had diabetes or were diagnosed as diabetic within 1 yr after enrollment were excluded. We reviewed the medical records of final cohort of 2,531 subjects. Follow-up of this cohort revealed 117 cases with diabetes with an incident of 7.8 per 1,000 person-years. Compared with those with BMI less than 23 kg/m2, the adjusted relative risks for diabetes mellitus for those with BMI of 23-24.9, 25-26.9, and greater than 27 kg/m2 were 0.85 (0.47-1.50), 1.29 (0.72-2.31), and 3.38 (1.22-4.63), respectively, for men (p for trend<0.01) and as for 9.14 (1.99-41.8), 7.36 (1.47-36.8), and 14.5 (3.03-69.2), respectively, for women (p for trend<0.01). These data indicate a direct relationship between obesity and the risk for the development of diabetes, emphasizing the importance of weight control for the prevention of NIDDM in Koreans.

Evaluation of Jump Into Action: a program to reduce the risk of non-insulin dependent diabetes mellitus in school children on the Texas-Mexico border.

Jump Into Action, a school-based non-insulin dependent diabetes mellitus (NIDDM) prevention program, encourages students to eat low-fat foods and exercise regularly to reduce their risks for developing NIDDM. A study was conducted in a school district with a predominately Hispanic enrollment to assess the effectiveness of Jump Into Action in improving fifth-graders' knowledge, self-efficacy, and behaviors regarding NIDDM prevention. Jump Into Action was found effective in increasing knowledge and self-efficacy regarding NIDDM prevention and improving dietary and exercise-related behaviors. These gains were sustained from posttest to follow-up four weeks later.

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.

The fasting hyperglycaemia study: I. Subject identification and recruitment for a non—insulin-dependent diabetes prevention trial

Subjects at increased risk for developing non—insulin-dependent diabetes mellitus (NIDDM) were encouraged via a public awarness campaign, general practitioners, or a direct approach (in the case of women with previous gestational diabetes) to attend one of three English and two French centers for fasting plasma glucose (FPG) measurement. Of 1,580 subjects (mean ± SD age, 47 ± 10 years), 29% were male, 56% had a diabetic relative, 20% had a history of elevated blood glucose or glycosuria, and 9% previously had gestational diabetes. Thirty-one percent (493) had an initial increased fasting glucose ([IFG] 5.5 to 7.7 mmol · L −1), 3% (41) a diabetic fasting glucose ([DFG] ≥ 7.8 mmol · L −1), and 66% (1,046) a normal fasting glucose ([INFG] < 5.5 mmol · L −1). For hundred forty-one of the 493 returned for a second FPG measurement, and 67% (293) of these had a similar values on repeat testing 2 weeks later. A 75-g, 2-hour oral glucose tolerance test (OGTT) in 223 of these subjects showed that 37% (83) had impaired glucose tolerance (IGT), 26% (58) diabetes mellitus (DM), and 37% (82) normal glucose tolerance [NGT). Seven percent of self-referred patients had NIDDM by World Health Organization (WHO) criteria. Eighty-eight percent of those with an initial DFG had an increased glycated hemoglobin (>6.2%), and 75% an increased fructosamine (>282 μmol · L −1). While these two glycemic measures provided good discrimination for diabetes, neither were reliable in detecting those with increased but not diabetic FPG values. In conclusion, 293 (19%) of 1,580 self-referred subjectes were identified as having persistently increased FGP, and 227 have been entered into a randomized NIDDM prevention trial evaluating healthy-living advice and sulfonylurea therapy.

The prediabetic problem: Development of non-insulin-dependent diabetes mellitus and related abnormalities

Non-insulin-dependent diabetes mellitus (NIDDM) is associated with approximately two fold increase in coronary heart disease (CHD) in men and fourfold increase in CHD in women. In most studies, the duration of diabetes and severity of glycemia are only weakly related to CHD in NIDDM, suggesting that the prediabetic period may be important for the increased CHD in NIDDM subjects. Both hyperinsulinemia and/or insulin resistance predict the development of NIDDM. A number of studies have shown that increased cardiovascular risk factors (especially high triglyceride, blood pressure, and small dense low-density lipoprotein (LDL) and low high-density liproprotein (HDL) cholesterol) precede the onset of NIDDM. Recent data from the San Antonio Heart Study suggest that the atherogenic pattern of cardiovascular risk factors is more marked in prediabetic women than in prediabetic men, thus partially explaining the higher risk of CHD in prediabetic women than in prediabetic men. The atherogenic changes in cardiovascular risk factors appear to be mainly due to increased hyperinsulinemia and insulin resistance in nondiabetic subjects. Interventions to reduce cardiovascular disease in NIDDM subjects should emphasize the primary prevention of NIDDM and very aggressive treatment of traditional cardiovascular risk factors in prediabetic subjects. Treatment of hypertension and dyslipidemia in high-risk patients for NIDDM should avoid agents that further worsen insulin resistance (nicotinic acid, β blockers, and thiazides), as subjects with hypertension and dyslipidemia are already at increased risk of NIDDM.

Physical inactivity and glucose intolerance in the multiethnic island of Mauritius

The island nation of Mauritius, located in the southwest Indian Ocean, has a high prevalence of non-insulin-dependent diabetes mellitus (NIDDM) among all of its ethnic groups (Hindu and Muslim Indians, African-origin Creoles, and Chinese). These high rates of NIDDM among groups of varying genetic background provide strong support for the importance of environmental components in the etiology of the disease. Research in Mauritius using a simple activity scale has suggested that physical inactivity may be one of these components. The current investigation further examined the association between glucose tolerance and physical activity in middle-aged nondiabetic residents of Mauritius using a more extensive physical activity questionnaire (the Modifiable Activity Questionnaire). Excluding individuals with NIDDM, a statistically significant (P < 0.05) inverse relationship between physical activity and 2-h post-load glucose concentration was found for both males (rho = -0.14) and females (rho = -0.11). Stratifying by ethnic group, similar inverse correlations were observed in Hindu, Creole, and Chinese males, and in Hindu females (P < 0.05), as well as weaker relationships in Muslim males and Creole females (P < 0.10). Total physical activity remained an independent predictor of 2-h post-load glucose concentration after controlling for body mass index, waist-hip ratio, age, and family history of NIDDM. These data are supportive of a potentially important role of physical activity in the prevention of NIDDM in middle-aged inhabitants of Mauritius.

The endocrine pancreas

The islets of Langerhans provide energy storage and disposal, and protection from plasma glucose excursions, especially hypoglycemia. Insulin-dependent diabetes mellitus (IDDM) results from autoimmune beta-cell damage. Prevention of IDDM has already been achieved in animal investigation and some centers are now screening and treating individuals at high risk for developing IDDM. Immunosuppressive drugs can induce transient remission of recent-onset IDDM. Intensive insulin treatment of IDDM delays the onset and slows the progression of long-term complications. Non-insulin dependent diabetes mellitus (NIDDM) is the result of beta-cell malfunction and is strongly associated with X syndrome. Diet and exercise are of undoubted importance in NIDDM prevention and treatment. Functional endocrine tumors of the pancreas (FET) are rare hormone and peptide-secreting neoplasms. These peptides may or may not occur naturally in the islets. FETs often occur with multiple endocrine neoplasia 1 (MEN 1) so that MEN-1 screening should always be performed, and extended to family members whenever diagnosed. Drugs--alcohol, insulin and sulfonilureas--are the main cause of hypoglycemia. Insulinoma is the main cause of post-absorptive organic hypoglycemia. Non islet-cell tumors seldom cause hypoglycemia. Insulinoma often is a solitary tumor, but it may be multicentric and may coexist with cell hyperplasia and nesidioblastosis. Symptoms of neuroglycopenia may be mistaken for neuropsychiatric disease. The diagnosis is based on confirmation of post absorptive hypoglycemia and hyperinsulinism. Gastrinoma causes Zollinger-Ellison syndrome (ZES) which is characterized by fulminating peptic ulcer disease. The tumor is often malignant, and it may be multicentric and may occur with cell hyperplasia and nesidioblastosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Diabetes mellitus — A priority health care issue for women

Diabetes occurs in more than 13 million persons in the United States, and approximately 60% of the new cases are diagnosed in women. This review examines health issues related to women with diabetes mellitus. The following issues are discussed in the review. The prevalence of diabetes is higher in Native-American, black, and Hispanic women than in white women. Women with upper-body obesity are at risk for developing non-insulin-dependent diabetes mellitus (NIDDM) and women with diabetes are at risk for developing heart disease. Diabetes, obesity, and heart disease are all modifiable by nutrition. White women with diabetes derive approximately 40% of energy from fat, which is 10% greater than the national goal. Women with a history of gestational diabetes are at risk for developing NIDDM. Women with insulin-dependent diabetes mellitus (IDDM) are at high risk of developing complications in pregnancy, and pregnancy outcomes improve with preconceptual counseling. Women with IDDM are at risk for developing eating disorders, although not to a greater extent than the nondiabetic population. Women with diabetes are at risk for developing endometrial cancer. Both IDDM and NIDDM prevention clinical trials are in progress, although none target women specifically. Dietetics practitioners are encouraged to use local and national diabetes resources.

Prevention of non???insulin-dependent diabetes mellitus with physical activity

Physical activity has been recommended by physicians in managing patients with noninsulin-dependent diabetes mellitus (NIDDM); however, it is unclear whether physical activity can prevent this disease. Several prospective studies have suggested that increased physical activity may lead to the prevention of NIDDM. In the University of Pennsylvania Alumni Health Study, 5990 men were surveyed to determine the relationship between physical activity and the development of NIDDM. A total of 202 men developed NIDDM from 1962 to 1976. Leisure-time physical activity, expressed in kilocalories (kcal) was inversely related to the development of NIDDM. Incidence rates declined as energy expenditure increased. For each 2000-kcal increment in energy expenditure, the risk of NIDDM was reduced by 24% [relative risk (RR) 0.76, 95% confidence interval (CI) 0.63-0.92]. This association remained when adjusting for obesity, hypertension, and parental history of diabetes. The protective effect of physical activity was strongest in individuals at highest risk for NIDDM. Based on the review of data from several large prospective studies, it is quite likely that increased levels of physical activity are effective in preventing NIDDM, and the protective benefit is especially pronounced in those individuals who have the highest risk of disease.

Primary Prevention of Non-insulin-dependent Diabetes Mellitus

Non-insulin-dependent diabetes mellitus (NIDDM) is one of the most prevalent chronic conditions worldwide. Despite an important role of genetic factors, NIDDM can be viewed as a largely preventable disease. In this article, the current epidemiologic evidence on potentially modifiable determinants of NIDDM is reviewed, including obesity, body fat distribution, physical activity, and dietary factors. Cigarette smoking, parity, and exogenous hormone use are also addressed. Achievable reductions in the risk of NIDDM by favorably altering the modifiable determinants of NIDDM were estimated to be 50%-75% for obesity and 30%-50% for physical activity. Inconsistent results have been observed between specific dietary factors, including saturated fat, sugar, and fiber intake. Data are currently insufficient to provide a reliable estimate of the influence of diet in the prevention of NIDDM. No randomized clinical trial data are available to prove conclusively the benefits of favorable modifications of body weight, body fat distribution, physical activity, and diet on the risk of NIDDM. An extension of research activities to include randomized trials of primary prevention strategies, as well as further observational, clinical, and laboratory research, is needed and strongly recommended.

A Prospective Study of Exercise and Incidence of Diabetes Among US Male Physicians

To examine prospectively the association between regular exercise and the subsequent development of non-insulin-dependent diabetes mellitus (NIDDM). Prospective cohort study including 5 years of follow-up. 21,271 US male physicians participating in the Physicians' Health Study, aged 40 to 84 years and free of diagnosed diabetes mellitus, myocardial infarction, cerebrovascular disease, and cancer at baseline. Morbidity follow-up was 99.7% complete. Incidence of NIDDM. At baseline, information was obtained about frequency of vigorous exercise and other risk indicators. During 105,141 person-years of follow-up, 285 new cases of NIDDM were reported. The age-adjusted incidence of NIDDM ranged from 369 cases per 100,000 person-years in men who engaged in vigorous exercise less than once weekly to 214 cases per 100,000 person-years in those exercising at least five times per week (P, trend, less than .001). Men who exercised at least once per week had an age-adjusted relative risk (RR) of NIDDM of 0.64 (95% Cl, 0.51 to 0.82; P = .0003) compared with those who exercised less frequently. The age-adjusted RR of NIDDM decreased with increasing frequency of exercise: 0.77 for once weekly, 0.62 for two to four times per week, and 0.58 for five or more times per week (P, trend, .0002). A significant reduction in risk of NIDDM persisted after adjustment for both age and body-mass index: RR, 0.71 (95% Cl, 0.56 to 0.91; P = .006) for at least once per week compared with less than once weekly, and P, trend, .009, for increasing frequency of exercise. Further control for smoking, hypertension, and other coronary risk factors did not materially alter these associations. The inverse relation of exercise to risk of NIDDM was particularly pronounced among overweight men. Exercise appears to reduce the development of NIDDM even after adjusting for body-mass index. Increased physical activity may be a promising approach to the primary prevention of NIDDM.

Kelly West Lecture 1991. Challenges in diabetes epidemiology--from West to the rest.

The application of epidemiology to the study of non-insulin-dependent diabetes mellitus (NIDDM) is providing new insights into many aspects of this major public-health problem, including its natural history, prevalence, incidence, morbidity, and mortality in diverse populations around the globe. The main impetus came from the late Kelly West's book Epidemiology of Diabetes and its Vascular Lesions. These studies are providing direction for research into the possible moleculardefect or defects and biochemical mechanism or mechanisms underlying NIDDM and important information on the extrinsic (social, cultural, environmental) risk determinants. Studies have highlighted the importance of regional adipose tissue distribution, particularly upper-body obesity, and physical inactivity in enhancing risk of NIDDM. These findings have important implications for the primary prevention of NIDDM, particularly in populations with increased genetic susceptibility such as Polynesians, Micronesians, American and Asian Indians, Mexican Americans, and Australian aborigines.

Community-based exercise and weight control: diabetes risk reduction and glycemic control in Zuni Indians

Cardiovascular disease is a significant health problem for the Zuni Indians of southwest New Mexico, in part because of high rates of non-insulin-dependent diabetes mellitus (NIDDM). The Zuni Diabetes Project was initiated in July 1983 to reduce rates of obesity and provide primary and secondary prevention of NIDDM. Two studies of the project's activities have been carried out to date. After 2 y of follow-up, diabetic participants in an exercise program compared with diabetic nonparticipants experienced weight loss, a drop in fasting blood glucose values, and reductions in the use of hypoglycemic medications. In a weight-loss competition, 45% (122/271) of the enrollees finished and lost greater than or equal to 2.3 kg. The results of these two studies demonstrate that 1) participation in a community-based exercise program can produce significant weight loss and improvement in glycemic control in Zuni Indians with NIDDM and 2) weight-loss competitions appear to be an important public health model for health-behavior change in communities similar to that of Zuni, NM.

Drug consumption in elderly diabetics

The drug use in 228 persons with diabetes was studied and compared with that of sex- and age-matched non-diabetic controls — all of whom were found by the screening of a well-defined Danish population aged 60–74 years. Ninety per cent of the diabetics had non-insulin-dependent diabetes mellitus (NIDDM), as evaluated by a glucagon-C-peptide test. Information on daily use of prescribed and non-prescribed drugs was obtained by questionnaires and interviews. More than 80% of the diabetics used drugs daily, compared to 55% of control subjects ( P<0.00001). Among subjects using drugs diabetics, on average, used 70% more defined daily doses (DDD) than controls, even when antidiabetics were excluded. There was no difference in the number of drug users among subgroups of diabetics when divided according to antidiabetic treatment but tablet-treated diabetics, on average, used 20% fewer DDD than other diabetics. Cardiovascular drugs were the most commonly used drugs. Diabetics in all antidiabetic treatment groups used significantly more cardiovascular drugs than non-diabetics. Diabetics treated with oral antidiabetics used fewer cardiovascular drugs than insulin- and diet-treated diabetics. The estimated cost of drug therapy was more than 2.5 times higher for diabetics than for the control group. Our results reflect the increased morbidity among elderly diabetics and emphasise, together with other aspects of costs of diabetes in the elderly, the need for allocating resources for the prevention of NIDDM instead of the treatment of its complications.

Primary prevention of diabetes mellitus.

Two-thirds of all deaths in developed countries are caused by the major noncommunicable diseases, e.g., cardiovascular disease, cancer, and non-insulin-dependent diabetes mellitus (NIDDM). There is increasing evidence that these diseases are a consequence of life-style change, and they have a number of risk factors in common. Primary prevention of both insulin-dependent diabetes mellitus (IDDM) and NIDDM has become increasingly important because of their significant morbidity and mortality and the human and economic costs associated with diabetes and its complications. Prevention of the two major forms of diabetes, IDDM and NIDDM, are quite separate issues. The former appears to be an autoimmune disorder, whereas the latter should be considered along with other life-style-related noncommunicable diseases. The primary prevention of NIDDM appears to offer the greatest promise of success. The uncertainty that still exists as to the role of obesity and other risk factors in the development of NIDDM gives support to a multiple-risk-factor intervention approach (through a healthy life-style strategy) for NIDDM prevention.