Sex distribution and frequency of diabetic concomitants of complications

The data herein presented or reviewed indicate that the prevalence of concomitants or complications of diabetes such as hypertension, obesity, retinopathy, neuropathy, etc. may vary greatly from clinic to clinic. Though variable diagnostic criteria, observer error, ethnic or national differences may account for some of the disparity, selection of patients through death, economic factors, etc., which results in clinic rosters which are not representative of the total diabetic population also plays a role of undetermined significance. Hence definitive statements concerning the relative predisposition of males and females to concomitants or complications of diabetes must await standardization of population and criteria, data on incidence as well as prevalence, and expression of such data on a cumulative basis. Until then we can only speak of findings in limited populations because we have as yet no basis for intergroup comparisons.

The duration of unrecognized diabetes mellitus

If the age specific prevalence rates for known and unrecognized diabetics are known, deduction can be made of the rates at which cases are moving in and out of these categories and, therefore, the average time spent in each category. For example, if between the age of forty and fifty the number of known diabetics in a population increased from 300 to 600, then the increase (300 over ten years) indicates that previously unrecognized diabetics have become recognized at an average rate of thirty per year. Similarly, if the number of unrecognized diabetics has in-creased from 400 to 900, the unrecognized group has been increasing at an average rate of fifty per year. If the rate at which death has been removing persons from each group is known, it is possible to form a theoretical model and calculate approximately how long a person is likely lo remain in the unrecognized category.

When the calculations are carried through, it appears that the average length of time spent in the unrecognized category is of the order of ten to twelve years. Unfortunately, some of the steps in the calculations are based on unknown factors, and in assuming arbitrary values for these factors, there will be some error introduced into the final estimate. Since the method of calculation may be of interest and value, however, the argument will be presented in detail.

When a new case of diabetes mellitus is diagnosed, it is not known how long the disease has been present. In this paper an attempt is made to deduce from epidemiological data the average length of time between development of impaired carbohydrate tolerance and diagnosis.

A survey for unknown diabetics in a mental hospital. I. Men under age fifty

A 100-gm., two-hour, oral glucose tolerance test was given to an institutional group of 359 mentally ill men under age fifty without known diabetes. The test was selectively repeated. In 11.7 per cent of the group, results were interpreted, in association with other data, as being consistent with previously unknown, unsuspected diabetes. It occurred more frequently among the older, the overweight and those with diabetic relatives, resembling the prevalence of known diabetes in the general population. The relatively high incidence of previously unknown diabetes that was discovered in the group is ascribed to their age range, commonness of overweight and the method of study.

Further investigation is required to determine if prolonged phenothiazine therapy may be a contributory diabetogenic influence.

Glucose tolerance, nutrition, and diabetes in Uruguay, Venezuela, Malaya, and East Pakistan

In each of four countries (Uruguay, Venezuela, Malaya and East Pakistan) where diets and other environmental factors differ greatly, the prevalence of diabetes as determined by impaired glucose tolerance was crudely estimated.

Since all subjects received glucose loads, rates of prevalence are much higher than those obtainable by certain less sensitive standard methods. In the tested subjects over thirty years of age the prevalence of “diabetes” (two-hour venous blood glucose levels greater than 149 mg. per 100 ml.) was 6.9 per cent in Uruguay (6.8 per cent for males and 6.9 per cent for females). The prevalence of impaired tolerance in this age group in Venezuela was 7.3 per cent (4.5 per cent in males and 9.4 per cent in females), while in Malaya the rate was only 3.5 per cent (4.5 per cent in males and 2.1 per cent in females). In East Pakistan impaired tolerance was present in only 1.5 per cent of this age group (1.2 per cent of males and 2.8 per cent of females). Comparable data are not available in the United States but with use of the technics employed abroad it was found that 17.2 per cent of volunteers in this age group in a Pennsylvania community had impaired tolerance.

In East Pakistan, 83 per cent of calories were derived from carbohydrate. Comparable figures were 77 per cent for Malaya, 62 per cent for Venezuela and 53 per cent for Uruguay. In East Pakistan, only 7 per cent of the dietary calories were derived from fat; in Malaya, fat accounted for 21 per cent of dietary calories, in Venezuela, 24 per cent, and in Uruguay, 33 per cent. In East Pakistan only 29 per cent of dietary fat was animal fat. In Malaya, Venezuela, and Uruguay, comparable figures were 30, 35 and 62 per cent, respectively.

In Uruguay, 34.4 per cent of the subjects were “obese” (30 per cent or more over “standard” weight), and in Venezuela 14.8 per cent were obese. In contrast none of the subjects from Malaya (566 persons), or East Pakistan (519 persons), was obese by these criteria.

In Venezuela and Uruguay there was an association between the prevalence of diabetes and both parity and a history of large babies.