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Asymptomatic unruptured intracranial aneurysms in the older people. Eur Geriatr Med 2019; 10:119-127. [PMID: 32720269 PMCID: PMC7385013 DOI: 10.1007/s41999-018-0122-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022]
Abstract
Purpose Unruptured intracranial aneurysm commonly occurs in the older people. Because the rupture risk increases with age, the factors associated with aneurysms might be different according to age. We aimed to evaluate unruptured intracranial aneurysm characteristics in healthy, symptom-free older patients. Methods Patients who visited the health examination center of two regional university hospitals and underwent computed tomography angiography between March 2001 and March 2017 were included. The putative aneurysm risk factors were identified; the aneurysm size and shape were determined by CT angiography, and measuring the ASPECT and dome/neck ratios. All images were interpreted independently by a neurosurgeon and a neurologist for improving size measurement accuracy. Results The unruptured intracranial aneurysm prevalence was 2.23% and 2.75% in the patients aged ≤ 60 and > 60 years, respectively. Among the younger group, female sex [odds ratio (OR), 1.85; P = 0.002], age (OR, 1.05; P < 0.001), hypertension (OR, 1.88; P < 0.001), coronary artery disease (OR, 0.26; P < 0.001), smoking (OR, 2.04; P < 0.001), and stroke family history (OR, 1.36; P = 0.047) were independently associated with aneurysm; anterior communicating artery aneurysms were the largest. Among the older group, female sex (OR, 1.76; P = 0.005), hypertension (OR, 2.54; P < 0.001), coronary artery disease (OR, 0.27; P < 0.001), and stroke family history (OR, 1.94; P = 0.003) were independently associated with aneurysm; internal carotid artery aneurysms were the largest. Conclusions The factors related to unruptured intracranial aneurysm formation varied by age, and coronary artery disease protected against aneurysm formation regardless of age. The factors affecting unruptured intracranial aneurysm formation are different according to age and aneurysm location.
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Wang H, Lin X, Zhang Z, Wang Q, Chen JM, Liu J, Yuan L. The economic burden of inpatients with type 2 diabetes: a case study in a Chinese hospital. Asia Pac J Public Health 2015; 27:49S-54S. [PMID: 25700857 DOI: 10.1177/1010539515572220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this research was to study the components, influencing factors, and their changing trend in a Chinese hospital, so as to reduce the economic burden of inpatients with type 2 diabetes. Data were collected from 7487 cases. There were 4368 inpatients with type 2 diabetes during 2002-2012 in a Chinese hospital. Multivariate linear regression analysis was performed to explore the influencing factors of hospitalization costs. The number of inpatients and their hospitalization costs had increasing trends in the study period. The medicine, test, and examination charges were the main sources of total costs. Longer hospital stays, older ages, and more times of hospitalization led to higher medical costs. Actions should be taken on all fronts to control the rapidly increasing trend of hospitalization costs and to reduce hospital stays and the number of times of hospitalization to reduce the economic burden of diabetic inpatients.
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Affiliation(s)
- Hao Wang
- Wuhan University, School of Public Health/Global Health Institute, Wuhan, China
| | - Xuan Lin
- WISCO General Hospital, Wuhan, China
| | - Zhi Zhang
- WISCO General Hospital, Wuhan, China
| | - Quan Wang
- Wuhan University, School of Public Health/Global Health Institute, Wuhan, China
| | | | - Jing Liu
- WISCO General Hospital, Wuhan, China
| | - Li Yuan
- WISCO General Hospital, Wuhan, China
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Kim NH, Kim DJ, Park SW, Oh JY, Park JY, Shin C, Lee HK, Park Y. Plasma glucose regulation and mortality in Korea: a pooled analysis of three community-based cohort studies. Diabetes Metab J 2014; 38:44-50. [PMID: 24627827 PMCID: PMC3950194 DOI: 10.4093/dmj.2014.38.1.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/09/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although diabetes is a well-known risk factor for death, its impact on cancer death is not clearly understood. Furthermore, it remains controversial whether impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are associated with increased risk of mortality. We investigated the impact of diabetes or glucose tolerance categories on all cause and cause-specific mortality. METHODS Mortality analysis was conducted in three population-based cohort studies of 3,801 participants, divided according to fasting plasma glucose (FPG) (normal; stage 1 IFG [5.6≤FPG<6.1 mmol/L]; stage 2 IFG [6.1≤FPG<7.0 mmol/L]; diabetes mellitus [DM]-FPG); or 2-hour glucose after 75 g glucose loading (2hPG) (normal; IGT; DM-2hPG), or a combination of FPG and 2hPG criteria. RESULTS During a median follow-up of 11.0 years, 474 subjects died from all causes. Hazard ratios (HRs) for all cause death were higher in those with diabetes as defined by either FPG or 2hPG criteria than their normal counterparts (HR, 2.2, 95% confidence interval [CI], 1.6 to 2.9 for DM-FPG; HR, 2.0, 95% CI, 1.5 to 2.7 for DM-2hPG). Similarly, diabetes defined by either FPG or 2hPG was associated with cancer death (HR, 2.9, 95% CI, 1.7 to 5.0; and HR, 2.1, 95% CI, 1.2 to 3.9, respectively). Although neither IFG nor IGT conferred higher risk for death, when combining stage 2 IFG and/or IGT, the risk of all cause death was higher than in subjects with normal glucose regulation (HR, 1.3; 95% CI, 1.0 to 1.6). CONCLUSION Diabetes is associated with higher risk of death from all causes and cancer. In subjects without diabetes, stage 2 IFG and/or IGT confers increased risk for mortality.
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Affiliation(s)
- Nan Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Seok Won Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jee-Young Oh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Joong-Yeol Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hong Kyu Lee
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Yongsoo Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine and Bioengineering, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea
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Wood AC, Kabagambe EK, Borecki IB, Tiwari HK, Ordovas JM, Arnett DK. Dietary Carbohydrate Modifies the Inverse Association Between Saturated Fat Intake and Cholesterol on Very Low-Density Lipoproteins. Lipid Insights 2011; 2011:7-15. [PMID: 21912485 DOI: 10.4137/lpi.s7659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We aimed to investigate the relationship between dietary saturated fat on fasting triglyceride (TG) and cholesterol levels, and any mediation of this relationship by dietary carbohydrate intake. Men and women in the NHLBI Genetics of Lipid-Lowering Drugs and Diet Network (GOLDN) study (n = 1036, mean age ± SD = 49 ± 16 y) were included. Mixed linear models were run with saturated fat as a predictor variable and fasting TG, very low density lipoprotein cholesterol (VLDL-C), low density cholesterol (LDL-C) and high density cholesterol (HDL-C) as separate outcome variables. Subsequent models were run which included dietary carbohydrate as a predictor variable, and an interaction term between saturated fat and carbohydrate. All models controlled for age, sex, BMI, blood pressure and dietary covariates. In models that included only saturated fat as a predictor, saturated fat did not show significant associations with fasting lipids. When carbohydrate intake and an interaction term between carbohydrates and saturated fat intake was included, carbohydrate intake did not associate with lipids, but there was an inverse relationship between saturated fat intake and VLDL-C (P = 0.01) with a significant interaction (P = 0.01) between saturated fat and carbohydrate with regard to fasting VLDL-C concentrations. Similar results were observed for fasting TG levels. We conclude that, when controlling for carbohydrate intake, higher saturated fat was associated with lower VLDL-C and TGs. This was not the case at higher intakes of carbohydrate. This has important implications for dietary advice aimed at reducing TG and VLDL-C levels.
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Lee HY, Won JC, Kang YJ, Yoon SH, Choi EO, Bae JY, Sung MH, Kim HR, Yang JH, Oh J, Lee YM, Park NH, Ko KS, Rhee BD. Type 2 diabetes in urban and rural districts in Korea: factors associated with prevalence difference. J Korean Med Sci 2010; 25:1777-83. [PMID: 21165294 PMCID: PMC2995233 DOI: 10.3346/jkms.2010.25.12.1777] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 08/06/2010] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study was to examine the urban-rural differences in the prevalence and associated factors with type 2 diabetes mellitus (T2DM) in Korean adults. A total of 1,060 adults >30 yr of age from urban (189 males and 331 females) and rural districts (219 males and 321 females) were recruited. Anthropometric measures, blood pressure, lipid profiles, and fasting and 2-hr after 75-g oral glucose load blood glucose were obtained. The crude- and age-standardized prevalence of T2DM was 15.4% and 14.5%, and 11.7% and 8.6% in urban and rural districts, respectively. Diabetic subjects were older and obese, and had a higher triglyceride level, and systolic blood pressure compared to non-diabetes in both population. Multivariate regression analysis revealed that older age, high triglyceride levels, central obesity, and hypertension were significantly associated with T2DM in both areas. Low monthly incomes were significantly associated with T2DM in urban population, while a family history of T2DM was significantly associated with T2DM in rural area. T2DM is more prevalent in urban than in rural population, and low economic status or genetic factor is differently associated with T2DM in both population, respectively.
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Affiliation(s)
- Hye Young Lee
- Department of Internal Medicine, Mitochondrial Research Group Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jong Chul Won
- Department of Internal Medicine, Mitochondrial Research Group Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Yoon Jung Kang
- Department of Internal Medicine, Mitochondrial Research Group Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sook Hee Yoon
- Department of Nursing and Institute for Health Science Research, Inje University College of Medicine, Seoul, Korea
| | - Eun Ok Choi
- Department of Nursing and Institute for Health Science Research, Inje University College of Medicine, Seoul, Korea
| | - Jeong Yee Bae
- Department of Nursing and Institute for Health Science Research, Inje University College of Medicine, Seoul, Korea
| | - Mi Hae Sung
- Department of Nursing and Institute for Health Science Research, Inje University College of Medicine, Seoul, Korea
| | - Hye-Ryoung Kim
- Department of Nursing and Institute for Health Science Research, Inje University College of Medicine, Seoul, Korea
| | - Jin Hyang Yang
- Department of Nursing and Institute for Health Science Research, Inje University College of Medicine, Seoul, Korea
| | - Jina Oh
- Department of Nursing and Institute for Health Science Research, Inje University College of Medicine, Seoul, Korea
| | - Yun Mi Lee
- Department of Nursing and Institute for Health Science Research, Inje University College of Medicine, Seoul, Korea
| | - Nam Hee Park
- Department of Nursing and Institute for Health Science Research, Inje University College of Medicine, Seoul, Korea
| | - Kyung Soo Ko
- Department of Internal Medicine, Mitochondrial Research Group Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byoung Doo Rhee
- Department of Internal Medicine, Mitochondrial Research Group Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, Jang HC, Cho YM, Song KH, Ahn CW, Sung YA, Park JY, Shin C, Lee HK, Park KS. A report on the diagnosis of intermediate hyperglycemia in Korea: A pooled analysis of four community-based cohort studies. Diabetes Res Clin Pract 2008; 80:463-8. [PMID: 18339440 DOI: 10.1016/j.diabres.2008.01.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 01/17/2008] [Indexed: 11/16/2022]
Abstract
Many studies show poor agreement between fasting plasma glucose (FPG)-based and 2-h postchallenge glucose (2-h PG)-based criteria to assess glucose metabolism. We examined the rate of agreement between FPG- and 2-h PG-based criteria in the diagnosis of intermediate hyperglycemia in four representative cohort studies in South Korea and compared the clinical characteristics and biochemical parameters in subjects with impaired fasting glucose (IFG) according to their FPG values. Of 6234 subjects from four population-based studies performed from 1993 to 2000, 4610 individuals with data from a 75g oral glucose tolerance test (OGTT) and no previous history of diabetes were selected. We examined the concordance rate between the FPG and 2-h PG-based criteria. We also investigated the differences in the clinical characteristics and biochemical parameters between individuals with IFG according to their FPG values. The fasting and 2-h PG criteria had large discordance rates in the diagnosis of diabetes and impaired glucose tolerance (IGT) in Korean adults. When individuals with IFG were classified into stage 1 [5.6-6.1mmol/L (100-109mg/dL)] and stage 2 [6.1-7.0mmol/L (110-125mg/dL)] IFG, individuals with stage 2 IFG are more obese and had higher blood pressure and total cholesterol and triglycerides concentrations compared with those with stage 1 IFG. In addition, more individuals with stage 2 IFG were with diabetes as determined by a 2-h PG>or=11.1mmol/L (14.1% vs. 1.9%) (P<0.05). Considering the poorer metabolic profile and higher percentage of people with diabetes by OGTT, these data indicate that, in the Korean population, individuals with stage 2 IFG should be treated differently from those with stage 1 IFG. To detect more cases of diabetes, the OGTT is recommended for all individuals with stage 2 IFG and cases with stage 1 IFG with some additional risk factors for diabetes.
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Affiliation(s)
- Jee-Young Oh
- Department of Internal Medicine, School of Medicine Ewha Womans University, Seoul, Korea
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Song KH, Nam-Goomg IS, Han SM, Kim MS, Lee EJ, Lee YS, Lee MS, Yoon S, Lee KU, Park JY. Change in prevalence and 6-year incidence of diabetes and impaired fasting glucose in Korean subjects living in a rural area. Diabetes Res Clin Pract 2007; 78:378-84. [PMID: 17544540 DOI: 10.1016/j.diabres.2007.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 04/24/2007] [Indexed: 12/14/2022]
Abstract
AIMS To determine the change in prevalence, incidence and risk factors associated with diabetes and impaired fasting glucose (IFG) in a rural Korean area. METHODS Initially a total of 1119 subjects (424 men and 695 women) aged 31-99 years were recruited in 1997. Baseline clinical data and various laboratory values were obtained. Six years later, we visited the same area and measured similar parameters in 814 subjects (316 men and 498 women) of which 558 were original participants and 256 subjects were new. Incidence and risk factors of diabetes were analyzed in 518 subjects. Diabetes and IFG were defined according to American Diabetes Association criteria. RESULTS Age- and sex-adjusted prevalence of diabetes in 1997 was 6.9%, increasing to 11.7% in 2003. The prevalence of IFG increased alarmingly from 21.9% in 1997 to 38.8% in 2003. The age- and sex-adjusted incidence rate of diabetes was 16.3 per 1000 person-years. Baseline fasting plasma glucose, 2h post-load glucose, abdominal circumference and urinary albumin excretion rate (UAER) acted as independent risk factors for diabetes in a multivariate logistic regression analysis. CONCLUSIONS The prevalence of diabetes and IFG increased markedly from 1997 to 2003, indicating the need for urgent preventive measures. Fasting and 2h post-load glucose, abdominal circumference and UAER independently predicted the development of diabetes in this rural Korean population.
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Affiliation(s)
- K-H Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
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Oh JY, Lim S, Kim DJ, Kim NH, Kim DJ, Moon SD, Jang HC, Cho YM, Song KH, Park KS. The diagnosis of diabetes mellitus in Korea: a pooled analysis of four community-based cohort studies. Diabet Med 2007; 24:217-8. [PMID: 17257287 DOI: 10.1111/j.1464-5491.2007.02051.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ko SH, Song KH, Kim SR, Lee JM, Kim JS, Shin JH, Cho YK, Park YM, Jeong JH, Yoon KH, Cha BY, Son HY, Ahn YB. Long-term effects of a structured intensive diabetes education programme (SIDEP) in patients with Type 2 diabetes mellitus--a 4-year follow-up study. Diabet Med 2007; 24:55-62. [PMID: 17227325 DOI: 10.1111/j.1464-5491.2007.02013.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Patient education is a very important part of diabetes care. However, until now, little data has been presented about the long-term effectiveness of structured intensive diabetes education programmes (SIDEP) for people with Type 2 diabetes mellitus. METHODS People with Type 2 diabetes (n = 547) hospitalized from December 1999 to December 2000 were randomly assigned to two groups. Two hundred and nineteen patients undertook an inpatient SIDEP and the remaining patients received conventional glycaemic control without intensive education. After discharge, all patients were monitored regularly. Laboratory data were obtained, and adherence to self-care behaviour was determined on a five-point scale by questionnaires completed annually. RESULTS Of the patients who completed the SIDEP, 160 (73.1%) were followed up for more than 4 years. The mean HbA(1c) (7.9 +/- 1.2 vs. 8.7 +/- 1.6%; P < 0.05) and the frequency of hospitalization related to diabetes per patient per year (0.3 +/- 0.6 vs. 0.8 +/- 0.9; P < 0.05) was significantly lower in the SIDEP group than in the control group. The SIDEP group adhered more closely to self-care behaviour than the control group over 4 years (P < 0.05). People with Type 2 diabetes mellitus of longer duration and those treated with insulin had poorer HbA(1c) at follow-up. CONCLUSIONS A well-designed, intensive patient education programme is necessary for people with diabetes. However, regular and sustained reinforcement with encouragement is also required to maintain optimal glycaemic control, especially in insulin-treated patients.
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Affiliation(s)
- S-H Ko
- Department of Inteernal Medicine, The Catholic University of Korea, Seoul, South Korea
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Choi YJ, Cho YM, Park CK, Jang HC, Park KS, Kim SY, Lee HK. Rapidly increasing diabetes-related mortality with socio-environmental changes in South Korea during the last two decades. Diabetes Res Clin Pract 2006; 74:295-300. [PMID: 16707191 DOI: 10.1016/j.diabres.2006.03.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2005] [Accepted: 03/30/2006] [Indexed: 10/24/2022]
Abstract
Diabetes mellitus is the result of complex interactions involving many genes and environmental factors, and rapid socio-environmental changes have been strongly associated with the development of diabetes. In this study, we examined the trends in diabetes mortality and associated socio-environmental changes that have occurred in South Korea over the last 20 years. Data from a national database and government reports for the years from 1983 to 2001 were analyzed. The data included mortality, socio-economic changes, physical activity and dietary pattern indicators. Deaths from diabetes per 100,000 people increased from 5.3 in 1983 to 18.4 in 2001. Along with increasing diabetes-related mortality, many socio-economic indices (gross domestic production, proportion of tertiary industry and urbanization rate), proxies for physical activity (numbers of cars and time spent watching television) and diet indices (animal protein intake and fat intake) showed remarkable changes. To counter increasing prevalence of diabetes and its related mortality in South Korea, multidirectional efforts including lifestyle modification should be mandatory features of future public health policy.
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Affiliation(s)
- Young Ju Choi
- Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-dong Chongno-gu, Seoul 110-744, Republic of Korea
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Kim SM, Lee JS, Lee J, Na JK, Han JH, Yoon DK, Baik SH, Choi DS, Choi KM. Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001. Diabetes Care 2006; 29:226-31. [PMID: 16443864 DOI: 10.2337/diacare.29.02.06.dc05-0481] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to estimate the prevalence of diabetes and impaired fasting glucose (IFG) and their association with risk factors in the Korean population. RESEARCH DESIGN AND METHODS The Korean National Health and Nutrition Survey 2001 was a nationally representative survey with a stratified multistage sampling design. Data from a comprehensive questionnaire, a physical examination, and blood tests were obtained from 5,844 Korean adults (2,513 men and 3,331 women) aged >20 years. RESULTS The age-adjusted prevalence of diabetes in this Korean population was 7.6%, and the age-adjusted prevalences of previously diagnosed diabetes and newly diagnosed diabetes were 4.4 and 3.3%, respectively (fasting plasma glucose > or = 7.0 mmol/l). Overall, these results indicate that 8.1% or 1.4 million Korean men and 7.5% or 1.3 million Korean women have diabetes. The age-adjusted prevalence of IFG was 23.9%, using the new American Diabetes Association criteria (fasting plasma glucose 5.6-6.9 mmol/l). Diabetes prevalence increased with age and peaked in the oldest age-group; however, IFG prevalence did not show the same trend. Diabetes was found to be associated with age, BMI, blood pressure, triglyceride, HDL cholesterol, education levels, alcohol consumption, exercise, and a family history of diabetes. CONCLUSIONS This study shows that diabetes and IFG are common in Korea, and about one-half of diabetes cases remain undiagnosed. These results emphasize the need to develop an urgent public program to improve the detection, prevention, and treatment of diabetes.
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Affiliation(s)
- S M Kim
- Department of Family Medicine, Korea University College of Medicine, Seoul, Korea
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Kim DJ, Cho NH, Noh JH, Kim HJ, Choi YH, Jung JH, Min YK, Lee MS, Lee MK, Kim KW. Fasting plasma glucose cutoff value for the prediction of future diabetes development: a study of middle-aged Koreans in a health promotion center. J Korean Med Sci 2005; 20:562-5. [PMID: 16100444 PMCID: PMC2782148 DOI: 10.3346/jkms.2005.20.4.562] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We determined optimal fasting plasma glucose (FPG) cutoff values predictive of future diabetes development in a group of middle-aged Koreans who visited a health promotion center. The medical records of 2,964 subjects, who attended the Health Promotion Center in 1998 and 2003, were examined. Subjects were classified into four groups according to their baseline FPG values (Group 1:FPG <5.0 mM/L; Group 2: 5.0< or =FPG <5.6 mM/L; Group 3: 5.6< or =FPG <6.1 mM/L; Group 4: 6.1< or =FPG <7.0 mM/L). No significant difference was observed between Group 1 and Group 2 in terms of diabetes incidence. However, incidence in Group 3 was significantly higher than that in Group 1 [hazards ratio 4.88 (1.65-14.41), p=0.004] and the hazards ratio in Group 4 for diabetes was 36.91 (13.11-103.61), p<0.001, versus Group 1. Receiver operator characteristics curve analysis showed that an FPG of 5.97 mM/L represents the lower limit and gives the best combination of sensitivity and specificity. Our data shows that the risk of future diabetes development started to increase below an FPG of 6.1 mM/L and suggests the importance of efforts to modify diabetes development risk factors at lower impaired fasting glucose levels.
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Affiliation(s)
- Dong-Jun Kim
- Department of Internal Medicine, Ilsan-Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Nam-Han Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jung-Hyun Noh
- Department of Internal Medicine, Ilsan-Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hyun-Jin Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Ho Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hoon Jung
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Ki Min
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung-Shik Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang-Won Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Söderberg S, Zimmet P, Tuomilehto J, de Courten M, Dowse GK, Chitson P, Gareeboo H, Alberti KGMM, Shaw JE. Increasing prevalence of Type 2 diabetes mellitus in all ethnic groups in Mauritius. Diabet Med 2005; 22:61-8. [PMID: 15606693 DOI: 10.1111/j.1464-5491.2005.01366.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To describe the prevalence of different stages of glucose intolerance in a population from Mauritius followed over 11 years. METHODS Population-based surveys were undertaken in the multiethnic nation of Mauritius in 1987, 1992 and 1998, with 5083, 6616, and 6291 participants, respectively. Questionnaires, anthropometric measurements, and a 2-h 75-g oral glucose tolerance test were included. Subjects aged between 25 and 75 years with classifiable data were identified; 4991, 6463 and 5392 from 1987, 1992 and 1998, respectively. Glucose tolerance was classified according to WHO 1999 criteria. RESULTS The prevalence of Type 2 diabetes increased significantly during the period studied, from 12.8% in 1987, to 15.2% in 1992, and 17.9% in 1998. The increasing prevalence was seen in both men and women, and in all age groups. The prevalence of known diabetes (KDM) increased progressively, and more markedly than the increase in newly diagnosed diabetes (NDM). A diagnosis of impaired glucose tolerance (IGT) was more prevalent amongst women whereas impaired fasting glucose (IFG) was more common amongst men. The prevalences of IGT and IFG did not change markedly during the period. The prevalence of diabetes and IGT was similar for participants of Indian, Creole and Chinese background in each survey, and the increasing prevalence of diabetes was seen in all ethnic groups. CONCLUSION In this study, we report an increasing prevalence of diabetes over an 11-year period in Mauritius. This increase was seen in both sexes, and in all age and ethnic groups, and was mainly due to an increase in the numbers of those with known diabetes.
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Affiliation(s)
- S Söderberg
- International Diabetes Institute, Melbourne, Australia.
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15
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Aekplakorn W, Stolk RP, Neal B, Suriyawongpaisal P, Chongsuvivatwong V, Cheepudomwit S, Woodward M. The prevalence and management of diabetes in Thai adults: the international collaborative study of cardiovascular disease in Asia. Diabetes Care 2003; 26:2758-63. [PMID: 14514576 DOI: 10.2337/diacare.26.10.2758] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to determine in Thai adults aged >or=35 years the prevalence and management of diabetes and the associations of diabetes with cardiovascular risk factors. RESEARCH DESIGN AND METHODS The International Collaborative Study of Cardiovascular Disease in Asia was a complex sample survey. Data from a structured questionnaire, brief physical examination, and blood sample were collected from 5,105 individuals aged >or=35 years (response rate 68%). Population estimates were calculated by applying sampling weights derived from the 2000 Thai census. RESULTS The estimated national prevalence of diabetes in Thai adults was 9.6% (2.4 million people), which included 4.8% previously diagnosed and 4.8% newly diagnosed. The prevalence of impaired fasting glucose was 5.4% (1.4 million people). Diagnosed diabetes, undiagnosed diabetes, and impaired fasting glucose were associated with greater age, BMI, waist-to-hip ratio, systolic blood pressure, total cholesterol, and serum creatinine levels. The majority of individuals with diagnosed diabetes had received dietary or other behavioral advice, and 82% were taking oral hypoglycemic therapy. Blood pressure-lowering therapy was provided to 67% of diagnosed diabetic patients with concomitant hypertension. CONCLUSIONS Diabetes is common in Thailand, but one-half of all cases are undiagnosed. Because diagnosed diabetes is likely to be treated with proven, low-cost, preventive therapies such as glucose lowering and blood pressure lowering, initiatives that increased diagnosis rates would be expected to produce substantial health benefits in Thailand.
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Affiliation(s)
- Wichai Aekplakorn
- Community Medicine Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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16
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Richard JL, Sultan A, Daures JP, Vannereau D, Parer-Richard C. Diagnosis of diabetes mellitus and intermediate glucose abnormalities in obese patients based on ADA (1997) and WHO (1985) criteria. Diabet Med 2002; 19:292-9. [PMID: 11943000 DOI: 10.1046/j.1464-5491.2002.00647.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM To assess the accuracy of the 1997 ADA criteria for diagnosing diabetes mellitus and related glucose disturbances in comparison with the reference WHO 1985 criteria in obese subjects. PATIENTS AND METHODS In 286 men and 881 women, 15-84 years of age, with obesity (body mass index (BMI) > or = 30 kg/m2), an oral glucose tolerance test (OGTT) was carried out according to WHO standard. Patients were classified into three categories of glucose tolerance using WHO 1985 (Normal Glucose Tolerance (NGT), Impaired Glucose Tolerance (IGT) and Diabetes Mellitus (DM)) and ADA (Normal Fasting Glucose (NFG), Impaired Fasting Glucose (IFG) and DM) criteria. Prevalence of each category was compared and agreement between the two classifications was assessed. The relation between fasting plasma glucose value and diabetes, as diagnosed by WHO 1985 criteria, was studied using various regression models, cumulative frequency curves, Finch method and ROC curve. RESULTS Compared with WHO 1985, ADA criteria strongly underestimated the prevalence rate of diabetes (3.7% vs. 10.6%) and intermediate glucose abnormalities (6.0% vs. 22.4%). Agreement between the two classifications was poor (kappa = 0.23). Moreover, many patients defined as glucose-intolerant by the WHO 1985 criteria were shifted to a more favourable metabolic status by ADA criteria. Thus, ADA criteria failed to detect 69% of WHO diabetic patients and 89% with IGT were considered as normal. According to the method, cut-off value of fasting blood glucose for detecting WHO 1985-diagnosed diabetes varied widely, from 5.3 to 6.3 mmol/l and none was satisfactory because of poor sensitivity and positive predictive value. CONCLUSION The ADA criteria do not appear to be a good substitute for those of the WHO 1985 at identifying diabetes and intermediate glucose abnormalities in an obese population. Since it appears impossible to determine a reliable cut-off value for fasting blood glucose to identify diabetic obese subjects with sufficient sensitivity, our results justify the retention of the OGTT in clinical practice or for epidemiological studies.
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Affiliation(s)
- J-L Richard
- Department for Nutritional Diseases and Diabetology, Medical Centre, University Hospital of Nîmes, Le Grau du Roi, France.
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17
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Abstract
Insulin resistance syndrome (IRS) is a cluster of prevalent conditions including glucose intolerance, hypertension and dyslipidemia, which commonly predispose to cardiovascular disease. However, the mechanism by which IRS is related with cardiovascular disease is not yet settled. Recently, it has been hypothesized that atherosclerosis is an inflammatory disease and that an increase in oxidative stress plays a key role in causing endothelial dysfunction associated with atherosclerosis. There has been, however, no study directly relating IRS with oxidative stress in human subjects. We measured various markers of oxidative stress among subjects who participated in a population-based epidemiological study performed in 1996. IRS was defined as non-diabetic subjects having more than two of three salient features of the syndrome (glucose intolerance, hypertriglyceridemia/low high density lipoprotein (HDL)-cholesterol and hypertension). The subjects with IRS (n=70) showed higher plasma malondialdehyde (MDA; 2.10+/-1.43 vs. 1.63+/-1.21 micromol/ml, P=0.009), homocysteine (16.32+/-8.34 vs. 13.06+/-6.49 micromol/l, P=0.002) and ceruloplasmin concentrations (29.80+/-5.28 vs. 27.39+/-5.10 mg/dl, P=0.002) than control subjects (n=196). Plasma MDA concentration was positively correlated with waist-to-hip ratio (r=0.124, P=0.044), and with plasma triglyceride (TG; r=0.163, P=0.008), ferritin (r=0.200, P=0.002) and homocysteine concentrations (r=0.136, P=0.032). These results suggest that increase in oxidative stress may contribute to the development of cardiovascular disease in IRS.
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Affiliation(s)
- K U Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, 388-1 Songpa-gu Pungnap-dong, 138-040, Seoul, South Korea.
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