To estimate the prevalence and incidence of diabetes, clinical characteristics, and risk factors for chronic complications among Navajo youth, using data collected by the SEARCH for Diabetes in Youth Study (SEARCH study).The SEARCH study identified all prevalent cases of diabetes in 2001 and all incident cases in 2002-2005 among Navajo youth. We estimated denominators with the user population for eligible health care facilities. Youth with diabetes also attended a research visit that included questionnaires, physical examination, blood and urine collection, and extended medical record abstraction.Diabetes is infrequent among Navajo youth aged <10 years. However, both prevalence and incidence of diabetes are high in older youth. Among adolescents aged 15-19 years, 1 in 359 Navajo youth had diabetes in 2001 and 1 in 2,542 developed diabetes annually. The vast majority of diabetes among Navajo youth with diabetes is type 2, although type 1 diabetes is also present, especially among younger children. Navajo youth with either diabetes type were likely to have poor glycemic control, high prevalence of unhealthy behaviors, and evidence of severely depressed mood. Youth with type 2 diabetes had more metabolic factors associated with obesity and insulin resistance (abdominal fat deposition, dyslipidemia, and higher albumin-to-creatinine ratio) than youth with type 1 diabetes.Our data provide evidence that diabetes is an important health problem for Navajo youth. Targeted efforts aimed at primary prevention of diabetes in Navajo youth and efforts to prevent or delay the development of chronic complications among those with diabetes are warranted.
Objectives: To determine whether Hispanics are at lower risk for the development of hypertension than non-Hispanic Whites. We also examined selected predictors of hypertension incidence and explored the role of markers of insulin resistance in the development of hypertension. Design A cohort study of a geographically-based sample of Hispanic and non-Hispanic white southern Colorado residents who were re-examined an average of 4 years after their baseline examination. Methods: These analyses included 664 participants who were normotensive and confirmed nondiabetic by an oral glucose tolerance test at their baseline examination. Hypertension was defined as systolic blood pressure ± 140 mmHg or diastolic blood pressure ± 90 mmHg or use of antihypertensive medication. Results: Hispanics and non-Hispanic Whites had similar hypertension incidence rates. The strongest predictors of hypertension incidence were baseline blood pressure and age. Higher baseline heart rates and higher body mass index also predicted hypertension. Increased fasting insulin levels were associated with hypertension incidence among lean participants, though the association disappeared once baseline blood pressure levels were added to the models. Models investigating change in systolic or diastolic blood pressure levels found higher baseline levels of insulin area under the glucose tolerance curve predicted greater increases in systolic blood pressure in non-Hispanic Whites only. Conclusions: Hypertension incidence rates were similar in Hispanics and non-Hispanic Whites. Higher levels of insulin area were associated with larger increases in systolic blood pressure among non-Hispanic Whites only.
s Of Papers To Be Presented At The Joint Meeting Of The American Association For The Surgery Of Trauma (Fifty-Seventh Annual Meeting) And The Japanese Association For Acute Medicine; The Hilton Waikoloa Village, Waikoloa, Hawaii September 24-27, 1997
The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 3rd expert report highlights up-to-date Cancer Prevention Recommendations that may reduce burdens of many chronic diseases, including diabetes. This study examined if following a lifestyle that aligns with the recommendations - assessed via the 2018 WCRF/AICR Score - was associated with lower risk of type 2 diabetes in high-risk adults participating in the Diabetes Prevention Program Outcomes Study (DPPOS).The Diabetes Prevention Program (DPP) randomized adults at high risk for diabetes to receive a lifestyle intervention (ILS), metformin (MET) or a placebo (PLB) (mean: 3.2 years), with additional follow-up in DPPOS for 11 years (mean: 15 years total). 2018 WCRF/AICR Scores included seven components: body weight, physical activity, plant-based foods, fast foods, red and processed meat, sugar-sweetened beverages, and alcohol; the optional breastfeeding component was excluded. Scores ranged 0-7 points (with greater scores indicating greater alignment with the recommendations) and were estimated at years 0, 1, 5, 6, 9, and 15 (N=3,147). Fasting glucose and HbA1c were measured every six months and oral glucose tolerance tests were performed annually. Adjusted Cox proportional hazard ratios (HRs) and 95% confidence intervals (CIs) were used to examine the association of both Score changes from years 0-1 and time-dependent Score changes on diabetes risk through DPP and year 15.Scores improved within all groups over 15 years (p<0.001); ILS Scores improved more than MET or PLB Scores after 1 year (p<0.001). For every 1-unit improvement from years 0-1, there was a 31% and 15% lower diabetes risk in ILS (95% CI: 0.56-0.84) and PLB (95% CI: 0.72-0.97) through DPP, and no significant association in MET. Associations were greatest among American Indian participants, followed by non-Hispanic White and Hispanic participants. Score changes from years 0-1 and time-dependent Score changes in ILS and PLB remained associated with lower risk through year 15.Score improvements were associated with long-term, lower diabetes risk among high-risk adults randomized to ILS and PLB, but not MET. Future research should explore impact of the Score on cancer risk.Diabetes Prevention Program: NCT00004992 ; Diabetes Prevention Program Outcomes Study: NCT00038727.
Background: The Diabetes Prevention Program (DPP) demonstrated that interventions can delay or prevent the development of type 2 diabetes. Objective: To estimate the lifetime cost–utility of the DPP interventions. Design: Markov simulation model to estimate progression of disease, costs, and quality of life. Data Sources: The DPP and published reports. Target Population: Members of the DPP cohort 25 years of age or older with impaired glucose tolerance. Time Horizon: Lifetime. Perspectives: Health system and societal. Interventions: Intensive lifestyle, metformin, and placebo interventions as implemented in the DPP. Outcome Measures: Cumulative incidence of diabetes, microvascular and neuropathic complications, cardiovascular complications, survival, direct medical and direct nonmedical costs, quality-adjusted life-years (QALYs), and cost per QALY. Results of Base-Case Analysis: Compared with the placebo intervention, the lifestyle and metformin interventions were estimated to delay the development of type 2 diabetes by 11 and 3 years, respectively, and to reduce the absolute incidence of diabetes by 20% and 8%, respectively. The cumulative incidence of microvascular, neuropathic, and cardiovascular complications were reduced and survival was improved by 0.5 and 0.2 years. Compared with the placebo intervention, the cost per QALY was approximately $1100 for the lifestyle intervention and $31 300 for the metformin intervention. From a societal perspective, the interventions cost approximately $8800 and $29 900 per QALY, respectively. From both perspectives, the lifestyle intervention dominated the metformin intervention. Results of Sensitivity Analysis: Cost-effectiveness improved when the interventions were implemented as they might be in routine clinical practice. The lifestyle intervention was cost-effective in all age groups. The metformin intervention did not represent good use of resources for persons older than 65 years of age. Limitations: Simulation results depend on the accuracy of the underlying assumptions, including participant adherence. Conclusions: Health policy should promote diabetes prevention in high-risk individuals. *The members of the Diabetes Prevention Program Group are listed in Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. [PMID: 11832527].
Persons with type 1 diabetes are at increased risk of developing vascular disease. Adiponectin concentrations may play an intermediate role in this process. We sought to determine whether adiponectin is correlated with vascular stiffness in adolescents with type 1 diabetes. Plasma adiponectin, pulse wave velocity (PWV), augmentation index (AIx-75), and brachial distensibility (BrachD) were collected in 225 adolescents. Outcomes were evaluated by sex, and regression models were used to determine whether adiponectin was an independent determinant of arterial stiffness. Males had lower adiponectin levels and stiffer vessels (lower BrachD, p<0.01) than females. Unadjusted correlations revealed that adiponectin was correlated with BrachD (p<0.01) but not PWV and AIx-75. After adjustment, adiponectin was not a significant predictor of BrachD. The most consistent predictors of increased stiffness were age, male sex, blood pressure, obesity, and total cholesterol (p<0.05). Adiponectin's contributions to arterial stiffness appear to be masked by other cardiovascular risk factors in persons with type 1 diabetes.
