Search

Aims The burden of diabetes is considerable for racial and ethnic minority populations in many places in the USA and worldwide, often disproportionately affecting immigrant communities. This paper reports findings from a community-based participatory research study that described diabetes risk and awareness, assessed the association between perceived and actual risk (high, two or more diabetes risk factors; low, fewer than two risk factors) and identified factors associated with disease risk among Chinese and Hispanic / Latino immigrant populations in Portland, OR, USA. Methods Cross-sectional, self-reported data were collected from a purposive sample of 324 Chinese (n = 159) and Hispanic / Latino (n = 165) adults, aged 18-86 years [mean (SD) age, 45.2(17.9) years; 50.7% women). Analyses described differences in variable distributions. Logistic regression estimated odds ratios and 95%confidence intervals in pooled and ethnic group-specific samples. Results Approximately 43% of participants were at high risk for diabetes, regardless of ethnicity or age. Of those unaware of their risk, or who perceived themselves not to be at risk, 25-53%had two or more risk factors (high risk); these patterns varied by ethnicity. The proportion of participants who reported two or more risk factors and were unaware of their risk status (31.8% Hispanic / Latino; 17% Chinese) or self-identified as not at risk (12.5% Hispanic / Latino; 13.0% Chinese) was substantial. Factors associated with diabetes risk also varied by ethnicity. Conclusions This study assessed the degree and determinants of diabetes risk and awareness among local Hispanic / Latino and Chinese communities and identified significant variation between groups. The results are important because they highlight substantial diabetes risk among persons who misestimate or are unaware of their risk status, regardless of ethnicity, and, in the USA, the Chinese immigrant population commonly is not considered a high-risk group for Type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aims There is evidence to suggest that mammography rates are decreased in women with diabetes and in women of lower socio-economic status. Given the strong association between low socio-economic status and diabetes, we explored the extent to which differences in socio-economic status explain lower mammography rates in women with diabetes. Methods A population-based retrospective cohort study in Ontario, Canada, of women aged 50 to 69 years with diabetes between 1999 and 2010 age matched 1:2 to women without diabetes. Main outcome measure is the likelihood of at least one screening mammogram in women with diabetes within a 36-month period, starting as of either 1 January 1999, their 50th birthday, or 2 years after diabetes diagnosis - whichever came last. Outcomes were compared with those in women without diabetes during the same period as their matched counterparts, adjusting for socio-economic status based on neighbourhood income and other demographic and clinical variables. Results Of 504 288 women studied (188 759 with diabetes, 315 529 with no diabetes), 63.8% had a screening mammogram. Women with diabetes were significantly less likely to have a mammogram after adjustment for socio-economic status and other factors (odds ratio 0.79, 95% CI 0.78-0.80). Diabetes was associated with lower mammogram use even in women from the highest socio-economic status quintile (odds ratio 0.79, 95% CI 0.75-0.83). Conclusions The presence of diabetes was an independent barrier to breast cancer screening, which was not explained by differences in socio-economic status. Interventions that target patient, provider, and health system factors are needed to improve cancer screening in this population. [ABSTRACT FROM AUTHOR]

Aims Gestational diabetes is a common pregnancy complication affecting races/ethnicities disproportionally. Adult height, an indicator of both genetic and early-life factors, is inconsistently associated with gestational diabetes risk. We examined the association and whether it varies by races in a nationally representative US cohort. Methods Analyses were conducted among 135 861 pregnancies in the Consortium on Safe Labor, 5567 of which were diagnosed with gestational diabetes based on medical records review. Generalized estimating equations were used to estimate odds ratios (95% confidence intervals) of gestational diabetes, controlling for other risk factors including body weight. Additionally, a meta-analysis of 15 761 pregnancies with gestational diabetes and 205 828 without gestational diabetes was conducted to estimate the pooled mean difference in height between those with gestational diabetes and control subjects. Results Height was inversely associated with gestational diabetes risk across races/ethnicities, with the strongest association among Asians ( P for interaction < 0.01). Comparing extreme quartiles (> 168 vs. < 157 cm), adjusted odds ratios (95% confidence intervals) were 0.18 (0.09-0.36) for Asians/Pacific Islanders, 0.33 (0.29-0.38) for non-Hispanic white women, 0.39 (0.31-0.51) for Hispanics and 0.59 (0.47-0.75) for non-Hispanic black women. Meta-analysis found women with gestational diabetes to be significantly shorter than others. Conclusions Taller women are at lower risk of developing gestational diabetes, with the magnitude of association varying significantly across races/ethnicities. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 441-452 (2012) Abstract Aims Alcohol is a potential risk factor of Type 2 diabetes. However, more detailed information on effects of alcohol types and early phases of Type 2 diabetes development seems warranted. The aim of this study was to investigate the influence of alcohol consumption and specific alcoholic beverages on the risk of developing pre-diabetes and Type 2 diabetes in middle-aged Swedish men and women. Methods Subjects, who at baseline had normal glucose tolerance (2070 men and 3058 women) or pre-diabetes (70 men and 41 women), aged 35-56 years, were evaluated in this cohort study. Logistic regression was performed to estimate the risk [odds ratio (OR) and 95% confidence interval (CI)] to develop pre-diabetes and Type 2 diabetes at 8-10 years follow-up, in relation to self-reported alcohol intake at baseline. Adjustment was performed for several risk factors. Results Total alcohol consumption and binge drinking increased the risk of pre-diabetes and Type 2 diabetes in men (OR 1.42, 95% CI 1.00-2.03 and OR 1.67, 95% CI 1.11-2.50, respectively), while low consumption decreased diabetes risk in women (OR 0.41, 95% CI 0.22-0.79). Men showed higher risk of pre-diabetes with high beer consumption (OR 1.84, 95% CI 1.13-3.01) and of Type 2 diabetes with high consumption of spirits (OR 2.03, 95% CI 1.27-3.24). Women showed a reduced risk of pre-diabetes with high wine intake (OR 0.66, 95% CI 0.43-0.99) and of Type 2 diabetes with medium intake of both wine and spirits (OR 0.46, 95% CI 0.24-0.88 and OR 0.55, 95% CI 0.31-0.97, respectively), whereas high consumption of spirits increased the pre-diabetes risk(OR 2.41, 95% CI 1.47-3.96). Conclusion High alcohol consumption increases the risk of abnormal glucose regulation in men. In women the associations are more complex: decreased risk with low or medium intake and increased risk with high alcohol intake. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 479-487 (2012) Abstract Aim To explore the putative association of new-onset diabetes and the soluble urokinase plasminogen activator receptor (suPAR), which is a new and stable plasma marker of immune function and low-grade inflammation. This association has been previously suggested by using the less sensitive International Classification of Disease system to detect incident diabetes in the Danish MONICA 10 cohort. Methods The Danish National Diabetes Register enabled more accurate identification of incident diabetes during a median follow-up of 13.8 years in the Danish MONICA 10 cohort ( n = 2353 generally healthy individuals). The soluble urokinase plasminogen activator receptor was measured by the ELISA method. To fulfil model assumptions, outcome analyses were stratified by age, and further by smoking, owing to the interaction between the soluble urokinase plasminogen activator receptor and smoking on new-onset diabetes ( P < 0.0001). Results New-onset diabetes ( n = 182) was associated with increased soluble urokinase plasminogen activator receptor levels ( P = 0.013). Among 699 middle-aged (41 and 51 years) and 564 older (61 and 71 years) non-smokers, participants in the upper soluble urokinase plasminogen activator receptor quartile had a sex- and age-adjusted relative risk of 6.01 (95% CI 2.17-16.6, P < 0.0006) and relative risk of 3.25 (95% CI 1.51-6.98, P = 0.0025), respectively, for new-onset diabetes compared with participants in the lowest quartile. This relationship remained significant after additional adjustments for C-reactive protein and leukocytes or fasting glucose and insulin or BMI ( P < 0.05). The soluble urokinase plasminogen activator receptor was not related to incident diabetes among smokers (P ≥ 0.85). Conclusions In these explorative analyses, the soluble urokinase plasminogen activator receptor associated independently with incident diabetes in non-smokers, supporting an immune origin of Type 2 diabetes. Competing disease risk may explain lack of association among smokers. [ABSTRACT FROM AUTHOR]

Diabet. Med. 28, 1425-1432 (2011) Abstract Aims To estimate the prevalence of diagnosed Type 2 diabetes mellitus in Greenland and to evaluate the quality of the diabetes care before and after implementation of a new diabetes programme. Methods In this observational and cross-sectional study, data from the medical records were collected in Greenland in 2008 and 2010. Information about age, gender, most recently measured HbA1c, blood pressure and serum cholesterol and from the examination of eyes, feet and urine was obtained. The prevalence was estimated using the whole adult population in Greenland as background population. The quality of the diabetes care was monitored by six process, three biological and three treatment indicators. A diabetes concept based on national guidelines, systematized recording in an electronic medical record and feedback to the clinics were used to improve diabetes care. Results Four hundred and sixty-five patients were included in the 2008 sample and 691 in the 2010 sample. The total prevalence increased from 2.3 (95% CI 2.1-2.5) % in 2008 to 2.7 (95% CI 2.5-3.0) among Greenlanders aged 40 years old or above, corresponding to an increase of 19% ( P = 0.006). All process indicators improved significantly between the two observations. Conclusions Along with an increasing prevalence of diagnosed Type 2 diabetes, all six process quality indicators increased. It is strongly recommended that focus on the quality of diabetes care in Greenland should be maintained in order to benefit from the programme in the longer term. [ABSTRACT FROM AUTHOR]

Aims To assess perinatal outcome in women with pregestational diabetes mellitus according to the sex of the fetus. Methods A retrospective review of all singleton pregnancies of women with pregestational diabetes progressing to a gestational age of 22 weeks or more who attended the diabetes and pregnancy clinic from 1981 to 2006 (n = 455). We compared maternal characteristics and perinatal outcomes (perinatal mortality, major congenital malformations, small and large for gestational age newborns, preterm birth and a composite of the former) according to the sex of the fetus. A logistic regression analysis was performed using the composite perinatal outcome as the dependent variable and all maternal variables and sex of fetus as potential predictors. Results Maternal characteristics did not differ in mothers of male and female newborns. In the whole cohort, the composite perinatal outcome was significantly higher in male fetuses; adjusted OR 1.61 (95% CI 1.04-2.50). Conclusions In women with pregestational diabetes, perinatal outcome was poorer in male newborns despite similar maternal characteristics. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to address the controversy over the influence of intensive glucose control on the risk for cardiovascular events in patients with Type 2 diabetes. Methods FRENA is an ongoing registry of stable outpatients with symptomatic coronary artery disease, cerebrovascular disease or peripheral artery disease.We compared the incidence of subsequent ischaemic events (myocardial infarction, stroke or critical limb ischaemia) in patients with Type 2 diabetes and mean HbA1c levels < 7.0% (< 53 mmol / mol) vs. those with HbA1c levels > 7.0%(> 53 mmol /mol). Results Of 974 patients with Type 2 diabetes, 480 (49%) had mean HbA1c levels < 7%(< 53 mmol/ mol). Over a mean follow-up of 14 months, 126 patients (13%) had subsequent ischaemic events: myocardial infarction (43), stroke (29) and critical limb ischaemia (64). The incidence of subsequent ischaemic eventswas significantly lower in patients with mean HbA1c levels < 7.0% (< 53 mmol / mol) than in those with HbA1c levels > 7.0%(> 53 mmol / mol) (8.6 vs. 14 per 100 patient-years; rate ratio 0.6; 95% CI 0.4-0.9). These differences persisted after adjusting for potential confounders. However, this better outcome was only found in patients presenting with coronary artery disease (rate ratio 0.4; 95% CI 0.2-0.8), not in those with cerebrovascular disease (rate ratio 0.9; 95% CI 0.4-2.0) or peripheral artery disease (rate ratio 0.8; 95% CI 0.5-1.3). Patients with mean HbA1c levels < 7.0% (< 53 mmol / mol) also had a lower mortality (rate ratio 0.6; 95% CI 0.3-0.99). Conclusions In secondary prevention, patients with diabetes and HbA1c levels < 7.0% (< 53 mmol /mol) had a lower incidence of subsequent ischaemic events and a lower mortality than those with HbA1c levels > 7.0% (> 53 mmol /mol). These differences appeared only in patients with coronary artery disease. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 1280-1283 (2010) Aims To assess oral status in a sample of Type 2 diabetic patients before and after therapy with saliva substitutes and oral status in a control group of diabetic patients who were not given saliva substitutes. Methods Salivary flow rate was determined in 134 patients (mean age 47.9 ± 2.9 years) with Type 2 diabetes. Mean salivary rate was significantly low compared with a healthy control group. The sample of 134 patients was randomly divided into two groups of 67 people each. One group was given immunologically active salivary substitutes for 6 months, the other group was given nothing. Each patient of the two groups underwent a dental and periodontal examination at the beginning of the study and 6 months later. Results As regards carious teeth and teeth loss, there was no statistical difference between the first group after 6 months of treatment with salivary substitutes and the control group ( P > 0.01). Salivary substitutes did not significantly reduce the periodontal disease ( P > 0.01). In the group treated with salivary substitutes, after 6 months of therapy, the average dental plaque index decreased from 2.3 ± 0.73 to 1.6 ± 0.56, patients with gingivitis decreased from 66 to 43% and patients with positive yeast counts decreased from 60 to 37%. These differences were statistically significant ( P < 0.01). Conclusions In Type 2 diabetes, in the case of hyposalivation, a therapy with immunologically active saliva substitutes can be of help in reducing the amount of plaque, gingivitis and positive yeast counts. [ABSTRACT FROM AUTHOR]