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Despite its potential usefulness for assessing preclinical atherosclerosis and cardiovas cular risk, the ankle/arm blood pressure index (AAI) has not yet been the matter of study evaluating its feasibility and reliability by nonspecialist doctors in a general population. This study was planned for two steps. In step 1, the measurement of AAI, (ratio between Doppler systolic pressure at the ankle for each lower limb and the highest value of Doppler systolic pressure of the two upper limbs), should be performed by 50 general practitioners (GPs), 50 social security center physicians, and 50 occupational health physicians in 3,000 male smokers, 40 to 59 years, without clinical cardiovascular disease. In step 2, AAI measurement, coupled with echography-Doppler of iliofemoral arteries, should be repeated by a specialist in all subjects with decreased AAI (

OBJECTIVE: To describe the nutritional status (body mass index (BMI) and waist-hip ratio (WHR)) of the population of New Caledonia in relation to ethnicity and urban-rural environment. DESIGN: Diabetes screening survey in two rural provinces of New Caledonia and in the suburbs of Noumea. SUBJECTS: 8875 subjects aged 30–59 y, Europeans, Melanesians and Polynesians. MEASUREMENTS: BMI, WHR. RESULTS: Obesity (BMI≥27 kg/m2 in men, 25 kg/m2 in women) was highly prevalent in all groups, but varied according to ethnicity: respectively, 43% and 52% in Europeans, 46% and 72% in Melanesians, 72% and 83% in Polynesians. In the urban area, mean WHR values, adjusted for age and BMI, were significantly higher than in rural areas, especially in Melanesians. CONCLUSION: Both ethnicity and urban-rural environment are linked to the amount and distribution of adiposity, which appeared worsened in the urban area in Europeans, and even more in Melanesians.

Within the framework of a European concerted action on diabetes mellitus (EURODIAB SubArea C), an epidemiological study was established in Belgium in 1990 in order to estimate the prevalence of drug-treated diabetes mellitus. An assessment was made of the sales of insulin and oral antidiabetic drugs and the average daily dose used. A sample of people with diabetes, clients of 107 pharmacies, provided the data to establish average daily doses. Those pharmacies, spread over the 9 provinces of the country, represent 2% of all private pharmacies in Belgium. Over a 2 month period each pharmacist presented a questionnaire to each client receiving an antidiabetic drug. In 1990, 164 per 10,000 inhabitants were treated with antidiabetic drugs, which means that there were approximately 163,000 drug-treated diabetics in Belgium. At the time of the survey 65% of the diabetics in the sample were 60 years or older. Overall, 38% of drug-treated diabetics took insulin, and 30% of them took only human insulin. Treatment type varied by the province where the pharmacy was located. The provinces of Hainaut and Luxembourg-Namur had a higher percentage of diabetics on oral treatment. This is the first description in Belgium of the prevalence of drug-treated diabetes and of the pattern of prescribing of these drugs.

The measurement of glycated haemoglobin (HbA(1c)) is a practical and more sensitive tool than fasting plasma glucose (FPG) in screening type 2 diabetes in current practice. Its use has been limited so far by the variability of the analytical methods. The standardization process is going on, and many laboratories are currently using valid methods. Our study is consistent with the results of other groups who recommended this measurement to identify undiagnosed diabetic patients, that are about 25% to 30% in the French population. The demonstration was provided through a survey including a screening step by both HbA(1c) and G0, and a second exam with a 2 hr OGTT in a sample of positive screenees according to at least one criterion (HbA(1c)=6% or G0=1.26 g/L), as well as in a sample of negative screenees. We showed that nine confirmed diabetic subjects out of ten had HbA(1c)=6% at the screening step, while only a half had G0=1.26 g/L. Conversely, 22% of the positive screenees according to HbA(1c) were not confirmed as diabetic by the OGTT, including however more than half with abnormal glucose values. A chart for practical use is proposed to define patients at risk, the process of screening, and the patient follow-up according to the results of the tests.

After several years of disease duration, blood glucose control is difficult without using insulin in type 2 diabetic patients. However, large differences are observed regarding the use of insulin from the south to the north of Europe. A positive effect of insulin therapy on metabolic control compared to oral antidiabetic agents is shown only in clinical trials performed on selected patients. As to degenerative complications, a great excess of retinopathy is observed in insulin-treated patients in several surveys, without possibility to determine the specific effect of treatment from that of disease severity. The UKPDS is the only randomised long-term clinical trial with a large number of patients. The aim was to compare conventional to intensive antidiabetic treatment, whatever the type or drug, insulin or sulfonyureas. After a ten-year follow-up, glycemic control was better with the intensive treatment, the microvascular complications less frequent by 25%, but the benefit on cardiovascular complications or mortality was modest. Another clinical trial from US shows that a too strict insulin regimen could perhaps have no effect or even opposite to the objectives regarding cardiovascular morbidity. Considering these clinical uncertainties and the need for more definite long-term clinical data, it is justified to conduct additional long-term clinical studies in this field. Furthermore after secondary failure of oral anti-diabetic agents in type 2 diabetic patients, it appears reasonable to discuss the rational for insulin treatment based on an individual assessment, particularly in older diabetics, weighing the whole benefits and risks for a given patient of such an important therapeutic change.

To analyse the relationships between body mass index, waist circumference, waist-to-hip ratio, physical activity and the risk of type 2 diabetes in a French elderly population.We conducted a cross-sectional study on 1113 men and 1419 women aged 60 y or more, participating in the POLA Study.The prevalence of diabetes was two-fold higher in men than in women (19.1% and 9.3%, respectively). The anthropometric variables studied-body mass index (BMI), waist circumference (WC) and the waist/hip ratio (WHR)-were all positively related to the prevalence of type 2 diabetes. The strongest relationships were found for BMI in men and WHR in women. In both genders, sport activity and diabetes were inversely linked whereas no relationship was shown between the amount of household activity and diabetes mellitus.In the elderly, overall obesity in men and abdominal fat accumulation in women appeared strongly related to diabetes. Sport activity was negatively and independently associated with the prevalence of diabetes mellitus.

GM and KM immunoglobulin allotypes, which are the markers, respectively, of the constant parts of the heavy and the light chains of the IgG1, IgG2 and IgG3 subclasses, have been analysed in diabetic mellitus patients and controls living in New Caledonia. We tested 40 Europeans, 256 Melanesians and 44 Polynesians, as well as their 340 matched controls, in order to search for a genetic susceptibility at those polymorphic loci. All the subjects were tested for G1M (1, 2, 3, 17), G2M (23), G3M (5, 6, 10, 11, 13, 14, 15, 16, 21, 24, 28) and KM (1) by the classical hemagglutination method. The frequencies of GM haplotypes and KM alleles have been estimated by a maximum likelihood method. The results are in favour of no influence of the GM and KM loci. The prevalence of diabetes mellitus varies in the populations of New Caledonia: Polynesians are at much higher risk than Melanesians or Europeans. The GM haplotype distribution differs among ethnic groups; so they provide a useful marker to measure genetic admixture. The higher prevalence of diabetes observed among New Caledonians of European origin compared to the prevalence in Europe may be explained by genetic admixture with neighbouring Pacific populations, notably Polynesians (Asian haplotypes are present at a frequency of 9.4%). So, the genetic admixture should be measured in any genetic epidemiological study.

The POLA (Pathologies Oculaires Liées à L'Age) Study is a population-based study of cataract and age-related macular degeneration and their risk factors being carried out among 2,584 residents of Sète, southern France, aged 60-95 years. Recruitment took place between June 1995 and July 1997. Cataract classification was based on a standardized lens examination by slit lamp, according to Lens Opacities Classification System III. This paper presents results obtained from cross-sectional analysis of the first phase of the study. In polytomous logistic regression analyses, an increased risk of cataract was found for female sex (cataract surgery: odds ratio (OR) = 3.03; cortical cataract: OR = 1.67), brown irises (cortical, nuclear, and mixed cataracts: OR = 1.61), smoking (cataract surgery: OR = 2.34 for current smokers and OR = 3.75 for former smokers), known diabetes of 10 or more years' duration (posterior subcapsular, cortical, and mixed cataracts and cataract surgery: OR = 2.72), use of oral corticosteroids for at least 5 years (posterior subcapsular cataract: OR = 3.25), asthma or chronic bronchitis (cataract surgery: OR = 2.04), cancer (posterior subcapsular cataract: OR = 1.92), and cardiovascular disease (cortical cataract: OR = 1.96). Decreased risk of cataract was found with higher education (all types of cataract and cataract surgery: OR = 0.59), hypertension (cataract surgery: OR = 0.57), and high plasma retinol levels (nuclear and mixed cataracts and cataract surgery: OR = 0.75 for a 1-standard-deviation increase). Most of the risk factors identified in this study confirm the findings of other studies. The association of cataract with plasma retinol level requires further investigation.

This study was implemented in France to determine the causes of death in diabetic patients, whether diabetes was mentioned or not on the death certificate, and to assess the underestimation of the prevalence of diabetes at death. Two stratified random samples of death certificates were selected in the national mortality data base. The first included certificates mentioning diabetes as a cause of death (cases). The second, included certificates with no mention of diabetes (controls). For each certificate, a record form was sent to the certifying physician to ascertain diabetes in the first group and to trace unrecorded diabetes in the second group. In case of diabetes, the characteristics of the patient and his disease were collected (age at onset, treatment, complications ...). We obtained complete data for 325 cases and 959 controls. Among cases, 1% of the subjects were not confirmed as diabetic, while almost 10% of the controls were identified as having diabetes. The corresponding ratio of the corrected prevalence at death to that provided by the French statistics was estimated to 4.0 in men and 3.1 in women. Particular features are that 2% of the total diabetic decedents died from acute metabolic complications (diabetic or hyperosmolar coma, acidoketosis, or acute hypoglycemia), and that 33% of the unreported diabetic decedents under 45 died from trauma or poisoning. These results show that in France, the death rates published in the statistics for diabetes dramatically underestimate the impact of diabetes. A high risk of death is linked to this disease, particularly in people aged under 45, a problem that health deciders should address.

To give the levels of antioxidant nutrients in relation to age-related macular degeneration (AMD).Pathologies Oculaires Liees a l'Age is a population-based study on cataract and AMD and their risk factors, carried out on 2584 inhabitants of Sete, France. Age-related macular degeneration was defined by findings from fundus photographs according to an international classification. Biological measurements were taken from fasting blood samples.After multivariate adjustment, plasma alpha-to-copherol levels showed a weak negative association with late AMD (P = .07). Lipid-standardized plasma alpha-tocopherol levels showed a significant negative association with late AMD (P= .003): the risk of late AMD was reduced by 82% in the highest quintile compared with the lowest. Similarly, lipid-standardized plasma alpha-tocopherol levels were inversely associated with early signs of AMD (odds ratio, 0.72 [95% confidence interval, 0.53-0.98]; P=.04). No associations were found with plasma retinol and ascorbic acid levels or with red blood cell glutathione values.These results suggest that vitamin E may provide protection against AMD. Only randomized interventional studies could prove the protective effect of vitamin E on AMD.

Oxidative mechanisms may play an important role in the etiology of cataract and age-related macular degeneration (AMD). The authors present the level of two antioxidant enzymes in relation to cataract and AMD.Population-based, cross-sectional study on cataract and AMD and their risk factors.This study includes 2584 participants recruited among the residents of the town of Sète (in the south of France), who were 60 years of age or older.Cataract was defined on the basis of slit-lamp examination, according to the Lens Opacities Classification System III, and AMD on the basis of fundus photographs according to an international classification. Biologic measurements were made centrally from blood samples for which the patient fasted.The presence of early and late AMD and of subcapsular, cortical, nuclear, and mixed cataracts was assessed and related to the levels of plasma glutathione peroxidase and erythrocyte superoxide dismutase.After multivariate adjustment, higher levels of plasma glutathione peroxidase (pIGPx) were significantly associated with a ninefold increase in late AMD prevalence, a sixfold increase in cortical cataract, and a twofold increase in nuclear and mixed cataracts. High levels of erythrocyte superoxide dismutase (SOD) activity were not associated with late AMD and early signs of AMD but were associated with a twofold increase in nuclear cataract.The authors show here, for the first time, a strong association of high levels of pIGPx with age-related eye diseases. High levels of SOD also are associated with increased risk of nuclear cataract. More data are needed at the biochemical and epidemiologic levels for a better understanding of these findings.

To assess ethnic differences in androgenic status related to non insulin-dependent diabetes mellitus (NIDDM) in male and female Melanesians and Europeans of New Caledonia.This is a case-control study nested in a prevalence study for diabetes mellitus in the multiracial population of New Caledonia.186 male subjects were included in the survey (77 Melanesians and 16 Europeans in each case and control group). Each case and control group included 104 female Melanesian subjects (69 premenopausal and 35 postmenopausal).Diabetic subjects were matched for age, gender, ethnic group and location, with healthy normoglycaemic subjects. Testosterone levels in men and sex hormone-binding globulin (SHBG) levels in women (measured by radioimmunoassay, RIA) were compared between NIDDM and control subjects in relation to obesity, central adiposity and insulin levels.In both ethnic groups, NIDDM was associated with lower testosterone levels but there was a marked difference among Europeans. Testosterone was negatively associated with the body mass index (BMI) (r= -0.35, P0.01) and fasting insulin (r= -0.37, P0.001) in control Melanesians only. In Melanesian women, NIDDM was associated with lower SHBG levels in pre- and postmenopausal women (P0.001). SHBG mean level was not associated with menopausal status.Our results confirm in a Pacific population that NIDDM is associated with low levels of testosterone in men and low levels in SHBG in women. In contrast to white populations, Melanesian women have a more androgenic profile, whatever their menopausal status.

To assess the associations between age-related macular degeneration (ARMD) and smoking.The POLA study is a population-based study taking place in the town of Sète, located on the French Mediterranean Sea border. The presence of early and late ARMD was assessed in 2196 participants on the basis of 50 degrees color fundus photographs using an international classification system.After adjustment for age and sex, current and former smokers showed an increased prevalence of late ARMD (odds ratio [OR] = 3.6, 95% confidence interval [CI] = 1.1-12.4; OR = 3.2, 95% CI = 1.3-7.7, respectively). An increased risk was present in participants who smoked more than 20 pack-years (OR = 3.0, 95% CI = 0.9-9.5 for 20-39 pack-years; OR = 5.2, 95% CI = 2.0-13.6 for 40 pack-years and more). In addition, the risk of late ARMD remained increased until 20 years after cessation of smoking (OR = 9.0, 95% CI = 3.0-27.0 for 1-9 years; OR = 4.0, 95% CI = 1.3-12.0 for 10-19 years; OR = 1.3, 95% CI = 0.4-4.3 for 20 years and more). Smoking was not significantly associated with early signs of ARMD.This study further confirms the adverse effect of tobacco on late ARMD. Former smokers seem to remain at high risk for ARMD.

The aim of this study was to assess the prevalence of long-term complications in a large sample of French NIDDM patients. Therefore, 427 NIDDM patients 35-74 years old were recruited in ten centers. Standardized clinical criteria and central reading for retinal and electrocardiographic changes were used to assess the presence of complications. The prevalence rates of complications were 29.7% and 3.3% for background and proliferative retinopathy; 21.8%, 6.1%, and 2.8% for microalbuminuria, proteinuria, and renal insufficiency; 19.9 and 11.7% for asymptomatic and symptomatic pheripheral neuropathy; 8.2% for orthostatic hypotension; 10.1% and 8.4% for angina pectoris and myocardial infarction; and 13.1% and 6.3% for mild and moderate to severe peripheral vascular disease, respectively. In conclusion, prevalence rates in this study were lower than in most studies from other countries.

The associations between androgens and cardiovascular risk factors in men are controversial. A nested case-control study was used to compare the levels of cardiovascular risk factors in two groups (n = 25 each) of healthy men contrasted by their plasma total testosterone (PTT) concentration, matched by age and ethnic origin. Compared to the men with normal PTT (mean +/- SEM, 19.8 +/- 0.7 nmol/L), the men with low PTT (10.1 +/- 0.3 nmol/L) had a significantly higher body mass index (P0.01), waist/hip ratio (P0.001), systolic blood pressure (P0.05), fasting and 2-h plasma glucose (P0.04 and P0.02 respectively), serum triglycerides (P0.001), total cholesterol (P0.04), low density lipoprotein cholesterol (P0.01), apolipoprotein B (P0.01), fasting and 2-h plasma insulin (both P0.0001), and lower values of serum high density lipoprotein cholesterol (P0.01) and apolipoprotein AI (P0.05). After adjustment for both body mass index and waist/hip ratio, fasting and 2-h plasma insulin and triglyceride levels remained significantly different between the two groups (P0.04, P0.001, and P0.03 respectively). Plasma sex hormone-binding globulin was markedly decreased in the low PTT group (P0.0001), whereas bioavailable testosterone was not significantly different. This case-control study provides further and stronger evidence of a negative association between PTT and plasma insulin in men, as suggested by cross-sectional studies. Because these are observational data, neither causality nor the direction of the associations among PTT, sex hormone-binding globulin, and insulin sensitivity can be determined. Intervention studies are needed to better assess the metabolic and cardiovascular benefits of androgen treatment that have been suggested by preliminary clinical trials.

The clinical correlates of advanced retinopathy were determined in a sample of 427 type II diabetic outpatients, aged 35 to 74 years, recruited in eight centers from all parts of France. The presence of retinopathy was assessed by fluorescein angiography with centralized interpretation. Advanced retinopathy (proliferative and/or macular edema) was independently linked with nephropathy, peripheral neuropathy, and insulin therapy. Prevalence of advanced retinopathy was 1.6% in the absence of signs of nephropathy and/or peripheral neuropathy, 10.4% in patients with mild signs, and 17.5% in patients with moderate to severe signs. Overall, 87% of the patients with advanced retinopathy had signs of nephropathy and/or peripheral neuropathy. In conclusion, patients showing signs of nephropathy and/or peripheral neuropathy should be sent in priority to an ophthalmologist. Prospective data are necessary to determine if screening is necessary in patients with no signs of nephropathy or peripheral neuropathy.

The prevalence of diabetes mellitus was assessed in the multiracial population of New Caledonia in the South Pacific with the use of a two-step procedure. The first step included 9,390 subjects aged 30-59 years who were visited at home for screening with glucose strips. All subjects who had a fasting capillary blood glucose valueor = 110 mg/dl were invited to come to the health center for a more detailed examination. In non-fasting subjects, a capillary blood glucose value of 140 mg/dl was chosen as the cut-off point for further examination. A 2-hour glucose tolerance test was performed according to World Health Organization (WHO) recommendations on 424 positive screenees as well as in a sample of 517 negative screenees. In all, 219 previously known diabetic subjects were found; among subjects classified as positive at the first step, 277 were detected as new cases or diabetes. After correction to take into account false negative subjects, the age-adjusted prevalence rate of diabetes was estimated to be 8.9% overall; Polynesians (15.3%) were found to be more at risk than Melanesians or Europeans (8.4% in two other groups). A higher prevalence of diabetes was found in Melanesians who lived in the urban area compared with Melanesians who lived in villages. This finding confirms the deleterious effect of western life in this population subject to rapid modernization.

The prevalence and causes of visual impairment have been estimated in a sample of 423 Type 2 diabetic outpatients, aged 35 to 74 years, recruited in 8 centres from all parts of France. The presence of retinopathy was assessed by fluorescein angiography with centralized interpretation. The presence of cataract and glaucoma was also recorded. Prevalence of blindness was 1.2%. Moderate visual impairment affected 7% of the patients. The major cause of blindness was cataract, explaining 38% of the cases of blindness. Retinopathy was associated to blindness in 2 cases out of 26. More than half of the patients with proliferative retinopathy and the third of those who had macular edema had been treated by photocoagulation. According to the present patient material, retinopathy is a minor cause of visual impairment in Type 2 diabetic patients, cataract remaining the major cause. This reflects the introduction of photocoagulation into ophthalmologic practice.

Dietary assessment methods usually are validated one against the other, using the correlation coefficient between the methods to assess agreement. The correlation coefficient, however, is only an indicator of relative agreement and depends on the range of intakes. As this dependence can lead to misinterpretation, we propose that the standard deviation of the difference between methods should be used as an indicator of absolute agreement and the standard deviation of their average as an indicator of the range of intakes. We illustrate this method in a validation study of a diet history against a 3-day diet record in 58 non-insulin-dependent diabetes mellitus patients. A re-analysis of studies from the literature validating food frequency questionnaires against diet records showed that the absolute agreement between methods is very consistent and that the differences in the correlation coefficients are mostly due to the selection of subjects.

An indirect method for estimating the prevalence rates of chronic diseases that are treated by specific drugs was proposed in 1988 to European countries in the framework of a European Community concerted action on diabetes epidemiology. Data on consumption of antidiabetic drugs were collected at the national level in nine countries and at a regional level in two. Using official drug sales data and recent demographic data, we estimated the diabetes prevalence rates in each country or region. The estimated diabetes prevalence in Europe varied from 1.6% in Northern Ireland to 4.7% in Malta. In four countries that already had diabetes prevalence data, the estimation through drug consumption provided figures 3-20% lower than those from field surveys. This study showed a large variety of prescribing habits for diabetic patients in Europe (for example, the proportion of insulin-treated patients varies from 13% to 36%) and underscores the need for a consensus on antidiabetic treatments based on valid clinical research. The proposed approach does not replace field surveys but provides an inexpensive and practical marker of disease frequency and therapeutic attitudes over space and time.

The regional prevalence of diabetes, in France, has been studied using data from a nationwide household survey conducted by INSEE and CREDOC, two national demographic statistics institutes, in a representative sample of 7,323 households (21,007 subjects). Each subject reported, on a form, all the drugs bought during the study period. Subjects reporting, at least once, an antidiabetic oral drug were classified as diabetic. Two hundred and sixty six subjects reported having bought one or more oral antidiabetic drugs, leading to an overall prevalence rate of 1.27%. Prevalence rates were calculated by region (range: 0.86% Pays de Loire--2.77% Franche-Comté) and by large administrative areas (ZEAT) (range: 0.90% Nord-Pas-de-Calais--1.92% Est). In both cases, a North-west, South-east gradient appeared, with the lowest rates in the North and West of France. This trend was maintained after standardization according to the age distribution in the regions studied. The rates are similar to other data in the literature, in particular those derived from national drug sales data, but there is no explanation for this inter regional variability, which merits specific surveys.

This study was designed to investigate the large differences in diabetes mortality rates in Europe. In each of the participating countries (France, Germany, The Netherlands, Northern Ireland-UK, Republic of Ireland, Romania, Scotland-UK, Switzerland) a random sample of certifying physicians was asked to certify the causes of death of six case histories which described the deaths of diabetic patients; the responses from an average of 220 physicians per country were analysed. These registered causes were then coded nationally and the underlying cause was compared with that following a central recoding. Overall 28% of the physicians surveyed recorded diabetes on the death certificate as the underlying cause of death--France was 25% below this overall average and Germany 21% above. The national coding of diabetes as the underlying cause of death differed from the central recoding with a comparative undercoding of almost 40% in Romania, 30% in Northern Ireland and 25% in Switzerland; in contrast, there was an overcoding of diabetes by 80% in The Netherlands and 60% in the Republic of Ireland. After adjusting for central recoding, in part an adjustment for certification habits, the national coding from this simulation study was able to explain 35% of the variation in the diabetes mortality rates. With such differences in the coding of diabetes, the currently published mortality rates for diabetes are not directly comparable between European countries; some suggestions are made for the reduction of the intercountry differences in the collection and analysis of mortality data for diabetes.

Glycated haemoglobin was determined by using the spot test method for blood sampling in all the children and teenagers attending the summer camps organized by l'Aide aux Jeunes Diabétiques in July 1989. A questionnaire was completed for each subject, relating age, the duration of the disease, the insulin regimen, the level of knowledge, the intensivity of urine and blood glucose self monitoring, and the presence of lipohypertrophies. The statistical analysis of the data suggests that the two only parameters which were found to have an influence on the level of glycated haemoglobin were the duration of the disease and the presence of lipohypertrophies: in the early years of diabetes (up to 4 years), HbA1c was significantly lower in patients without lipohypertrophies (7.90 +/- 0.18%, n = 78), than in those with lipohypertrophies (8.60 +/- 0.22%, n = 46, m +/- SEM, p0.02). This study should focus the attention of clinicians on the deleterious effect of lipohypertrophies, which can be observed very early on in the course of the disease.

An epidemiologic study of end-stage diabetic nephropathy in France (Uremidiab) was performed, aiming to establish the prevalence of both types of diabetes in dialysis patients. Because discrimination between type I and type II diabetes remains mostly clinical, our aim was to evaluate what the most fitted clinical criteria were. We studied 494 hemodialyzed diabetic patients. A first classification (Cn) was offered by the nephrologist. Clinical data of 472 patients (22 patients of the 494 have been excluded) were then collected with a standardized questionnaire, allowing one diabetologist of us to establish the diagnosis of type of diabetes (classification Cd). Plasma C-peptide at this stage of the disease was expected to be very discriminative, measured in 88 patients and defined classification Ccp (or = 0.6 ng/ml = "negative C-peptide" = type I,0.6 ng/ml = "positive C-peptide" = type II). Classification Cd observed 98 type I and 374 type II diabetes. Cn overestimated type I diabetes, 37% of type II diabetes being misclassified because insulin-treated. Classification Ccp observed 74 positive C-peptide patients, classified as type II, among whom 45 were insulin-treated. Only 3 patients were discordant for classification Cd and Ccp. Predictive value of "negative C-peptide" and "positive C-peptide" were 100% and 96% respectively. Multiple regression analysis of the Ccp classification was performed with the clinical criteria and showed very significant correlation with: age at the time of diagnosis of diabetes (AGE), maximal body mass index ever reached (BMI MAX) and delay between diagnosis and consistent insulin use (DI).(ABSTRACT TRUNCATED AT 250 WORDS)

STUDY OBJECTIVE--The aim was to assess the level of mortality related to diabetes in France. In other countries, an underrecording of diabetes on the death certificates of diabetic patients has been reported. DESIGN AND SETTING--Estimated death rate of diabetic patients was calculated using (a) the actual number of death certificates where diabetes was registered either as an underlying or as a contributory cause of death, and (b) estimates of the prevalence of diabetes in the population, by sex and age group, from which expected numbers of diabetic deaths were determined. Standardised mortality ratios were calculated using 1988 French mortality statistics as reference. MAIN RESULTS--The estimated standardised mortality ratio for diabetic subjects, with diabetes registered as the underlying cause, was 0.36. This standardised mortality ratio increased to 0.92 if both the underlying and contributory causes were considered. The estimated death rate, by sex and age group, implies that diabetes has a protective effect between the ages of 45 and 64 years, particularly in men. CONCLUSIONS--Evidence suggests that diabetes is completely omitted on the death certificates of many diabetic subjects, especially for those between the ages of 45 and 64 years. Using mortality statistics underestimates the prevalence of diabetes and its effects on public health. The difference in diabetes mortality between countries will not be reliable until there is a better registration of the causes of death in diabetic patients, and contributory as well as the underlying cause are coded and published.

The authors describe pragmatic aspects of the use of the main statistical software packages for biomedical research with microcomputers. Data analysis and management facilities and some technical and commercial features are comparatively indicated.

The prevalence of diabetes mellitus among patients treated for end-stage renal failure was studied using a questionnaire mailed to all dialysis units of mainland France in 1989. With a response rate of 80.8%, the study population amounted to 12,903 dialysed patients of whom 884 were declared diabetic (6.9%). In a second phase, the study focused on the diabetic patients treated in the 63 largest units (those with at least four diabetic patients). Seven specially trained physicians completed questionnaires after having interviewed the patients and checked their medical records. All this material was reviewed by the same diabetologist. The conflict of diabetes type declared by both sources of information (the nephrologists and the diabetologist) showed a misclassification rate of 31.2%. Using these new data, the prevalence of type 1 diabetes mellitus was estimated at 1.4% of patients on dialysis therapy in mainland France, and 5.5% for type 2 diabetes mellitus. A north-south declining trend was suggested for type 2 diabetes mellitus. Diabetic nephropathy was the only primary renal diagnosis among 93.9% of type 1 diabetic patients, but only for 36.8% of type 2 diabetic patients. Of the latter, 51.6% had a non-diabetic cause of renal failure. These data show that the proportion of diabetics among patients receiving dialysis, while steadily increasing in France, remains lower than in other countries in Europe and in North America. However, the validity of international comparisons depends on diabetes ascertainment. Heterogeneity in selection of patients and in diabetes type classification by dialysis units may account to a considerable degree for the differences between diabetes mellitus prevalence across countries.

The aim of this study was to analyse the characteristics and the mortality rate of diabetic patients, in France, between 1970 and 1987, as well as the association between diabetes and other pathologies at death. These results are based on both the underlying and the associated causes of death registered on the death certificate, in contrast to most studies which use only the underlying cause. In 1987, there were 16,790 deaths in France for which diabetes was mentioned on the death certificate (as the underlying cause in 38% of cases). There was a higher mortality in male diabetic subjects then in female, for all ages except over 75 years. Between 1970 and 1987, the mortality decreased for both sexes, except for the oldest age group. The death rate varied greatly between geographical regions. A particularly high mortality occurred in the Nord-Pas-de-Calais, Lorraine and Alsace. Diabetes was significantly associated, at death, with other diseases and pathologies. The most frequent were vascular diseases (ischaemic heart disease, cerebral diseases and hypertension) and diseases of the genitourinary system. It if of note that 5% of the death certificates of these diabetic subjects indicated diabetic coma as a cause of death.

Mineral and vitamin intakes were assessed among 1108 subjects, aged 6 months to 97 years in 12 of 47 towns and cities in the district of Val-de-Marne (Paris area), using the telephone directory as random sampling base. Micronutrients intake was evaluated by individual interviews at home by specialized dietitians (dietary history method). Mineral and vitamin intake was found to vary widely with age. In absolute value, overall mineral and vitamin dietary intakes was higher in men than in women (except for vitamin C). Conversely, the dietary density for mineral and vitamins was higher in females. For a large part of the studied population, it would appear difficult to satisfy recommended dietary allowances for many micronutrients (iron, zinc, vit. B1, B6, C, A et E). These results bring to light possible difficulties in covering certain mineral and vitamin requirements in the French population.

Dietary intakes and its nutritional value were assessed during a nutritional survey performed in a population living in a district in the Paris area (Val-de-Marne). Data were obtained from 1108 subjects, aged 6 months to 97 years, randomly selected from the telephone directories of 12 of 47 towns and cities in the district. Dietary intake was evaluated in individual home interviews conducted by specialized dietitians, using the dietary history method. Age appears to be an important determining factor in variations in nutritional intake. Large differences exist between men and women for most types of food consumption. But the relative contribution of the main groups of food groups to the structure of energy intake is very similar in both sexes and virtually constant in the different age groups after the age of 6.

Incidence rates of insulin dependent diabetes mellitus (IDDM) are distributed over Europe along a North to South gradient where the values observed in Finland are 7-fold greater than in the South. According to previous data, France represented the bottom of this gradient. A survey in 1988 and 1989 was conducted in order to record all newly diagnosed diabetic children under 20 years of age, in 4 French regions: Aquitaine, Lorraine, lower Normandie, upper Normandie. The mean annual incidence rate was 7.3/10(5), without any significant geographical variation. Age-specific incidence rates indicated two peaks: one in the younger age group and the other around puberty, already described in most incidence studies. The study confirms that France is a country with one of the lowest incidence rate in Europe. It also suggests that incidence has increased over the past decades as in other countries.

The aim of this study was to determine which candidates were suitable for immunotherapy among adult insulin dependent diabetic patients of recent onset. A statistical analysis was performed using the results of a multicentre randomized trial of cyclosporine versus placebo after nine months of treatment. When the baseline characteristics of the patients in remission were compared with those not in remission, there was no difference observed either in initial residual beta-cell function (glucagon stimulated C-peptide level), or in immunological markers (T4 and T8 lymphocytes counts, Interleukin 2). The parameters showing the most difference were, in addition to treatment group, the duration of diabetes symptoms and body mass index at inclusion, and the HLA-DR phenotype. This was confirmed using a logistic regression analysis, in which these variables were found to be significantly related to remission. The probability of remission in each individual patient was then calculated using these variables in the mathematical function provided by the logistic model. Ninety eight out of 110 patients were correctly classified using this method. In addition, it must be noted that only subjects adequately treated by cyclosporine were still in complete remission after a one year follow-up. Conversely, it appeared that immunosuppression in subjects having a predicted probability of remission lower than 0.35 using the mathematical function, and being non-DR3, non-DR4 has to be avoided. These results will be useful in optimizing the recruitment of patients in on-going or future trials of immunotherapy in early diabetes.

In a double-blind trial 122 patients aged 15-40 years with insulin-dependent diabetes of recent onset were randomly assigned to cyclosporin 7.5 mg/kg per day or placebo. At the sixth month 25.4% of the cyclosporin group and 18.6% of the placebo group were in complete remission (not a significant difference). Treatment was continued in those patients with complete or partial remission (insulin requirement less than 0.25 U/kg per day) and 106 patients were followed to nine months, at which stage 24.1% of the original cyclosporin group and 5.8% of the original placebo group were in complete remission (p less than 0.01). For those patients whose whole-blood trough cyclosporin levels in the first three months averaged 300 ng/ml or more, the rates of complete remission at six and nine months were 37.5% and 37%. The rates of partial remission were also higher in the cyclosporin group and at six months the rate of complete or partial remission was 46% in the whole cyclosporin group and 65.6% in those with an average blood level exceeding 300 ng/ml in the first three months, versus 28.8% in the placebo group. The principal side-effect of cyclosporin was a modest and reversible increase in plasma creatinine. These results indicate that cyclosporin promotes the remission of type I diabetes and suggest the need for new controlled protocols aimed at evaluating the length of the effect and selecting the best drug regimen.

An epidemiological survey was carried out in France in 1982-3 to study the proportions of occasional and chronic drinkers among people injured in accidents of all kinds. The characteristics of 4796 victims recruited in the emergency units of 21 hospitals were recorded. Systematic blood sampling was performed to determine the blood alcohol concentration and two markers of chronic alcohol consumption--gamma-glutamyltransferase activity and mean corpuscular volume. Alcohol was present in the blood of 35% of the injured people, with concentrations exceeding 17.4 mmol/l (0.8 g/l) in one man out of four and in one woman out of 10. gamma-Glutamyltransferase values and mean corpuscular volume were also much higher than in a reference population of healthy subjects, indicating that most of the intoxicated subjects were probably chronic drinkers. This was confirmed by a discriminant analysis which showed an overall proportion of 30% of chronic drinkers among casualties. In France, therefore, the policy for preventing accidents should focus on chronic as much as on occasional drinking.

A cohort of 372 insulin-dependent diabetic children, diagnosed between October 1949 and December 1960, were followed-up until December 1976 by the same team of physicians. At the time of diagnosis all patients were under 16 yr of age and were given standardized treatment which did not change from 1949 to 1976. The therapy consisted of daily insulin adjustment based on clinical assessment, the degree of physical activity, and the results of semi-quantitative urine tests for sugar and ketone bodies. These tests were systematically performed before breakfast, lunch, and dinner. Diet was normal, unmeasured, rich in carbohydrates (approximately 60%), and quantitatively unrestricted unless the patient was overweight. Rates for mortality and for the principal complications among this cohort were computed by the actuarial method. During the 26 yr of study, 26 deaths occurred, 16 of which were directly connected with diabetes. After 16 yr of follow-up, rates of proteinuria and hypertension were 4% and 2.1% respectively. The incidence of retinopathy reached 27%, including 1.5% proliferative retinopathy. After 26 yr, the rates rose to 14% for proteinuria, 16% for hypertension, and 85% for retinopathy, including 18% in the proliferative phase.

A study on dietary behavior during pregnancy was performed between June and December 1975 at the Saint Antoine Maternity Hospital in Paris. In addition to the routine clinical examinations at the 3rd, 6th, 8th and 9th month of pregnancy, the women were systematically questioned on their dietary and tobacco habits. Results show that: (1) the mean caloric intake is constant during the first trimester and then significantly decreases in the last two trimesters (2) the fatter the woman before pregnancy, the lower the caloric intake at the successive examinations (3) the total weight gain is positively related to the caloric intake during the first trimester, but not related to the dietary data observed at the 6th, 8th or 9th examinations (4) birth weight seems to be more related to body size before pregnancy than to weight gain.