Diabetes Care
1935-5548
0149-5992
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Cơ quản chủ quản: American Diabetes Association Inc. , AMER DIABETES ASSOC
Các bài báo tiêu biểu
MỤC TIÊU—Mục tiêu của nghiên cứu này là ước lượng tỷ lệ mắc bệnh đái tháo đường và số lượng người ở mọi độ tuổi mắc bệnh đái tháo đường trong các năm 2000 và 2030.
THIẾT KẾ NGHIÊN CỨU VÀ PHƯƠNG PHÁP—Dữ liệu về tỷ lệ mắc bệnh đái tháo đường theo độ tuổi và giới tính từ một số ít quốc gia đã được ngoại suy cho tất cả 191 quốc gia thành viên của Tổ chức Y tế Thế giới và áp dụng cho ước lượng dân số của Liên Hợp Quốc trong năm 2000 và 2030. Dân số đô thị và nông thôn ở các quốc gia đang phát triển được xem xét riêng biệt.
KẾT QUẢ—Tỷ lệ mắc bệnh đái tháo đường trên toàn cầu đối với tất cả các nhóm tuổi ước tính là 2.8% vào năm 2000 và 4.4% vào năm 2030. Tổng số người mắc bệnh đái tháo đường được dự đoán sẽ tăng từ 171 triệu người vào năm 2000 lên 366 triệu người vào năm 2030. Tỷ lệ mắc bệnh đái tháo đường cao hơn ở nam giới so với nữ giới, nhưng số lượng nữ giới mắc bệnh đái tháo đường nhiều hơn nam giới. Dân số đô thị ở các quốc gia đang phát triển được dự báo sẽ gấp đôi từ năm 2000 đến 2030. Thay đổi nhân khẩu học quan trọng nhất đối với tỷ lệ mắc bệnh đái tháo đường trên toàn thế giới dường như là sự gia tăng tỷ lệ người >65 tuổi.
KẾT LUẬN—Những phát hiện này cho thấy rằng “dịch bệnh đái tháo đường” sẽ tiếp tục ngay cả khi mức béo phì giữ nguyên. Với tỷ lệ béo phì ngày càng tăng, có khả năng rằng những con số này chỉ ra mức dưới mức của tỷ lệ mắc bệnh đái tháo đường trong tương lai.
To estimate the prevalence of diabetes and the number of people with diabetes who are ≥20 years of age in all countries of the world for three points in time, i.e., the years 1995, 2000, and 2025, and to calculate additional parameters, such as sex ratio, urban-rural ratio, and the age structure of the diabetic population.
Age-specific diabetes prevalence estimates were applied to United Nations population estimates and projections for the number of adults aged ≥20 years in all countries of the world. For developing countries, urban and rural populations were considered separately
Prevalence of diabetes in adults worldwide was estimated to be 4.0% in 1995 and to rise to 5.4% by the year 2025. It is higher in developed than in developing countries. The number of adults with diabetes in the world will rise from 135 million in 1995 to 300 million in the year 2025. The major part of this numerical increase will occur in developing countries. There will be a 42% increase, from 51 to 72 million, in the developed countries and a 170% increase, from 84 to 228 million, in the developing countries. Thus, by the year 2025, >75% of people with diabetes will reside in developing countries, as compared with 62% in 1995. The countries with the largest number of people with diabetes are, and will be in the year 2025, India, China, and the U.S. In developing countries, the majority of people with diabetes are in the age range of 45–64 years. In the developed countries, the majority of people with diabetes are aged ≥65 years. This pattern will be accentuated by the year 2025. There are more women than men with diabetes, especially in developed countries. In the future, diabetes will be increasingly concentrated in urban areas.
This report supports earlier predictions of the epidemic nature of diabetes in the world during the first quarter of the 21st century. It also provides a provisional picture of the characteristics of the epidemic. Worldwide surveillance of diabetes is a necessary first step toward its prevention and control, which is now recognized as an urgent priority.
MỤC ĐÍCH: Đã có nhiều phương pháp được đề xuất để đánh giá độ nhạy cảm insulin từ dữ liệu thu được từ thử nghiệm dung nạp glucose đường uống (OGTT). Tuy nhiên, tính hợp lệ của các chỉ số này chưa được đánh giá nghiêm ngặt bằng cách so sánh với đo lường trực tiếp độ nhạy cảm insulin được thu thập bằng kỹ thuật kẹp insulin euglycemic. Trong nghiên cứu này, chúng tôi so sánh các chỉ số nhạy cảm insulin khác nhau thu được từ OGTT với độ nhạy cảm insulin toàn cơ thể được đo bằng kỹ thuật kẹp insulin euglycemic. PHƯƠNG PHÁP NGHIÊN CỨU: Trong nghiên cứu này, 153 đối tượng (66 nam và 87 nữ, trong độ tuổi 18-71 tuổi, BMI từ 20-65 kg/m2) với các mức độ dung nạp glucose khác nhau (62 đối tượng có dung nạp glucose bình thường, 31 đối tượng bị suy giảm dung nạp glucose và 60 đối tượng mắc tiểu đường type 2) đã được nghiên cứu. Sau khi nhịn ăn suốt 10 giờ qua đêm, tất cả đối tượng được thực hiện, theo thứ tự ngẫu nhiên, một thử nghiệm OGTT 75 g và một kỹ thuật kẹp insulin euglycemic, được thực hiện với truyền dịch [3-3H]glucose. Các chỉ số độ nhạy cảm insulin thu được từ dữ liệu OGTT và kẹp insulin euglycemic được so sánh bằng phân tích tương quan. KẾT QUẢ: Nồng độ glucose huyết tương trung bình chia cho nồng độ insulin huyết tương trung bình trong OGTT không hiển thị tương quan với tỉ lệ tiêu thụ glucose toàn cơ thể trong kẹp insulin euglycemic (r = -0.02, NS). Từ OGTT, chúng tôi đã phát triển một chỉ số nhạy cảm insulin toàn cơ thể (10,000/căn thức bậc hai của [glucose khi đói x insulin khi đói] x [glucose trung bình x insulin trung bình trong OGTT]), có tương quan cao (r = 0.73, P < 0.0001) với tỉ lệ tiêu thụ glucose toàn cơ thể trong kẹp insulin euglycemic. KẾT LUẬN: Các phương pháp trước đây đã được sử dụng để tạo ra chỉ số nhạy cảm insulin từ OGTT dựa vào tỷ lệ nồng độ glucose huyết tương so với nồng độ insulin trong OGTT. Kết quả của chúng tôi chỉ ra hạn chế của phương pháp này. Chúng tôi đã phát triển một ước tính mới về độ nhạy cảm insulin, đơn giản để tính toán và cung cấp một phép xấp xỉ hợp lý cho độ nhạy cảm insulin toàn cơ thể từ OGTT.
OBJECTIVE—To estimate the prevalence of and the cardiovascular risk associated with the metabolic syndrome using the new definition proposed by the World Health Organization (WHO).
RESEARCH DESIGN AND METHODS—A total of 4,483 subjects aged 35–70 years participating in a large family study of type 2 diabetes in Finland and Sweden (the Botnia study) were included in the analysis of cardiovascular risk associated with the metabolic syndrome. In subjects who had type 2 diabetes (n = 1,697), impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) (n = 798), or insulin-resistance with normal glucose tolerance (NGT) (n = 1,988), the metabolic syndrome was defined as presence of at least two of the following risk factors: obesity, hypertension, dyslipidemia, or microalbuminuria. Cardiovascular mortality was assessed in 3,606 subjects with a median follow-up of 6.9 years.
RESULTS—In women and men, respectively, the metabolic syndrome was seen in 10 and 15% of subjects with NGT, 42 and 64% of those with IFG/IGT, and 78 and 84% of those with type 2 diabetes. The risk for coronary heart disease and stroke was increased threefold in subjects with the syndrome (P < 0.001). Cardiovascular mortality was markedly increased in subjects with the metabolic syndrome (12.0 vs. 2.2%, P < 0.001). Of the individual components of the metabolic syndrome, microalbuminuria conferred the strongest risk of cardiovascular death (RR 2.80; P = 0.002).
CONCLUSIONS—The WHO definition of the metabolic syndrome identifies subjects with increased cardiovascular morbidity and mortality and offers a tool for comparison of results from different studies.
Homeostatic model assessment (HOMA) is a method for assessing β-cell function and insulin resistance (IR) from basal (fasting) glucose and insulin or C-peptide concentrations. It has been reported in >500 publications, 20 times more frequently for the estimation of IR than β-cell function.
This article summarizes the physiological basis of HOMA, a structural model of steady-state insulin and glucose domains, constructed from physiological dose responses of glucose uptake and insulin production. Hepatic and peripheral glucose efflux and uptake were modeled to be dependent on plasma glucose and insulin concentrations. Decreases in β-cell function were modeled by changing the β-cell response to plasma glucose concentrations. The original HOMA model was described in 1985 with a formula for approximate estimation. The computer model is available but has not been as widely used as the approximation formulae. HOMA has been validated against a variety of physiological methods.
We review the use and reporting of HOMA in the literature and give guidance on its appropriate use (e.g., cohort and epidemiological studies) and inappropriate use (e.g., measuring β-cell function in isolation). The HOMA model compares favorably with other models and has the advantage of requiring only a single plasma sample assayed for insulin and glucose.
In conclusion, the HOMA model has become a widely used clinical and epidemiological tool and, when used appropriately, it can yield valuable data. However, as with all models, the primary input data need to be robust, and the data need to be interpreted carefully.
Individuals with impaired glucose tolerance (IGT) have a high risk of developing NIDDM. The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM, i.e., reduce the incidence of NIDDM, and thereby reduce the overall incidence of diabetic complications, such as cardiovascular, renal, and retinal disease, and the excess mortality attributable to these complications.
In 1986, 110,660 men and women from 33 health care clinics in the city of Da Qing, China, were screened for IGT and NIDDM. Of these individuals, 577 were classified (using World Health Organization criteria) as having IGT. Subjects were randomized by clinic into a clinical trial, either to a control group or to one of three active treatment groups: diet only, exercise only, or diet plus exercise. Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM. Cox's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment.
The cumulative incidence of diabetes at 6 years was 67.7% (95% CI, 59.8–75.2) in the control group compared with 43.8% (95% CI, 35.5–52.3) in the diet group, 41.1% (95% CI, 33.4–49.4) in the exercise group, and 46.0% (95% CI, 37.3–54.7) in the diet-plus-exercise group (P < 0.05). When analyzed by clinic, each of the active intervention groups differed significantly from the control clinics (P < 0.05). The relative decrease in rate of development of diabetes in the active treatment groups was similar when subjects were stratified as lean or overweight (BMI < or ≥ 25 kg/m2). In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose, the diet, exercise, and diet-plus-exercise interventions were associated with 31% (P < 0.03), 46% (P < 0.0005), and 42% (P < 0.005) reductions in risk of developing diabetes, respectively.
Diet and/or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT.
To assess predictors of CVD mortality among men with and without diabetes and to assess the independent effect of diabetes on the risk of CVD death.
Participants in this cohort study were screened from 1973 to 1975; vital status has been ascertained over an average of 12 yr of follow-up (range 11–13 yr). Participants were 347,978 men aged 35–57 yr, screened in 20 centers for MRFIT. The outcome measure was CVD mortality.
Among 5163 men who reported taking medication for diabetes, 1092 deaths (603 CVD deaths) occurred in an average of 12 yr of follow-up. Among 342,815 men not taking medication for diabetes, 20,867 deaths were identified, 8965 ascribed to CVD. Absolute risk of CVD death was much higher for diabetic than nondiabetic men of every age stratum, ethnic background, and risk factor level—overall three times higher, with adjustment for age, race, income, serum cholesterol level, sBP, and reported number of cigarettes/day (P < 0.0001). For men both with and without diabetes, serum cholesterol level, sBP, and cigarette smoking were significant predictors of CVD mortality. For diabetic men with higher values for each risk factor and their combinations, absolute risk of CVD death increased more steeply than for nondiabetic men, so that absolute excess risk for diabetic men was progressively greater than for nondiabetic men with higher risk factor levels.
These findings emphasize the importance of rigorous sustained intervention in people with diabetes to control blood pressure, lower serum cholesterol, and abolish cigarette smoking, and the importance of considering nutritional-hygienic approaches on a mass scale to prevent diabetes.
To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes.
A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20–79 years.
A total of 35 studies (1980–2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5–34.8) for any DR, 6.96% (6.87–7.04) for proliferative DR, 6.81% (6.74–6.89) for diabetic macular edema, and 10.2% (10.1–10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A1c, and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes.
There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.