Diabetes Risk Factors (diabetes + risk_factor)

Distribution by Scientific Domains


Selected Abstracts


The impact of diabetes and obesity on liver histology in patients with hepatitis C

DIABETES OBESITY & METABOLISM, Issue 3 2003
F. Friedenberg
Aim:, An association between diabetes mellitus and HCV has been recognized previously. No study has examined whether there is an independent association between the degree of hepatic fibrosis and the incidence of diabetes in HCV patients when controlling for other risk factors. Methods:, We reviewed the charts of 264 consecutive patients with chronic HCV infection at a referral liver centre from January 1991 to December 1999. Demographic background, medical history, laboratory and liver biopsy results were retrieved. Results:, The prevalence of diabetes was 16.3%. Gender, intravenous drug use, steatosis scores, aminotransferase levels and iron studies were similarly distributed in patients with and without diabetes (all p > 0.05). In contrast, mean age was greater in the diabetic group (49.8 vs. 44.3, p = 0.003). The prevalence of diabetes was substantially higher in African-Americans (p = 0.001) and those with BMI > 30 (p = 0.015). Although the fibrosis score was higher in diabetics (, = 0.14, p = 0.03), that association did not remain significant when controlling for diabetes risk factors (p > 0.3). The degree of steatosis and fibrosis both tended to increase with increasing BMI (, = 0.47, p < 0.001 and , = 0.13, p = 0.03, respectively). Even after controlling for diabetes, age, gender, race, and current alcohol use, those associations remained (both p < 0.001). Conclusions:, The prevalence of diabetes in our group of HCV patients was high, consistent with other studies. Diabetes is not an independent predictor of degree of fibrosis. Body mass index is an independent predictor of both fibrosis and steatosis in HCV patients. [source]


Low serum concentration of sulfatide and presence of sulfated lactosylceramid are associated with Type 2 diabetes.

DIABETIC MEDICINE, Issue 9 2005
The Skaraborg Project
Abstract Aims The glycosphingolipid sulfatide (sulfated galactosyl-ceramide) increases exocytosis of ,-cell secretory granules, activates KATP -channels and is thereby able to influence insulin secretion through its presence in the islets. A closely related compound, sulfated lactosylceramide (sulf-lac-cer), is present in the islets during fetal and neonatal life when, as in Type 2 diabetes, insulin is secreted autonomically without the usual first phase response to glucose. The aim was to examine whether serum concentrations of these glycolipids are associated with Type 2 diabetes. Methods A case,control study, comprising 286 women and 283 men, was designed using a population-based sample of patients with Type 2 diabetes and a population survey. Results Low serum concentrations of sulfatide were associated with Type 2 diabetes, independent of traditional risk factors for diabetes in a sex-specific analysis: odds ratio (OR) 2.1 (95% confidence interval 1.1, 3.9) in men, and 2.3 (1.2, 4.3) in women, comparing the lowest and the highest tertiles. Type 2 diabetes was also associated with detectable amounts of sulf-lac-cer in serum: OR 1.7 (0.9, 3.4) in men, and 7.6 (3.8, 15.2) in women. After adjustment for confounding from other diabetes risk factors, these associations remained basically unchanged. The connections between sulfatide and Type 2 diabetes, and sulf-lac-cer and Type 2 diabetes were independent of each other. Insulin resistance (HOMA-IR) was negatively correlated with sulfatide concentration and positively correlated with sulf-lac-cer (both P < 0.0001, independently). Conclusions We report a new, robust and highly significant independent association between Type 2 diabetes and serum concentrations of sulfatide in both sexes, and sulf-lac-cer in females. The associations were also independent of other known diabetes risk factors. [source]


One-year changes in glucose and heart disease risk factors among participants in the WISEWOMAN programme

EUROPEAN DIABETES NURSING, Issue 2 2007
JC Will PhD
Abstract Background: WISEWOMAN provides chronic disease risk factor screening, referrals and lifestyle interventions to low-income, uninsured women, to reduce their heart disease and stroke risk. Participants learn behaviour-changing skills tailored to low-income populations, such as collaborative goal setting, the need to take small steps and other empowerment techniques. Aim: To quantify the baseline prevalence of pre-diabetes (fasting blood glucose 5.5,6.9 mmol/l) and diabetes among WISEWOMAN participants and assess one-year changes in glucose levels and other diabetes risk factors. Methods: We used 1998,2005 baseline and one-year follow-up data from WISEWOMAN participants. Using a multilevel regression model, we assessed one-year changes in glucose, blood pressure (BP), total cholesterol and 10-year risk of coronary heart disease (CHD) among participants with baseline pre-diabetes (n=688) or diabetes (n=338). Results: At baseline, 15% of participants had pre-diabetes and 10% had diabetes. Of those with diabetes, 26% were unaware of their condition before baseline screening. During the one-year follow-up period, participants with pre-diabetes experienced statistically significant improvements in glucose (2.9%) and cholesterol (2.1%) levels and 10-year CHD risk (4.3%). Participants with newly diagnosed diabetes experienced statistically significant improvements in glucose (11.5%), BP (3.1%,3.5%) and cholesterol (6.4%) levels. Participants with previously diagnosed diabetes experienced significant improvements in BP (1.9%,3.4%), cholesterol level (3.8%), and 10-year CHD risk (8.5%). Conclusions: Implementing patient-centered, comprehensive and multilevel interventions and demonstrating their effectiveness will likely lead to the adoption of this approach on a much broader scale. [source]


Investing time in health: do socioeconomically disadvantaged patients spend more or less extra time on diabetes self-care?

HEALTH ECONOMICS, Issue 6 2009
Susan L. Ettner
Abstract Background: Research on self-care for chronic disease has not examined time requirements. Translating Research into Action for Diabetes (TRIAD), a multi-site study of managed care patients with diabetes, is among the first to assess self-care time. Objective: To examine associations between socioeconomic position and extra time patients spend on foot care, shopping/cooking, and exercise due to diabetes. Data: Eleven thousand nine hundred and twenty-seven patient surveys from 2000 to 2001. Methods: Bayesian two-part models were used to estimate associations of self-reported extra time spent on self-care with race/ethnicity, education, and income, controlling for demographic and clinical characteristics. Results: Proportions of patients spending no extra time on foot care, shopping/cooking, and exercise were, respectively, 37, 52, and 31%. Extra time spent on foot care and shopping/cooking was greater among racial/ethnic minorities, less-educated and lower-income patients. For example, African-Americans were about 10 percentage points more likely to report spending extra time on foot care than whites and extra time spent was about 3,min more per day. Discussion: Extra time spent on self-care was greater for socioeconomically disadvantaged patients than for advantaged patients, perhaps because their perceived opportunity cost of time is lower or they cannot afford substitutes. Our findings suggest that poorly controlled diabetes risk factors among disadvantaged populations may not be attributable to self-care practices. Copyright © 2008 John Wiley & Sons, Ltd. [source]


Hepatitis C virus infection and incident type 2 diabetes

HEPATOLOGY, Issue 1 2003
M.P.H. Assistant Research Professor, Shruti H. Mehta Ph.D.
Although hepatitis C virus (HCV) infection is more common among adults with type 2 diabetes, it is uncertain whether HCV precedes the development of diabetes. Thus, we performed a prospective (case-cohort) analysis to examine if persons who acquired type 2 diabetes were more likely to have had antecedent HCV infection when enrolled in a community-based cohort of men and women between the ages of 44 and 65 in the United States (Atherosclerosis Risk in Communities Study [ARIC]). Among 1,084 adults free of diabetes at baseline, 548 developed diabetes over 9 years of follow-up evaluation. Incident cases of diabetes were identified by using fasting glucose and medical history and HCV antibodies were assessed at baseline. A priori, persons were categorized as low-risk or high-risk for diabetes based on their age and body mass index, factors that appeared to modify the type 2 diabetes-HCV infection incidence estimates. The overall prevalence of HCV in this population was 0.8%. Among those at high risk for diabetes, persons with HCV infection were more than 11 times as likely as those without HCV infection to develop diabetes (relative hazard, 11.58; 95% confidence interval, 1.39-96.6). Among those at low risk, no increased incidence of diabetes was detected among HCV-infected persons (relative hazard, 0.48; 95% confidence interval, 0.05-4.40). In conclusion, pre-existing HCV infection may increase the risk for type 2 diabetes in persons with recognized diabetes risk factors. Additional larger prospective evaluations are needed to confirm these preliminary findings. [source]


Detection of Undiagnosed Diabetes and Prediabetic States in High-risk Emergency Department Patients

ACADEMIC EMERGENCY MEDICINE, Issue 5 2009
Michelle A. Charfen MD
Abstract Background:, Diabetes is often not diagnosed until complications appear, and one-third of those with diabetes may be undiagnosed. Prediabetes and diabetes are conditions in which early detection would be appropriate, because the duration of hyperglycemia is a predictor of adverse outcomes, and there are effective interventions to prevent disease progression and to reduce complications. Objectives:, The objectives were to determine the prevalence of diabetes mellitus and prediabetes in emergency department (ED) patients with an elevated random glucose or risk factors for diabetes but without previously diagnosed diabetes and to identify which at-risk ED patients should be considered for referral for confirmatory diagnostic testing. Methods:, This two-part study was composed of a prospective 2-year cohort study, and a 1-week cross-sectional survey substudy, set in an urban ED in Los Angeles County, California. A convenience sample was enrolled of 528 ED patients without previously diagnosed diabetes with either 1) a random serum glucose , 140 mg/dL regardless of the time of last food intake or a random serum glucose , 126 mg/dL if more than 2 hours since last food intake or 2) at least two predefined diabetes risk factors. Measurements included presence of diabetes risk factors, ED glucose, cortisol, insulin and glycosylated hemoglobin (HbA1c), and 2-hour oral glucose tolerance test results, administered at 6-week follow-up. Results:, Glycemic status was confirmed at follow-up in 256 (48%) of the 528 patients. Twenty-seven (11%) were found to have diabetes, 141 (55%) had prediabetes, and 88 (34%) had normal results. Age, ED glucose, HbA1c, cortisol, and random serum glucose , 140 mg/dL were associated with both diabetes and prediabetes on univariate analysis. A random serum glucose , 126 mg/dL after 2 hours of fasting was associated with diabetes but not prediabetes; ED cortisol, insulin, age , 45 years, race, and calculated body mass index (BMI) were associated with prediabetes but not diabetes. In multivariable models, among factors measurable in the ED, the only independent predictor of diabetes was ED glucose, while ED glucose, age , 45 years, and symptoms of polyuria and polydipsia were independent predictors of prediabetes. All at-risk subjects with a random ED blood glucose > 155 mg/dL had either prediabetes or diabetes on follow-up testing. Conclusions:, A substantial fraction of this urban ED study population was at risk for undiagnosed diabetes and prediabetes, and among the at-risk patients referred for follow-up, the majority demonstrated diabetes or prediabetes. Notably, all patients with two risk factors and a random serum glucose > 155 mg/dL were later diagnosed with prediabetes or diabetes. Consideration should be given to referring ED patients with risk factors and a random glucose > 155 mg/dL for follow-up testing. [source]


Estimated Risk for Undiagnosed Diabetes in the Emergency Department: A Multicenter Survey

ACADEMIC EMERGENCY MEDICINE, Issue 5 2007
Adit A. Ginde MD
BackgroundOne third of the 21 million Americans with diabetes remain undiagnosed. The emergency department (ED) is a novel setting for diabetes screening. ObjectivesTo estimate risk factors for undiagnosed diabetes in the ED. MethodsThis was a cross sectional survey in five Boston EDs. The authors enrolled consecutive adults without known diabetes over two 24-hour periods at each site. The focus was on diabetes risk factors and estimated risk for diabetes on the basis of American Diabetes Association (ADA) criteria. The authors also examined prior diabetes testing and willingness to participate in ED-based diabetes screening. ResultsSix hundred four patients (70% of eligible) were enrolled. On the basis of ADA risk score, 33% (95% confidence interval [CI] = 29% to 37%) were high risk for undiagnosed diabetes, and an additional 42% (95% CI = 38% to 46%) had elevated risk. For example, 58% (95% CI = 54% to 62%) of participants were overweight or obese (body mass index of ,25). Among these at-risk participants without prior diabetes testing, 73% (95% CI = 66% to 80%) reported amenability to having additional blood drawn for ED diabetes screening, and 98% (95% CI = 96% to 100%) indicated that they would follow up for confirmation of abnormal screening. ConclusionsMany ED patients in the study had risk factors for undiagnosed diabetes. Patient attitudes toward ED-based diabetes screening support further exploration of this important and currently underutilized opportunity for public health intervention. [source]