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A Longitudinal Study of Diabetes Mellitus: With Special Reference to Incidence and Prevalence, and to Determinants of Macrovascular Complications and Mortality
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.ORCID iD: 385375
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives. To investigate diabetes prevalence, incidence, mortality trends, the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment, and the effect of screening detection on total and cardiovascular disease (CVD), myocardial infarction (MI) and stroke incidence.

Study population and methods. Between 1972 and 2001 all patients with diabetes, some detected clinically and some by case-finding procedures (screening), were entered in a diabetes register at Laxå Primary Health Care Center in Sweden. The register included information on medical treatment and laboratory data as well as information on mortality and morbidity from National Registers. The register was supplemented with five non-diabetic subjects, matched to each diabetes patients by age, sex, and year of detection.

Results. During the study period 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. Age standardised incidence and prevalence rates for type 1 and type 2 diabetes did not increase over time. Diabetic patients had 17% higher mortality rate than non-diabetic persons, 22% in women and 13% in men. The corresponding over-mortality in CVD was 33%, 41% in women and 27% in men. CVD mortality decreased across time in non-diabetic subjects and in diabetic men but not in diabetic women. Results regarding coronary heart disease (CHD) were similar. CVD incidence increased with fasting blood glucose (FBG), body mass index (BMI), mean arterial blood pressure (MABP), and decreased with metformin treatment and sulfonylurea. Myocardial infarction incidence increased with FBG, BMI and MABP, and decreased with metformin treatment. Stroke incidence increased with MABP. There was no difference in prognoses between those detected by screening or clinically.

Conclusions. Diabetes prevalence and incidence did not change over time. The over-mortality according to diabetes was moderate. CVD and MI during follow up were negatively affected by hypertension and hyperglycaemia, and positively by pharmacological diabetic treatment. For stroke no pharmacological protective effect was seen. Screening did not improve prognosis.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 132 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 955
Keyword [en]
Diabetes mellitus, clinical epidemiology, longitudinal study, prevalence, incidence, mortality, macrovascular complications, pharmacological diabetes treatment, hypertension treatment, screening
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-210916ISBN: 978-91-554-8819-2 (print)OAI: oai:DiVA.org:uu-210916DiVA: diva2:668104
Public defence
2014-01-17, Wilandersalen, Universitetssjukhuset, Örebro, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2013-12-18 Created: 2013-11-17 Last updated: 2014-01-24
List of papers
1. Prevalence and incidence rate of diabetes mellitus in a Swedish community during 30 years of follow-up
Open this publication in new window or tab >>Prevalence and incidence rate of diabetes mellitus in a Swedish community during 30 years of follow-up
2007 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 50, no 4, 703-710 p.Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis: Increasing diabetes prevalence has been reported in most European countries in the last 20 years. In this study we report on the development of prevalence and incidence of diabetes from 1972 to 2001 in Laxå, a rural community in central Sweden. Materials and methods: A diabetes register was established at the primary healthcare centre (PHCC) in Laxå, beginning in 1972 and based on data from clinical records at the PHCC, nearby hospitals and private practitioners in the area. In addition, case-finding procedures involving 85% of the residents aged 35 to 79 years old was performed from 1983 onwards. Results: During the study period a total of 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. The age-standardised incidence rates for type 1 diabetes mellitus and type 2 diabetes mellitus were 0.15 and 3.03 cases per 1,000 population, respectively. No increase in incidence over time was detected for either forms of diabetes. Age-standardised prevalence for women and men increased from 28.3 and 25.9, respectively, per 1,000 in 1972 to 45 and 46.3 per 1,000 in 1988 (p<0.0001), thereafter falling to a mean of 43.5 per 1,000 for women, while men had a mean of 44.9 per 1,000 for the rest of the study period. Conclusions/interpretation: The prevalence of diabetes mellitus in Laxå is high, but has not increased during the last 13 years. The incidence rate was relatively stable over the whole 30-year period.

Keyword
Case-finding, Diabetes mellitus, Incidence, Prevalence, Time trend
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-10365 (URN)10.1007/s00125-007-0593-4 (DOI)000244687700002 ()17268796 (PubMedID)
Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-11Bibliographically approved
2. Mortality Trends in Subjects With and Without Diabetes During 33 Years of Follow-up
Open this publication in new window or tab >>Mortality Trends in Subjects With and Without Diabetes During 33 Years of Follow-up
2010 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 33, no 3, 551-556 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE - Mortality rates have declined substantially over the Past decades in the general population, but the situation among diabetic subjects is less clear. The aim of this study was to analyze mortality trends in diabetic and nondiabetic subjects during 1972-2004. RESEARCH DESIGN AND METHODS - Since 1972, all patients With diabetes are entered in a diabetes register at Laxa Primary Health Care Center; 776 incident cases were recorded Up to 2001. The register has been supplemented with a nondiabetic population of 3,880 subjects and with data from the National Cause of Death Register during 1972 to 2004. RESULTS - During the 33-year follow-up period, 233 (62.0%) diabetic women and 240 (60.0%) diabetic men and 995 (52.9%) nondiabetic women and 1,082 (54.1%) nondiabetic men died. The age-adjusted hazard ratio (HR) for all-cause mortality among diabetic and nondiabetic subjects was 1.17 (P < 0.0021) for all, 1.22 (P < 0.007) for women, and 1.13 (P = 0.095) for men. The corresponding cardiovascular disease (CVD) mortality HRs were 1.33 (P < 0.0001), 1.41 (P < 0.0003), and 1.27 (P < 0.0093), respectively. The CVD Mortality reduction across time was significant in nondiabetic subjects (P < 0.0001) and in men with diabetes (P = 0.014) but not in diabetic women (P = 0.69). The results regarding coronary heart disease (CHD) were similar (P < 0,0001, P < 0.006, and P = 0.17, respectively). The CVD and CHD mortality rate change across time was fairly linear in all groups. CONCLUSIONS - Diabetic subjects had less mortality rate reduction during follow-up than nondiabetic subjects. However the excess mortality risk for diabetic subjects was smaller than that found in Other Studies.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-136927 (URN)10.2337/dc09-0680 (DOI)000275562700019 ()20009100 (PubMedID)
Available from: 2010-12-14 Created: 2010-12-14 Last updated: 2017-12-11Bibliographically approved
3. Effects of fasting blood glucose, diabetes treatment, blood pressure, and hypertension treatment on cardiovascular disease incidence: A 30-year follow-up study of 740 incident patients with type 2 diabetes
Open this publication in new window or tab >>Effects of fasting blood glucose, diabetes treatment, blood pressure, and hypertension treatment on cardiovascular disease incidence: A 30-year follow-up study of 740 incident patients with type 2 diabetes
(English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491Article in journal (Refereed) Submitted
Abstract [en]

Aims: To analyse the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment on total and various types of cardiovascular disease (CVD) incidence in patients with type 2 diabetes followed for 30 years.

Methods: 740 incident patients with type 2 diabetes were registered at the Laxå Primary Health Care Centre, Sweden between 1972 and 2001. Annual information on systolic, diastolic, and mean arterial blood pressure (MABP), mean fasting blood glucose (FBG), type of diabetes and hypertension treatment was obtained from the patient records, and information on CVD, myocardial infarction (MI), and stroke events from National Registers.

Results: During the follow-up period cumulative CVD incidence increased significantly with male sex (HR 1.48, 95% CI 1.21-1.82), number of previous CVD events (HR 1.13, 95% CI 1.08-1.18) age (HR 1.05, 95% CI 1.04-1.07), mean FBG (HR 1.05, 96% CI 1.00-1.10) BMI, (HR 1.04, 95% CI 1.01-1.06), MABP (HR 1.02, 95% CI 1.01-1.03), and decreased significantly with metformin treatment (HR 0.58, 95% CI 0.38-0.90) and sulfonylurea (HR 0.73, 95% CI 0.55-0.97). Cumulative MI incidence increased significantly with male sex, number of previous MI events, mean FBG, BMI, age, and MABP, and decreased with metformin treatment. Cumulative stroke incidence increased with previous number of stroke events, age, and MABP.

Conclusions: Cumulative CVD and MI incidence increased with number of previous events and presence of hypertension and hyperglycaemia and decreased with pharmacological diabetic treatment. For stroke, previous number of events increased the incidence but no pharmacological protective effect was seen.

Keyword
Diabetes, CVD, blood pressure, blood glucose, drug treatment, longitudinal
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-211531 (URN)
Available from: 2013-11-26 Created: 2013-11-25 Last updated: 2017-12-06Bibliographically approved
4. Mortality and cardiovascular outcomes in patients detected by screening or clinically diagnosed type 2 diabetes.: A 30-year follow-up study of 740 incident patients with type 2 diabetes
Open this publication in new window or tab >>Mortality and cardiovascular outcomes in patients detected by screening or clinically diagnosed type 2 diabetes.: A 30-year follow-up study of 740 incident patients with type 2 diabetes
(English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548Article in journal (Refereed) Submitted
Abstract [en]

Objective

Screening for type 2 diabetes among high-risk subjects is recommended by many organizations. The aim of this study was to analyse all-cause mortality and cardiovascular disease (CVD) outcomes in type 2 diabetes subjects detected by screening and those clinically diagnosed during 30 years of follow-up.

Research design and methods

A diabetes register was established at the primary healthcare centre (PHCC) in Laxå, beginning in 1972 and based on data from clinical records with information on medical treatment and laboratory data as well as information on all-cause mortality, CVD, myocardial infarction (MI), and stroke events from National Registers. A total of 740 incident patients with type 2 diabetes were registered between 1972- 2001. In addition, case-finding procedures involving 85% of residents aged 35 to 79 were performed from 1983 onwards.

Results

Baseline characteristics showed a significantly higher CVD risk, mainly depending on more prevalent CVD events in the screened as compared with the clinically detected group (propensity score 0.59 vs. 0.46, p<0.0001). After a mean follow-up of 10 and 11.5 years for screening detected and clinically detected subjects respectively, HRs incidences were for all-cause mortality 1.01 (p=0.97), CVD 1.00 (p=0.99), and MI 1.03 (p=0.87). For stroke a 24% non-significant lower risk for screening detected as compared with clinically detected subjects were found, HR 0.76 (p=0.15).

Conclusions

No reduction in total mortality and CVD outcomes was found in type 2 diabetes subjects detected by screening as compared with those clinically diagnosed, even though stroke incidence tended to be lower.

Keyword
Diabetes, screening, clinically diagnosed, macrovascular outcomes, longitudinal
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
urn:nbn:se:uu:diva-210918 (URN)
Available from: 2013-11-26 Created: 2013-11-17 Last updated: 2017-12-06Bibliographically approved

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