How should developing countries manage diabetes?
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Cost of Illness↗
Biomedical subjects
Giuseppina Imperatore
Publications and source records attributed to Giuseppina Imperatore.
Childhood obesity: is it time for action?
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Abdominal Fat↗
Improvements in diabetes processes of care and intermediate outcomes: United States, 1988-2002.
BACKGROUND: Progress of diabetes care is a subject of public health concern. OBJECTIVE: To assess changes in quality of diabetes care in the United States by using standardized measures. DESIGN: National population-based, serial cross-sectional surveys. SETTING: National Health and Nutrition Examination Survey (1988-1994 and 1999-2002) and the Behavioral Risk Factor Surveillance System (1995 and 2002). PARTICIPANTS: Survey participants 18 to 75 years of age who reported a diagnosis of diabetes. MEASUREMENTS: Glycemic control, blood pressure, low-density lipoprotein (LDL) cholesterol level, annual cholesterol level monitoring, and annual foot and dilated eye examination, as defined by the National Diabetes Quality Improvement Alliance measures. RESULTS: In the past decade, the proportion of persons with diabetes with poor glycemic control (hemoglobin A1c > 9%) showed a nonstatistically significant decrease of 3.9% (95% CI, -10.4% to 2.5%), while the proportion of persons with fair or good lipid control (LDL cholesterol level < 3.4 mmol/L [<130 mg/dL]) had a statistically significant increase of 21.9% (CI, 12.4% to 31.3%). Mean LDL cholesterol level decreased by 0.5 mmol/L (18.8 mg/dL). Although mean hemoglobin A1c did not change, the proportion of persons with hemoglobin A(1c) of 6% to 8% increased from 34.2% to 47.0%. The blood pressure distribution did not change. Annual lipid testing, dilated eye examination, and foot examination increased by 8.3% (CI, 4.0% to 12.7%), 4.5% (CI, 0.5% to 8.5%), and 3.8% (CI, -0.1% to 7.7%), respectively. The proportion of persons reporting annual influenza vaccination and aspirin use improved by 6.8 percentage points (CI, 2.9 percentage points to 10.7 percentage points) and 13.1 percentage points (CI, 5.4 percentage points to 20.7 percentage points), respectively. LIMITATIONS: Data are self-reported, and the surveys do not have all National Diabetes Quality Improvement Alliance indicators. CONCLUSION: Diabetes processes of care and intermediate outcomes have improved nationally in the past decade. But 2 in 5 persons with diabetes still have poor LDL cholesterol control, 1 in 3 persons still has poor blood pressure control, and 1 in 5 persons still has poor glycemic control.
Adolescent↗
Lipid abnormalities are prevalent in youth with type 1 and type 2 diabetes: the SEARCH for Diabetes in Youth Study.
OBJECTIVE: Assessment of the prevalence of serum lipid abnormalities in US youth with type 1 or type 2 diabetes. STUDY DESIGN: The SEARCH for Diabetes in Youth Study was a cross-sectional, population-based study, conducted in six centers. Subjects were 2448 youth with diabetes who had a study examination. Outcome measures were fasting measures of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and non-HDL-C. Analysis was descriptive. RESULTS: The overall prevalence of high TC concentration (>240 mg/dL) was 5%; the overall prevalence of high LDL-C (>160 mg/dL) was 3%, and the overall prevalence of high triglyceride (>400 mg/dL) was 2%. About half of the participants (48%) had an LDL-C concentration above the optimal level of 100 mg/dL. Among youth ages 10+, the prevalence of abnormal lipids was higher in type 2 (n = 283) than in type 1 diabetes (n = 1963): 33% versus 19% had TC concentration >200 mg/dL; 24% versus 15% had LDL-C concentration >130 mg/dL; 29% versus 10% had triglyceride concentration >150 mg/dL; 44% versus 12% had HDL-C concentration <40 mg/dL. Only 1% of youth were receiving pharmacologic therapy for dyslipidemia. CONCLUSIONS: A substantial proportion of young patients with diabetes have abnormal serum lipids.
Adolescent↗
Prevalence of cardiovascular disease risk factors in U.S. children and adolescents with diabetes: the SEARCH for diabetes in youth study.
OBJECTIVE: The purpose of this study was to determine the prevalence and correlates of selected cardiovascular disease (CVD) risk factors among youth aged <20 years with diabetes. RESEARCH DESIGN AND METHODS: The analysis included 1,083 girls and 1,013 boys examined as part of the SEARCH for Diabetes in Youth study, a multicenter, population-based study of youth 0-19 years of age with diabetes. Diabetes type was determined by a biochemical algorithm based on diabetes antibodies and fasting C-peptide level. CVD risk factors were defined as follows: HDL cholesterol <40 mg/dl; age- and sex-specific waist circumference >90th percentile; systolic or diastolic blood pressure >90th percentile for age, sex, and height or taking medication for high blood pressure; and triglycerides >110 mg/dl. RESULTS: The prevalence of having at least two CVD risk factors was 21%. The prevalence was 7% among children aged 3-9 years and 25% in youth aged 10-19 years (P < 0.0001), 23% among girls and 19% in boys (P = 0.04), 68% in American Indians, 37% in Asian/Pacific Islanders, 32% in African Americans, 35% in Hispanics, and 16% in non-Hispanic whites (P < 0.0001). At least two CVD risk factors were present in 92% of youth with type 2 and 14% of those with type 1A diabetes (P < 0.0001). In multivariate analyses, age, race/ethnicity, and diabetes type were independently associated with the odds of having at least two CVD risk factors (P < 0.0001). CONCLUSIONS: Many youth with diabetes have multiple CVD risk factors. Recommendations for weight, lipid, and blood pressure control in youth with diabetes need to be followed to prevent or delay the development of CVD as these youngsters mature.
Adolescent↗
Physical activity, cardiovascular fitness, and insulin sensitivity among U.S. adolescents: the National Health and Nutrition Examination Survey, 1999-2002.
OBJECTIVE: The purpose of this study was to examine the association of physical activity and cardiovascular fitness (CVF) with insulin sensitivity in a nationally representative sample of U.S. youth. RESEARCH DESIGN AND METHODS: The study included 1,783 U.S. adolescents (11% Mexican American, 14% non-Hispanic black, 63% non-Hispanic white, and 12% other) aged 12-19 years who were examined in the 1999-2002 National Health and Nutrition Examination Survey. Physical activity was assessed by questionnaire and expressed in units of MET hours per week. Predicted maximal oxygen uptake (Vo(2max), expressed in milliliters per kilogram of body weight per minute), a measure of CVF, was determined by a submaximal multistage treadmill test. Insulin sensitivity was defined by the Quantitative Insulin Sensitivity Check Index. RESULTS: Boys were more likely than girls to be highly active (>or=30 MET h/week; 51 vs. 37%, P < 0.001) and had higher levels of CVF (mean Vo(2max) 47 vs. 39 ml x kg(-1) x min(-1), P < 0.001). Sex-specific multiple regression models controlled for age, race/ethnicity, and BMI showed that in boys, high levels of physical activity and high levels of CVF were significantly and positively associated with insulin sensitivity (beta = 0.84, P < 0.001 and beta = 0.82, P = 0.01, respectively). Among girls, insulin sensitivity was not significantly associated with physical activity or with CVF but was inversely and significantly associated with BMI. CONCLUSIONS: Increasing physical activity and CVF may have an independent effect of improving insulin sensitivity among boys. For girls, the primary role of physical activity may be in weight maintenance.
Adolescent↗
Age, sex, and ethnic variations in serum insulin concentrations among U.S. youth: findings from the National Health and Nutrition Examination Survey 1999-2002.
OBJECTIVE: Distributions of serum concentrations of insulin among adolescents and young adults are poorly understood in the U.S. The objective of this study was to describe the distribution of serum insulin across demographic characteristics of U.S. adolescents and young adults. RESEARCH DESIGN AND METHODS: A total of 1,791 male and female subjects aged 12-19 years who participated in the National Health and Nutrition Examination Surveys for 1999-2002 were included in the analyses. RESULTS: Among male participants, serum concentrations of insulin increased from age 12 to 14 years before decreasing. Among female participants, concentrations were highest at age 13 years before decreasing steadily through age 19 years. Among participants aged 12-17 years but not those aged 18-19 years, females had higher mean log-transformed concentrations than males (P, Wald, F = 0.038 and 0.125, respectively) after adjusting for age and ethnicity. After adjusting for age and BMI percentile, mean log-transformed concentrations were higher in African-American females aged 12-17 years than in white or Mexican-American participants. No significant ethnic differences were found among female participants aged 18-19 years or male participants aged 12-19 years. Concentrations of insulin increased strongly with increasing levels of BMI. CONCLUSIONS: These results provide detailed information about serum concentrations of insulin in a representative sample of U.S. adolescents and young adults and may be useful to monitor future trends of this risk factor for diabetes and cardiovascular disease.
Adolescent↗
Testing the accelerator hypothesis: body size, beta-cell function, and age at onset of type 1 (autoimmune) diabetes.
OBJECTIVE: The "accelerator hypothesis" predicts that fatness is associated with an earlier age at onset of type 1 diabetes. We tested the hypothesis using data from the SEARCH for Diabetes in Youth study. RESEARCH DESIGN AND METHODS: Subjects were 449 youth aged <20 years at diagnosis who had positive results for diabetes antibodies measured 3-12 months after diagnosis (mean 7.6 months). The relationships between age at diagnosis and fatness were examined using BMI as measured at the SEARCH visit and reported birth weight, both expressed as SD scores (SDSs). RESULTS: Univariately, BMI SDS was not related to age at diagnosis. In multiple linear regression, adjusted for potential confounders, a significant interaction was found between BMI SDS and fasting C-peptide (FCP) on onset age (P < 0.0001). This interaction remained unchanged after additionally controlling for number and titers of diabetes antibodies. An inverse association between BMI and age at diagnosis was present only among subjects with FCP levels below the median (<0.5 ng/ml) (regression coefficient -7.9, P = 0.003). A decrease of 1 SDS in birth weight (639 g) was also associated with an approximately 5-month earlier age at diagnosis (P = 0.008), independent of sex, race/ethnicity, current BMI, FCP, and number of diabetes antibodies. CONCLUSIONS: Increasing BMI is associated with younger age at diagnosis of type 1 diabetes only among those U.S. youth with reduced beta-cell function. The intrauterine environment may also be an important determinant of age at onset of type 1 diabetes.
Adolescent↗
Meprin beta metalloprotease gene polymorphisms associated with diabetic nephropathy in the Pima Indians.
There is evidence that susceptibility to diabetic nephropathy has a significant genetic component. This investigation tested the hypothesis that variations in the structural or regulatory regions of the MEP1B gene are related to susceptibility to diabetic nephropathy in the Pima Indian population. The structure of the human MEP1B gene on chromosome 18 was determined by polymerase chain reaction (PCR) amplification. Samples from 154 diabetic individuals were analyzed for polymorphisms. These individuals belonged to 65 sibships with at least one sibling pair discordant for diabetic nephropathy. Approximately half of the individuals had diabetic nephropathy. Of the 154 samples, there were 91 discordant sibling pairs. Sequencing revealed 19 single nucleotide polymorphisms (SNPs) in the MEP1B gene. SNPs 1-5 were in the 5' region upstream of the start site for transcription; SNPs 6, 7, 9, 11-15, 17, and 19 were within introns; SNPs 8, 10, 16, and 18 were in exons 4, 9, 12, and 14. SNP 18 was the only one that results in an amino acid change (proline to leucine in the cytoplasmic tail). No overall associations were found for individual SNPs. Within-family association tests found significant results for SNPs 1, 3, 4, 5, 6, 9, 11, 18, and 19 such that the more common allele was more frequently observed in those with nephropathy than in their unaffected siblings. The present study demonstrates significant within-family association for SNPs in MEP1B gene with diabetic nephropathy. These results could be explained by functional effects of one or more of these SNPs or by linkage disequilibrium with a nearby functional locus.
DNA Primers↗
Secular trends in cardiovascular disease risk factors according to body mass index in US adults.
CONTEXT: Prevalence of obesity in the United States has increased dramatically in recent decades, but the magnitude of change in cardiovascular disease (CVD) risk factors among the growing proportion of overweight and obese Americans remains unknown. OBJECTIVE: To examine 40-year trends in CVD risk factors by body mass index (BMI) groups among US adults aged 20 to 74 years. DESIGN, SETTING, AND PARTICIPANTS: Analysis of 5 cross-sectional, nationally representative surveys: National Health Examination Survey (1960-1962); National Health and Nutrition Examination Survey (NHANES) I (1971-1975), II (1976-1980), and III (1988-1994); and NHANES 1999-2000. MAIN OUTCOME MEASURES: Prevalence of high cholesterol level (> or =240 mg/dL [> or =6.2 mmol/L] regardless of treatment), high blood pressure (> or =140/90 mm Hg regardless of treatment), current smoking, and total diabetes (diagnosed and undiagnosed combined) according to BMI group (lean, <25; overweight, 25-29; and obese, > or =30). RESULTS: The prevalence of all risk factors except diabetes decreased over time across all BMI groups, with the greatest reductions observed among overweight and obese groups. Compared with obese persons in 1960-1962, obese persons in 1999-2000 had a 21-percentage-point lower prevalence of high cholesterol level (39% in 1960-1962 vs 18% in 1999-2000), an 18-percentage-point lower prevalence of high blood pressure (from 42% to 24%), and a 12-percentage-point lower smoking prevalence (from 32% to 20%). Survey x BMI group interaction terms indicated that compared with the first survey, the prevalence of high cholesterol in the fifth survey had fallen more in obese and overweight persons than in lean persons (P<.05). Survey x BMI changes in blood pressure and smoking were not statistically significant. Changes in risk factors were accompanied by increases in lipid-lowering and antihypertensive medication use, particularly among obese persons. Total diabetes prevalence was stable within BMI groups over time, as nonsignificant 1- to 2-percentage-point increases occurred between 1976-1980 and 1999-2000. CONCLUSIONS: Except for diabetes, CVD risk factors have declined considerably over the past 40 years in all BMI groups. Although obese persons still have higher risk factor levels than lean persons, the levels of these risk factors are much lower than in previous decades.
Adult↗
A population-based comparison of BMI percentiles and waist-to-height ratio for identifying cardiovascular risk in youth.
OBJECTIVE: Determine whether waist-to-height ratio (WHtR) or sex- and age-specific percentiles of body mass index (BMI) better identifies cardiovascular risk. STUDY DESIGN: The third National Health and Nutrition Examination Survey (NHANES III) provided measurements on 7657 participants statistically weighted to represent 50.05 million youth 4 to 17 years of age. We estimated the subpopulations corresponding to BMI strata that were normal (< 85th percentile), at risk for overweight (85th to <95th percentile), and overweight (> or =95th percentile). We chose WHtR cutoff points (0.490 and 0.539) so that subpopulation sizes in the three WHtR strata would equal those in the three BMI strata. For 13 cardiovascular risk factors we compared mean levels among youth discordant for their BMI and WHtR strata. RESULTS: 726 participants (representing 3.69 million youth) were identified as having WHtR stratum >BMI stratum. Compared with the 603 participants (representing 3.70 million youth) who were discordant in the opposite direction, weighted analyses showed they had higher mean levels of heart rate, low-density lipoprotein (LDL) cholesterol, fasting triglycerides, and total cholesterol ( P <.015, adjusted for sex, age, and race-ethnicity). Their mean systolic blood pressure was lower, but this difference was eliminated after adjustment for their shorter stature. CONCLUSION: WHtR, a simpler anthropometric index than sex- and age-specific BMI percentiles, better identifies youth with adverse cardiovascular risk factors.
Adolescent↗
Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 1999-2000.
OBJECTIVE: PEDIATRICS (ISSN 0031 4005). Published in the public domain by the American Academy of Pediatrics. Several studies have reported increases in the occurrence of type 2 diabetes in youths. People with prediabetic states such as impaired fasting glucose (IFG) are at increased risk for developing diabetes and cardiovascular disease (CVD). The objective of this study was to examine the prevalence of IFG and its relationship with overweight and CVD risk factors in a nationally representative sample of US adolescents who were aged 12 to 19 years. METHODS: We used data from the 1999-2000 National Health and Nutrition Examination Survey (NHANES). Adolescents who had fasted for 8 hours or more were included in the study (n = 915). IFG was defined as a fasting glucose of 100 to 125 mg/dL. Participants were classified as overweight when their age- and gender-specific BMI was > or = 95th percentile and as at-risk for overweight when their BMI was > or = 85th and < 95th percentile. RESULTS: In 1999-2000, the prevalence of IFG in US adolescents was 7.0% and was higher in boys than in girls (10.0% vs 4.0%). Prevalence of IFG was higher in overweight adolescents (17.8%) but was similar in those with normal weight and those who were at risk for overweight (5.4% vs 2.8%). The prevalence of IFG was significantly different across racial/ethnic groups (13.0%, 4.2%, and 7% in Mexican Americans, non-Hispanic black individuals, and non-Hispanic white individuals, respectively). Adolescents with IFG had significantly higher mean hemoglobin A1c, fasting insulin, total and low-density lipoprotein cholesterol, triglycerides, and systolic blood pressure and lower high-density lipoprotein cholesterol than those with normal fasting glucose concentrations. CONCLUSIONS: These data, representing 27 million US adolescents, reveal a very high prevalence of IFG (1 in 10 boys and 1 in 25 girls) among adolescents; the condition affects 1 in every 6 overweight adolescents. Adolescents with IFG have features of insulin resistance and worsened CVD risk factors. Evidence for prevention is still forthcoming in this age group.
Adolescent↗
Thirty-year trends in cardiovascular risk factor levels among US adults with diabetes: National Health and Nutrition Examination Surveys, 1971-2000.
Among US adults with diabetes, using data from the National Health and Nutrition Examination Survey for 1971-1974, 1976-1980, 1988-1994, and 1999-2000, the authors describe 30-year trends in total cholesterol, blood pressure, and smoking levels. Using Bayesian models, the authors calculated mean changes per year and 95% credible intervals for age-adjusted mean total cholesterol and blood pressure levels and the prevalence of high total cholesterol (> or =5.17 mmol/liter), high blood pressure (systolic blood pressure: > or =140 mmHg and/or diastolic blood pressure: > or =90 mmHg), and smoking. Between 1971-1974 and 1999-2000, mean total cholesterol declined from 5.95 mmol/liter to 5.48 mmol/liter (-0.02 (95% credible interval: -0.03, -0.01) mmol/liter per year). The proportion with high cholesterol decreased from 72% to 55%. Mean blood pressure declined from 146/86 mmHg to 134/72 mmHg (systolic blood pressure: -0.5 (95% credible interval: -1.1, 0.5) mmHg per year; diastolic blood pressure: -0.6 (95% credible interval: -1.0, -0.03) mmHg per year). The proportion with high blood pressure decreased from 64% to 37%, and smoking prevalence decreased from 32% to 17%. Although these trends are encouraging, still one of two people with diabetes has high cholesterol, one of three has high blood pressure, and one of six is a smoker.
Adult↗
The evolving diabetes burden in the United States.
A diabetes epidemic emerged during the 20th century and continues unchecked into the 21st century. It has already taken an extraordinary toll on the U.S. population through its acute and chronic complications, disability, and premature death. Trend data suggest that the burden will continue to increase. Efforts to pre- vent or delay the complications of diabetes or, better yet, to prevent or delay the development of diabetes itself are urgently needed.
Diabetes Complications↗
An update on type 2 diabetes in youth from the National Diabetes Education Program.
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Adolescent↗
Impaired fasting glucose and risk of diabetes in Taiwan: follow-up over 3 years.
The purpose of this paper was to examine the relationship between fasting glucose levels and development of diabetes among residents of Penghu, Taiwan. From July 1995 to June 1996, a population-based cohort study was conducted among residents aged >or=40 years on the island of Penghu, Taiwan. Of the 1601 surveyed, 1306 (81.6%) did not have diabetes. Six hundred of these 1306 persons were re-examined 3 years later. Participants with fasting plasma glucose (FPG) concentration <110 mg/dl (<6.1 mmol/l) were classified as normoglycemic, those with a glucose concentration of 110-126 mg/dl (6.1-7.0 mmol/l) had impaired fasting glucose (IFG), and those with a fasting glucose concentration of >or=126 mg/dl (7.0 mmol/l) were considered to have diabetes. During the 3-year follow-up, 4.3% of the total population (1.4% per year, 95% CI 0.9-1.9%) developed diabetes. Of those with IFG at baseline, 9.6% (3.2% per year, 95% CI 1.8-5.0%) progressed to diabetes, but only 2.5% (0.8% per year, 95% CI 0.4-1.2%) of normoglycemic people did so. The multivariate-adjusted odds ratio of developing diabetes was 4.4 (95% CI 1.9-10.6) for persons with IFG compared with those who were normoglycemic at baseline. Other significant predictors of progression to diabetes were higher waist-hip ratio (WHR), triglyceride and apolipoprotein B (apo B) levels. In this Asian Chinese population, IFG is a strong predictor of diabetes. The high rate of conversion from IFG to diabetes, combined with the previously observed high IFG prevalence, suggests future high prevalence rates of diabetes in Taiwan.
Adult↗
Serum iron and iron-binding capacity: a round-robin interlaboratory comparison study.
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Blood Chemical Analysis↗
Relationship between quality of diabetes care and patient satisfaction.
OBJECTIVE: Patient satisfaction is regarded as a component of the quality of medical care. We examined the association between quality of care and patient satisfaction. DESIGN: Cross-sectional study. SETTING: Population-based random sample in North Carolina, United States, 1997. PARTICIPANTS: 591 African-Americans aged > or = 18 years with self-reported diabetes were interviewed for providers' delivery of 10 preventive measures and patients' performance of four preventive measures for diabetes care. MAIN OUTCOME MEASURES: Satisfaction with health care providers with respect to 11 items, on a 4-point scale (excellent, good, fair, and poor). Average satisfaction scores were compared according to levels of quality of care. RESULTS: Patient satisfaction was positively associated with income, employment, diabetes education, ease of getting care during the last year, having health care coverage and having one physician for diabetes care (P < 0.05 for each). Adjusted for age, sex, education, employment, and income, 8 of 10 preventive care practices by providers during the previous year--monitoring of concentrations of glycosylated hemoglobin (HbA1c) and cholesterol; performing eye, foot, and gum examinations; and physician counseling on self-monitoring of blood glucose concentrations, exercise, and weight reduction--were associated with higher satisfaction scores (P < 0.05). Patients' performance of three of four preventive practices--taking medications for diabetes as prescribed, performing daily self-examination of the feet, and going for an eye examination with dilation of the pupils--were also associated with higher satisfaction scores (P < 0.05). CONCLUSION: Quality of diabetes care was positively associated with patient satisfaction with provider of care. Prospective studies are needed to confirm this association and its direction.
Adult↗