Introduction Low BMD and fracture may be complications of type 1 diabetes. We sought to determine the roles of bone turnover and glycemic control in the etiology of low BMD. Methods Premenopausal women from the Wisconsin Diabetes Registry Study and matched controls were compared (n=75 pairs). Heel and forearm BMD were measured, and hip and spine BMD were measured in a subset. Markers of bone formation (osteocalcin) and resorption (NTx), and glycemic control (HbA1c) were determined. Results Age ranged from 18–50 years with a mean of 28, and 97% were Non-Hispanic white. Among women with diabetes, mean disease duration was 16 years and current HbA1c was 8%. Compared to controls, women with diabetes had a high prevalence of previous fracture (37% vs. 24%) and low BMD for age (heel or forearm: 49% vs. 31%), low heel and forearm BMD, and low osteocalcin levels. Levels of NTx were similar, suggesting uncoupled turnover favoring resorption. Poor glycemic control was associated with low BMD at all bone sites except the spine, and with low osteocalcin and NTx levels. Conclusions Optimal glycemic control may prevent low BMD and altered bone turnover in type 1 diabetes, and decrease fracture risk.
Care for type 1 diabetes mellitus should both alleviate the physical complications of the disease and improve overall quality of life. The Wisconsin Diabetes Registry, comprising a population-based cohort that is followed longitudinally from diagnosis of type 1 diabetes, provided the authors with a unique opportunity to examine quality of life in children, adolescents, and young adults with type 1 diabetes and its relation to both sociodemographic and clinical risk factors. The authors analyzed data from 1987-2002 with a mean of 10.2 years' duration of diabetes (n = 569). They used ordinal-scaled self-rated global health as a measure of quality of life. In this paper, they propose a random-effects model for drawing inferences on individuals regarding the relation of longitudinally measured quality of life to multiple risk factors. Results showed that male gender, higher parental socioeconomic level, younger age at diabetes diagnosis, shorter diabetes duration, no hospitalization in the preceding 6 months, lower glycosylated hemoglobin level, and questionnaire responses by a person other than the subject were independently associated with better reported health. The authors found that individuals varied in their reported health even after adjustment for all identified risk factors. This could imply either that there is variability in perception even with the same health status or that there are independent unmeasured risk factors for poor health in persons with type 1 diabetes.
FOR THE WISCONSIN DIABETES REGISTRY PROJECTOBJECTIVE -To determine the risk of frequent and severe hypoglycemia and the associated demographic and clinical risk factors.RESEARCH DESIGN AND METHODS -Demographic and diabetes self-management factors were measured in 415 subjects followed prospectively for 4 -6.5 years of type 1 diabetes duration as participants in a population-based incident cohort. Blood samples were collected up to three times yearly to test glycosylated hemoglobin (GHb) levels. Reports of frequent (2-4 times/week) and severe (lost consciousness) hypoglycemia as well as other diabetes selfmanagement data were collected by questionnaires.RESULTS -Frequent hypoglycemia was common (33 and 35% of participants reported this on the 4-and 6.5-year questionnaires, respectively), whereas severe hypoglycemia occurred much less often. Better glycemic control (odds ratio [OR] 1.3 per 2% decrease in GHb, 95% CI 1.1-1.5) and more frequent self-monitored blood glucose (1.5 per blood glucose check, 1.3-1.7) were independently related to frequent hypoglycemia. The association of frequent hypoglycemia with intensive insulin therapy increased with age. Better glycemic control (1.5 per 2% decrease in GHb, 1.2-2.0) and older age were related to severe hypoglycemic reactions. No sociodemographic factors other than age increased the risk of hypoglycemia.CONCLUSIONS -Frequent hypoglycemia was common in a population representing the full range of glycemic control in the community. Intensive insulin management and blood glucose monitoring independently predicted frequent but not severe hypoglycemia. This information may be useful for updating patients such that minor changes in diabetes management might decrease the daily burden of this condition while maintaining intensive insulin therapy. Diabetes Care 24:1878 -1881, 2001H ypoglycemia is the most common acute complication of type 1 diabetes (1). Onset is usually rapid, and symptoms range from very mild to severe enough to cause brain damage or death (2,3). Results of the Diabetes Control and Complications Trial (DCCT) (4) increased emphasis on intensive insulin treatment but also drew attention to the accompanying risk of hypoglycemia with such therapy, particularly in adolescents.The frequency of and risk factors for moderate and/or severe hypoglycemia in young adults were described in studies conducted in clinic-or hospital-based samples (5-8), the DCCT (9), one national cross-sectional study from France, and a limited number of populationbased cohort studies (10 -12). From these studies, it is clear that a history of hypoglycemia (6,9,13) and intensive insulin therapy (9) is an important predictor.Findings regarding other factors such as age, sex, duration of diabetes, and glycemic control are not consistent across studies. The frequency of all levels of hypoglycemia has not been reported. Also, no large population-based cohort has been studied prospectively to determine the relationship of both intensive insulin therapy and glycemic control to frequent and severe hy...
Background The social and economic environment has become a major area of interest regarding the determinants of cardiovascular health. Among markers of economic distress, food insecurity has been found associated with metabolic disorders, dyslipidemia, and obesity, but no previous studies have examined its association with overall cardiovascular health. Methods and results We conducted a cross-sectional analysis among 2935 participants in the Survey of the Health of Wisconsin (SHOW), a statewide population-based representative sample. The presence of food insecurity was determined by an affirmative answer to the question “In the last 12 months, have you been concerned about having enough food for you or your family?” Cardiovascular health (CVH) was defined based on the American Heart Association Life’s Simple 7 criteria and classified as “poor,” “intermediate,” or “ideal” using previously published criteria. “Good” CVH was defined as having no poor in any of the seven criteria (any amount of intermediate or ideal). Crude and adjusted odds ratios (OR) of good CVH according to presence of food insecurity were calculated using logistic regression models. Overall, food insecurity was associated with a decreased likelihood of good CVH (OR 0.53; 95% Confidence Interval 0.31 to 0.92; p = 0.02). This association persisted in models controlling for age, gender, race, and urbanization. Conclusions Participants who were food insecure were significantly less likely to have good CVH compared to participants who were food secure. Even though this study cannot confirm causality, these results suggest that food insecurity might be one of several socio-economic barriers contributing to poor CVH.
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