Diabetes epidemiology as a tool to trigger diabetes research and care

Zimmet, Paul

doi:10.1007/s001250051188

Cited by 244 publications

(153 citation statements)

References 125 publications

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“…GADA together with IA-2A or ICA, or alternatively quantified measurement of GADA, is therefore recommended for the classification of adult patients with type 2 diabetes for inclusion in trials of immune intervention. Recent studies of GADA and other markers of autoimmunity in various populations have highlighted the difficulties of classifying diabetes in adults, suggesting that many genetic and clinical research studies, as well as pharmaceutical trials of therapies for type 2 diabetes, may have been confounded by the inclusion of LADA subjects [21]. Correct classification of subjects in trials of prevention of type 2 diabetes that are now underway may also be a problem.…”

Section: Discussionmentioning

confidence: 99%

IA-2 antibody prevalence and risk assessment of early insulin requirement in subjects presenting with type 2 diabetes (UKPDS 71)

et al. 2005

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Aims/hypothesis: Established autoimmune markers of type 1 diabetes, including islet cell autoantibodies (ICA) and autoantibodies to glutamic acid decarboxylase (GADA) have been used to screen people presenting with type 2 diabetes for latent autoimmune diabetes in adults. We have examined the prevalence of autoantibodies to protein tyrosine phosphatase isoforms IA-2 (IA-2A) and IA-2β/phogrin (IA-2βA) in a cohort of adult UKPDS patients thought to have type 2 diabetes, and investigated the possible role of these autoantibodies in predicting requirement for insulin therapy. Methods: IA-2A and IA-2βA were measured by a validated radioimmunoassay with human recombinant autoantigens in 4,169 white Caucasian patients aged 25-65 years and newly diagnosed with type 2 diabetes. The clinical requirement for insulin therapy within 6 years was examined in 2,556 patients not randomised to insulin. Results: IA-2A and IA-2βA were present in 2.2 and 1.4%, respectively, of these patients. IA-2A were more prevalent in younger patients (p for trend <0.00001), more often associated with the HLA-DR4 allele (26.3 vs 8.0%, p<0.0001), and their presence increased the likelihood of insulin therapy requirement within 6 years from diagnosis [relative risk (95%CI) 12.2 (9.8-15.3)]. The presence of IA-2A together with GADA increased the relative risk of requiring insulin therapy from 5.4 (4.1-7.1) for GADA alone to 8.3 (3.7-18.8) and the corresponding positive predictive value from 33 to 50%. Conclusions/interpretation: In type 2 diabetes, the presence of IA-2A is infrequent, associated with the HLA-DR4 haplotype, and highly predictive of future need for insulin therapy. The measurement of IA-2βA does not provide additional information.

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Section: Discussionmentioning

confidence: 99%

IA-2 antibody prevalence and risk assessment of early insulin requirement in subjects presenting with type 2 diabetes (UKPDS 71)

et al. 2005

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“…The socio-economic and public health impact of Type 11 diabetes on both patients and society is constantly increasing and includes effects on the work force, time taken for treatment, premature morbidity and mortality and negative consequences on fertility and reproduction [1]. Trials such as the Diabetes Control and Complications Trial (DCCT) and the UKPDS have shown that metabolic control can influence the development of complications, primarily microvascular disease.…”

Section: Complications and Their Managementmentioning

confidence: 99%

The Cost of Diabetes Type II in Europe The CODE-2 Study

Massi‐Benedetti

2002

Diabetologia

105

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“…Diabetes mellitus is a major cause of morbidity and mortality worldwide [1,2]. Retinopathy, a common microvascular complication of diabetes, is the leading cause of vision loss in adults of working age [3].…”

Section: Introductionmentioning

confidence: 99%

The relationship of retinal vascular calibre to diabetes and retinopathy: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study

et al. 2007

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Aims/hypothesis The aim of the study was to examine the relationship of retinal vascular calibre with glucose intolerance, diabetes and retinopathy in a population-based cohort. Methods The Australian Diabetes, Obesity and Lifestyle study recruited adults aged ≥25 years old from across Australia. Participants were classified using an oral glucose tolerance test as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), impaired fasting glucose (IFG), known diabetes or newly diagnosed diabetes. Digital retinal photographs were taken of all participants with diabetes, IGT and IFG, and a sample of those with NGT, and graded for the presence of retinopathy. Retinal vascular calibre was measured from photographs by a computerassisted method.Results Of the 1,998 participants with gradable retinal images, 16% had known diabetes, 17% newly diagnosed diabetes, 42% IGT, 6% IFG and 19% NGT. After multivariable adjustment, retinal arteriolar calibre was significantly larger in people with known diabetes (178.9 μm) compared with participants with NGT (174.6 μm, p=0.02), IGT/IFG (175.5 μm, p=0.02) or newly diagnosed diabetes (175.6 μm, p=0.047). One SD increase in mean arteriolar calibre was associated with higher odds of diabetes compared with NGT (odds ratio [OR]=1.28, 95%CI=1.06-1.55). After multivariable adjustment, each SD increase in venular calibre was associated with higher odds of having retinopathy in persons with IGT/IFG (OR=1.78, 95% CI=1.36-2.34) or in persons with diabetes (OR=1.68, 95% CI=1.23-2.29). Conclusions/interpretation Diabetes is associated with larger retinal arteriolar calibre and retinopathy with larger retinal venular calibre. The contrasting associations may reflect different underlying pathophysiological processes in the natural history of diabetes.

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Diabetes epidemiology as a tool to trigger diabetes research and care

Cited by 244 publications

References 125 publications

IA-2 antibody prevalence and risk assessment of early insulin requirement in subjects presenting with type 2 diabetes (UKPDS 71)

IA-2 antibody prevalence and risk assessment of early insulin requirement in subjects presenting with type 2 diabetes (UKPDS 71)

The Cost of Diabetes Type II in Europe The CODE-2 Study

The relationship of retinal vascular calibre to diabetes and retinopathy: the Australian Diabetes, Obesity and Lifestyle (AusDiab) study

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