Role of Risk Factors in Complications of Diabetes Mellitus1

Dupree, Elizabeth A.; Meyer, Mary B.

doi:10.1093/oxfordjournals.aje.a112959

Cited by 70 publications

(23 citation statements)

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“…However, all of these studies had a small number of subjects, and some used a dichotomous smoking exposure (20), whereas others only adjusted for age in the model (21). Our findings were generally consistent with previous studies that found increased mortality risk in relation to smoking among diabetic patients (6 -11).…”

Section: Discussionsupporting

confidence: 90%

“…Several cohort studies among people with diabetes have failed to find a significantly increased risk of coronary heart disease (CHD) mortality or total mortality rates among smokers (4,5,20,21). However, all of these studies had a small number of subjects, and some used a dichotomous smoking exposure (20), whereas others only adjusted for age in the model (21).…”

Section: Discussionmentioning

confidence: 99%

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Smoking and Mortality Among Women With Type 2 Diabetes

et al. 2001

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OBJECTIVE -To assess the relationship between cigarette smoking and mortality among women with type 2 diabetes in the Nurses' Health Study cohort.RESEARCH DESIGN AND METHODS -The Nurses' Health Study, a prospective cohort of U.S. female registered nurses, included 7,401 women with type 2 diabetes diagnosed at baseline or during follow-up from 1976 to 1996. Total and cause-specific mortality of these diabetic women were the outcomes of interest.RESULTS -We documented 724 deaths during 20 years of follow-up (67,420 person-years) among women with type 2 diabetes. In multivariate analyses, adjusting for age, history of high blood pressure and high cholesterol, and other cardiovascular risk factors, compared with never smokers, the RRs of mortality were 1.31 (95% CI 1.11-1.55) for past smokers, 1.43 (0.96 -2.14) for current smokers of 1-14 cigarettes/day, 1.64 (1.24 -2.17) for current smokers of 15-34 cigarettes/day, and 2.19 (1.32-3.65) for current smokers of Ն35 cigarettes/day (P for trend ϭ 0.0002). Women with type 2 diabetes who had stopped smoking for Ն10 years had a mortality RR of 1.11 (0.92-1.35) compared with diabetic women who were never smokers.CONCLUSIONS -Cigarette smoking is associated in a dose-response manner with an increased mortality among women with type 2 diabetes. Furthermore, quitting smoking appears to decrease this excess risk substantially. Diabetes patients should be strongly advised against smoking.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Smoking and Mortality Among Women With Type 2 Diabetes

et al. 2001

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“…It is well known that diabetes is associated with an increased risk of death from renal failure, coronary artery disease, and cerebrovascular disease. When hypertension is superimposed, the risk of death from all causes may increase as much as fourfold (17).…”

Section: Natural History and Complicationsmentioning

confidence: 99%

Etiology and Prevalence of Hypertension in Diabetic Patients

Simonson

1988

Diabetes Care

126

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Data from several epidemiologic studies have suggested that the prevalence of hypertension in patients with diabetes mellitus is -1.5-2.0 times greater than in an appropriately matched nondiabetic population. In patients with insulin-dependent diabetes mellitus (IDDM), hypertension is generally not present at the time of diagnosis. As renal insufficiency develops, blood pressure rises and may exacerbate the progression to end-stage renal failure. In non-insulin-dependent diabetes mellitus (NIDDM), many patients are hypertensive at the time of diagnosis. The incidence of hypertension in NIDDM is related to the degree of obesity, advanced age, and extensive atherosclerosis that is typically present, and it probably includes many patients with essential hypertension. Several other pathophysiologic mechanisms also contribute to the genesis and maintenance of hypertension in the patient with diabetes. Hyperglycemia and increases in totalbody exchangeable sodium may lead to extracellular fluid accumulation and expansion of the plasma volume. In some patients, alterations in the function of the renin-angiotensin-aldosterone system and vascular sensitivity to vasoactive hormones may also play a role. It has recently been suggested that hyperinsulinemia and insulin resistance may also contribute to the maintenance of an elevated blood pressure because insulin is known to promote sodium retention and enhance sympathetic nervous system activity. The evidence for these hypotheses and their respective contributions to the etiology of hypertension in IDDM and NIDDM are discussed. Diabetes Care 11:821-27, 1988

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“…Furthermore, several studies have demonstrated a significant increase in mortality in diabetic patients with hypertension [9,10]. Although the epidemiological evidence demonstrating the strong association between hypertension and diabetic vascular complications is compelling, no intervention studies have been done to evaluate the efficacy of antihypertensive therapy in preventing these complications in patients with NIDDM.…”

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confidence: 99%

Appropriate Blood Pressure Control in NIDDM (ABCD) Trial

1996

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There is considerable epidemiologic evidence suggesting that hypertension plays a significant role in the development and progression of diabetic nephropathy [1], retinopathy [2,3], cardiovascular disease [4][5][6][7], and neuropathy [8] in patients with non-insulindependent diabetes mellitus (NIDDM). Furthermore, several studies have demonstrated a significant increase in mortality in diabetic patients with hypertension [9,10]. Although the epidemiological evidence demonstrating the strong association between hypertension and diabetic vascular complications is compelling, no intervention studies have been done to evaluate the efficacy of antihypertensive therapy in preventing these complications in patients with NIDDM. The absence of intervention studies in the NIDDM population is particularly remarkable, since NIDDM patients account for more than 90 % of all diabetic patients [11] and 60 % of diabetic end-stage renal disease in the United States. Moreover, endstage renal disease secondary to diabetes costs the Diabetologia (1996)

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Role of Risk Factors in Complications of Diabetes Mellitus1

Cited by 70 publications

References 0 publications

Smoking and Mortality Among Women With Type 2 Diabetes

Smoking and Mortality Among Women With Type 2 Diabetes

Etiology and Prevalence of Hypertension in Diabetic Patients

Appropriate Blood Pressure Control in NIDDM (ABCD) Trial

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