ABSTRACT
OBJECTIVE: To investigate the theoretical distribution of incident cardiovascular events and retinopathy with respect to 2-hour glucose concentration in a population-based study of Jamaican adults and the implications of these distributions for the diagnosis of diabetes mellitus. METHODS: The American Diabetes Association and WHO diagnostic criteria for diabetes are based on the risk of microvascular complications of diabetes mellitus. There appears to be a threshold glucose concentration for incidence of retinopathy and nephropathy. However, no such threshold is apparent for macrovascular complications of diabetes mellitus. We applied risk estimates of incident cardiovascular disease associated with increasing 2-hour glucose concentration derived from a metaregression analysis of 20 studies to the distribution of 2-hour glucose concentration in the Spanish Town Survey. A sample of 1907 adults aged 25-74 years was recruited by door-to-door canvassing. Oral glucose tolerance testing was conducted after an overnight fast. The theoretical distribution of cardiovascular disease in the Spanish Town Survey was derived and compared with the theoretical distribution of retinopathy based on risk estimates from studies of Pima Indians. RESULTS: The prevalence of diabetes mellitus (2-hour glucose = 11.1 mmol/l) was 13.2 percent and 12.5 percent in subjects who had glucose concentrations between 8 and 11 mmol/l [approximately equivalent to range for impaired glucose tolerance (IGT)]. All cases of incident retinopathy would occur above 2-hour glucose concentration of 11.1 mmol/l. Only 38.5 percent of incident cases of cardiovascular disease would occur in this range while a further 13 percent would occur in the IGT range. Half of the cases would therefore occur in individuals considered to be normoglycaemic. CONCLUSION: The current WHO diagnostic criteria for diabetes mellitus identify all subjects at risk for microvascular complications of diabetes. However, they may miss as many as half of those at risk for cardiovascular disease, the leading cause of morbidity and mortality in diabetes mellitus.(Au)
Subject(s)
Adult , Humans , Middle Aged , Aged , Female , Male , Diabetic Retinopathy/complications , Glucose/diagnosis , Diabetes Mellitus/complications , Cardiovascular Diseases/complications , Jamaica/epidemiology , Cross-Sectional Studies , Risk , Blood Glucose Self-MonitoringSubject(s)
Female , Male , Comparative Study , Humans , Adolescent , Adult , Saliva/microbiology , Dental Plaque/microbiology , Streptococcus mutans/isolation & purification , Streptococcus sanguis/isolation & purification , Colony Count, Microbial/statistics & numerical data , Culture Media/analysis , Dental Caries/microbiology , Water Quality , Colony Count, Microbial/instrumentation , Colony Count, Microbial/methods , Glucose/diagnosis , Anaerobiosis/drug effects , Environmental HealthABSTRACT
The urinary output in thirty-eight patients was observed during the intermittent running of an oxytocin drip at or near term. Urinary volumes at half-hourly intervals were significantly lower during an oxytocin infusion than when dextrose only was infused. No differences in blood pressure changes were evident, in comparison with normal patients in labour. It is shown that oxytocin has an antidiuretic effect on the kidney. The sensitivity of this effect increases as pregnancy advances. Oxytocin infusion may need to be used with care in women in whom renal output is already compromised (Summary)
