Prevalence of undiagnosed diabetes and abnormalities of carbohydrate metabolism in a U.S. Army population.

OBJECTIVE: The Third National Health and Nutrition Examination Survey (NHANES III) reported that 4.3-6.3% of adult Americans have undiagnosed diabetes. 15.6% have impaired glucose tolerance, and 10.1% have impaired fasting glucose. By design, NHANES III excluded people in the U.S. military. The purpose of this study was to determine the prevalence of undiagnosed diabetes, impaired glucose tolerance, and impaired fasting glucose among U.S. Army soldiers. RESEARCH DESIGN AND METHODS: A 2-h, 75-g oral glucose tolerance test was performed on a prospective, consecutive sample of 625 asymptomatic soldiers presenting to a U.S. Army medical clinic for physical examinations. Age of subjects was 32 +/- 9 years (mean +/- SD), and 81.0% of subjects were male. BMI was 26.2 +/- 3.7 kg/m2. Race/ethnicity categories included Caucasian (54.4%), African-American (24.4%), Hispanic (17.4%), and other (3.7%). A family history of diabetes was reported by 25.4% of the subjects, and the number of exercise sessions per week was 4.0 +/- 1.5. RESULTS: The prevalence of undiagnosed diabetes was 3 of 625 (0.5%) (95% CI, 0.1-1.4): impaired glucose tolerance, 11 of 598 (1.8%) (0.9-3.3); and impaired fasting glucose 6 of 585 (1.0%) (0.4-2.2). CONCLUSIONS: In this low-diabetes risk U.S. Army population, the prevalence of undiagnosed diabetes, impaired glucose tolerance, and impaired fasting glucose were 0.5, 1.8, and 1.0%, respectively. The prevalence rates found in this study are approximately one-tenth of those found in NHANES III.

Expression of a 26S proteasome ATPase subunit, MS73, in muscles that undergo developmentally programmed cell death, and its control by ecdysteroid hormones in the insect Manduca sexta.

MS73, an ATPase regulatory subunit of the 26S proteasome in the moth Manduca sexta, is shown to be expressed at a high level only in muscles that are undergoing developmentally programmed cell death, or which are destined to do so. The amount of MS73 is increased by more than two-fold just before death in each of three different muscles that die at different times, under different developmental controls. An ecdysteroid (moulting hormone) agonist, RH-5849, that prevents the occurrence of programmed cell death in two of these muscles also prevents the normally occurring rise in level of MS73 in these muscles. This evidence is consistent with a role for MS73 in programmed cell death.

Development of health surveillance in Togo, west Africa.

Since 1988, the Ministry of Health (MOH) of Togo, with technical assistance from CDC, has systematically adapted and strengthened its health information system (HIS) to enable improved monitoring of trends in diseases. The previous system had been hampered by complicated, lengthy reporting forms; incomplete and delayed receipt of reporting forms; absence of mortality reporting; slow, cumbersome manual compilation and analysis methods; and lack of standard case definitions. To simplify the adaptation process, the system was divided into three main activities: data collection, data compilation and analysis, and dissemination of reports and follow-up action. Public health authorities in Togo have built on existing strengths and successfully adapted the HIS to focus on national morbidity and mortality prevention priorities.

Assessing trends in mortality in 121 U.S. cities, 1970-79, from all causes and from pneumonia and influenza.

The Centers for Disease Control receives weekly reports of mortality due to all causes and to pneumonia and influenza from 121 cities and counties in the United States. To assess the epidemiologic applicability of these data, the trends of death rates based on data compiled by the Centers for Disease Control's mortality reporting system (CDC-MRS) from 1970 through 1979 were compared with trends derived from national mortality statistics compiled by the National Center for Health Statistics (NCHS). In general, CDC-MRS trends in death rates from all causes and from pneumonia and influenza followed patterns similar to those shown by mortality statistics for the entire nation. CDC-MRS data were particularly sensitive to annual fluctuations in the nationwide rate of death from pneumonia and influenza among the elderly population. However, because of higher death rates among residents of the CDC-MRS reporting areas, in addition to other ascertainment biases, CDC-MRS death rates--from all causes and from pneumonia and influenza--consistently exceeded NCHS rates for the nation. Moreover, for each age group, trends based on CDC-MRS reflected an underestimate of the rate of decline in mortality observed over time according to NCHS data. It is concluded that despite its limitations, the CDC-MRS provides mortality data that are both timely and useful for epidemiologic purposes.

Milk-alkali syndrome with a serum calcium level of 22 mg/dl and J waves on the ECG.

A man with severe hypercalcemia (22 mg/dl) secondary to ingestion of a calcium carbonate antacid (Tums) was admitted with obtundation and hyperreflexia, which disappeared with treatment. Laboratory values, which were consistent with milk-alkali syndrome, included low-normal serum chloride (96 mEq/L), normal phosphorus of 2.7 mg/dl (phosphorus is usually normal to increased in this syndrome), increased blood urea nitrogen (39 mg/dl), and increased serum creatinine (2.4 mg/dl). A normal C-terminal parathormone level helped distinguish this patient from patients with severe hypercalcemia due to primary hyperthyroidism. The ECG revealed a widened rather than a shortened QT interval, as well as a J wave, a broadened T wave, and a U wave with this marked hypercalcemia, all of which reverted to normal with correction of the hypercalcemia.

Persistent adrenal insufficiency secondary to low-dose ketoconazole therapy.

Persistent adrenal insufficiency secondary to ketoconazole therapy has not previously been documented. A case of adrenocortical insufficiency secondary to low-dose (400 mg per day) ketoconazole therapy for blastomycosis is described. Symptomatic adrenal insufficiency was documented on endocrine testing, required physiologic replacement doses of glucocorticoids, and has not been reversible in two years of follow-up. Thus, adrenal insufficiency may be caused by low-dose ketoconazole therapy, and such adrenal insufficiency may have a prolonged course.

Facial flushing secondary to hypoglycemia.

Facial flushing is usually not associated with hypoglycemia. Diabetics treated with chlorpropamide can have an antabuse-like flushing with ingestion of alcohol, but flushing secondary to hypoglycemia per se has not been reported. The first case demonstrating that facial flushing can occur in insulin-induced hypoglycemia is described. This patient had marked erythematous facial flushing that was repeatable with each instance of hypoglycemia. Endocrine evaluation revealed no evidence of carcinoid or a pheochromocytoma in this patient and the facial flushing was unrelated to alcohol. Without insulin-induced hypoglycemia, this diabetic patient has had no further facial flushing in one year follow-up.

The low risk of hepatitis B in rural hospitals. Results of a seroepidemiologic survey.

To determine the risk of hepatitis B virus infection for rural hospital employees, we obtained serum and a completed questionnaire from each of 2,064 employees of 11 rural hospitals. Only 96 (4.7%) employees had hepatitis B virus markers. Increased marker prevalence was significantly associated with prior residence in a city with a population of greater than 100,000 (odds ratio, 2.9; 95% confidence interval, 1.6 to 5.2) and increasing blood contact (odds ratio, 1.6; confidence interval, 1.2 to 2.3); however, the association with blood contact was not significant when we limited analysis to the 836 employees who had never lived in a city. We conclude that the risk of hepatitis B virus infection for these rural hospital employees is low, probably because the incidence of hepatitis B in rural areas is low.