[Mortality from cardiovascular diseases in patients with type 2 diabetes]. / Umieralnosc z powodu chorób ukladu krazenia u chorych na cukrzyce typu 2.

In the period 1973/74-1995 a prospective observation was carried out on 4420 diabetic patients (1990 males and 2430 females) aged 30-68 years, with type 2 (non-insulin dependent diabetes) of 1-10 years duration. During the 22-year period nearly 80% of the initial cohort died. The risk of death was 2-times higher in diabetes than in the samples of general population observed at the same time. The death risk from cardiovascular diseases was over 3.0 times higher than in general population. The relevant risk ratio was found over 5-times higher for coronary heart disease, which was unlike to result from the differences in death ascertainment between diabetics and the city dwellers. The all-causes ratio of death and cardiovascular diseases was the same for women and men but it was selectively higher for females than males group for coronary heart disease and cerebrovascular diseases, and for males 50% higher for atherosclerosis and other heart diseases. The highest cumulation of risk factors was observed for deaths from cardiovascular diseases, and coronary heart disease. There were risk factors typical for cardiovascular disease and typical for poor metabolic control of diabetes (hyperglycaemia, glucosuria) and presence of complications of diabetes (nephropathy).

[Risk factors of the incidence of late vascular complications of diabetes]. / Czynniki ryzyka zapadalnosci z powodu powiklan naczyniowych cukrzycy.

From the follow-up examination of 1329 out of 4420 type 2 (non-insulin-dependent) diabetes followed for 17 years, the incidence of micro and macrovascular complications (proteinuria and nephropathy, symptoms of leg vascular disease, ischemic heart disease, and cerebrovascular events, was estimated and related to the levels of baseline-risk variables using logistic regression. For new cases of proteinuria and heavy proteinuria, hyperglycemia was the common predictor (alongside diastolic hypertension, smoking and overweight); hyperglycemia and glycosuria were among significant predictors of leg vascular disease (with duration of diabetes, smoking, male sex, diastolic hypertension, and proteinuria). On the other hand, systolic hypertension and male sex prevailed among factors predicting both ischemic heart disease (with high cholesterol and overweight), and stroke. The data confirm the higher involvement of diabetic milieu in micro than macrovascular incidents, with diabetic foot disease placed in between.

[Mortality of diabetic patients in Warsaw--22 year prospective observation (1973/74-1995). I. Mortality of diabetic patients with type 2 diabetes (non-insulin-dependent-diabetes)]. / Umieralnosc chorych na cukrzyce w Warszawie--22-letnia obserwacja prospektywna (1973/74-1995). Czesc I. Umieralnosc chorych na cukrzyce typu 2 (insulinoniezalezna).

In the period 1973/74-1995 a prospective observation was carried out on 4420 diabetic patients (1990 males and 2430 females) aged 30-68 years, with type 2 (non-insulin dependent diabetes) of 1-10 years duration. During the 22-years period nearly 80% of initial cohort died. The risk of death were 2-times higher in diabetes than in the samples of general population observed at the same time. The death risk from cardiovascular disease were over 3-times higher than in general population. The relevant risk ratio has been found over 5-times higher for coronary heart disease, which were unlike to results from the differences in death ascertainment between diabetics and the city dwellers. The all-causes ratio of death and cardiovascular diseases were the same for women and men but it was selectively higher for females then males group for coronary heart disease and cerebrovascular diseases. Among diabetic cohort the risk of death was also higher for neoplasms, especially in women.

[Mortality of diabetic patients in Warsaw--22 year prospective observation (1973/74-1995). II. Mortality of patients with type I diabetes (insulin-dependent-diabetes)]. / Umieralnosc chorych na cukrzyce w Warszawie--22-letnia obserwacja prospektywna (1973/74-1995) czesc II. Umieralnosc chorych z cukrzyca typu 1 (insulinozalezna).

During the follow-up 1973/74-1995 years 171 subjects with type 1 (insulin dependent diabetes) (105 males and 66 females) aged 18-30 years died 31.6% (32.4% males and 30.3% females). The relative risk of mortality for all causes in the compared to the general population was 5.0 (3.5 for men and 7.5 for women). Almost 30% deaths were from renal disease, 17% from ischemic heart disease, and 3 death in women from carcinoma of breast.

Risk factors of cardiovascular death in diabetic patients.

In 1974 a cross-sectional study was conducted on 4591 out-patients (2095 males and 2496 females) aged 18-67 years, with diabetes of 1-10 years duration, and cardiovascular fatalities followed for 10 years. A multiple logistic regression was then performed on total cardiovascular deaths, deaths from ischaemic heart disease, and from stroke on selected baseline variables related to the course and control of diabetes, selected symptoms of macroangiopathy, and other risk factors, separately for insulin-treated and non-insulin-treated patients. Hyperglycaemia, proteinuria, arterial hypertension, various symptoms of ischaemic heart disease, age, and current cigarette smoking were found to be important predictors of cardiovascular mortality, more so in non-insulin-treated than in insulin-treated patients. Proteinuria and arterial hypertension carried a greater risk in females than males, but the opposite was true for the signs and symptoms of ischaemic heart disease. Relative body mass was found to correlate inversely with probability of cardiovascular death among insulin-treated males but not in non-insulin-treated males, whereas duration of diabetes was a significant factor only among non-insulin-treated females.

[Factors determining the presence and predicting the development of diabetic retinopathy]. / Czynniki okreslajace obecnosc i zapowiadajace wystapienie retinopatii cukrzycowej.

In a group of 329 diabetics aged 35-56 years with diabetes duration 1-30 years 134 cases were found diabetic retinopathy (40.7%). After 7 years funduscopy was repeated in 136 out of 248 patients and 50 new cases of retinopathy were disclosed. After multivariate analysis it was found that retinopathy was associated most closely with diabetes duration, while arterial hypertension was most surely predicting during 7 years future retinopathy, particularly in the case of higher level of glycosylated haemoglobin at the final examination.

[Mortality among patients with diabetes mellitus in Warsaw--a 10-year prospective study]. / Umieralnosc chorych na cukrzyce w Warszawie--10-letnia obserwacja prospektywna.

In the period 1973/74-1983 a prospective observation was carried out on 4591 out-patients (2095 males and 2496 females) aged 18-68, with predominantly non-insulin treated diabetes of 1-10 years' duration. During the ten years period over a third of initial cohort died. Age-standardized mortality rate was twice that for the general population of Warsaw for the median year 1978. The risk of death rose with decreasing age, especially in females. The most frequent causes of death were cardiovascular diseases, particularly coronary heart disease, standardized mortality ratios amounting to 2.7 and 2.4 respectively. Among diabetic cohort the risk of death was also higher for nephritis, nephrosis, cirrhosis of the liver and pneumonia. No excess death rate could be found for tuberculosis, malignant neoplasms, and diabetes itself. Diabetic patients were less frequently exposed to accidental deaths than the general population of Warsaw. The mortality diabetic patients in Warsaw was similar to that seen in most of the developed countries with the exception of the higher mortality due to cirrhosis of the liver and smaller due to accident, trauma and poisoning.

[Mortality risk factors in cardiovascular diseases in patients with diabetes mellitus in Warsaw--a 10-year prospective study]. / Czynniki zagrozenia zgonem z powodu chorób ukladu krazenia u chorych na cukrzyce w Warszawie--10-letnia obserwacja prospektywna.

A prospective study was made in the years 1973 through 1983 on mortality among 4591 patients (2095 men and 2469 women) with usually noninsulin dependent diabetes, of 1-10 years duration. The anamnestic data and examination parameters obtained during a cross-sectional investigation served as the prognostic changeables (risk factors) to assess the mortality due the most frequent circulatory diseases. The applied model of the logistic regression allowed an attempt of the assessment of their independent effect. Analysis regarding the sex and the methods of diabetes treatment was done in four groups of mortality causes classified according to the VIII Revision of the International Classification of Disease. Injuries and Causes of Death: 1. Cardiovascular system diseases. 2. Ischaemic heart diseases. 3. Other diseases of the cardiovascular system. 4. Vascular diseases of the brain. The quantitative and qualitative effect of the arbitrarily chosen factor of death risk was of varying importance and was related to the sex and the methods of the hypoglycemising treatments. The effect of ageing was an independent factor of death risk among all analysed causes of mortality in both sexes independent from the methods of the hypoglycemising treatment with the one exception of women treated with insulin who died of stroke. Generally however, the ageing factor showed a greater prognostic value in patients treated with insulin. Hypertension, especially if marked, showed to have the most prognostic value among the all analysed factors of death-risk especially in patients on oral antidiabetics. The risk in this group was due mainly to the cerebral stroke, to a lesser degree to the "other" diseases of the circulatory system, and to the all diseases of the circulatory system but to the least degree it was related to the ischaemic heart disease, in both sexes. Among insulin treated diabetics the hypertension was a death-risk of most importance in men usually due to the vascular brain disease and other diseases of the cardiovascular system but to a lesser degree to the circulatory diseases, as a whole. In women however the marked hypertension increased the death-risk in patients with coexisting circulatory disease, not a particular one, but as a whole. Albuminuria had a pronounced prognostic value, especially if massive, in both types of diabetes, mainly, however, among women who died of any cardiovascular causes.(ABSTRACT TRUNCATED AT 400 WORDS)

Health behaviour and its determinants among insulin-dependent diabetics. Results of the diabetes Warsaw study.

Health behaviour of a group of insulin-dependent diabetics and some factors influencing it have been described and analyzed. Aspects of health behaviour measured were: adherence to diet, insulin injection technique, urine self-testing and the pattern of action adopted in response to hypo- and hyperglycemia. Data were collected in 1975, from 170 insulin-dependent diabetics, aged 18-41, with known diabetes of from 6 months to 12 years duration. A standard questionnaire included items on health behaviour, knowledge of the disease and other factors. Of the subjects studied only 40% stated that they adhered to diet prescription. Occasional insulin injections were missed by 15%. Half the patients restricted diet or increased insulin dose in hyperglycemia but only 18% regularly tested urine for sugar. An important determinant of health behaviour was the level of understanding of the disease, which was found to be low among 58%. The present health education system for diabetic patients in Poland is discussed.

Mortality from cardiovascular diseases among diabetics.

A retrospective analysis of a cohort of 5210 diabetic patients revealed a mortality rate 1.3 times higher than in the general population of Warsaw. The higher death rate in the cohort under study was mainly due to an excess mortality from coronary heart disease and cerebrovascular disease. The excess mortality was greater in men than in women. Th risk of death from cardiovascular diseases was higher among the patients with early onset diabetes. Mortality from cerebrovascular disease was highest in patients treated with insulin, intermediate in the group treated with oral drugs, and lowest in the group treated only with diet. The mortality ratio from coronary heart disease in men was not related to the method of hypoglycaemic therapy given at the onset or during the course of the diabetes. In women, the highest mortality was in the group treated with insulin, intermediate in the group treated with oral agents, and lowest in the group treated with diet only.