Relationship of glucose concentrations with PAI-1 and t-PA in subjects with normal glucose tolerance.

AIM: To study metabolic risk factors for the development of cardiovascular disease (CVD), including markers of the fibrinolytic system in relation to blood glucose levels in subjects with normal glucose tolerance and fasting blood glucose levels below 5.6 mmol/l. METHODS: Cross-sectional, community-based study from a primary health-care centre of adult subjects with normal glucose tolerance. Analysis of fasting and 2-h post-load blood glucose concentrations were centralized and related to anthropometric characteristics, metabolic variables, inflammatory markers, and coagulation and fibrinolytic variables. RESULTS: Increasing fasting blood glucose concentrations within the normal range in subjects with normal glucose tolerance were associated with increasing age, body mass index, and waist circumference, and with increasing concentrations of metabolic risk factors for development of CVD. After adjustment for gender, age, body mass index (BMI), and fasting insulin, levels of plasmin activator inhibitor (PAI-1) and tissue type plasminogen activator (t-PA) increased significantly with increasing levels of fasting glucose within the normal range (P = 0.012 and P < 0.0001, respectively). CONCLUSIONS: We found risk factors for CVD, specifically key components of the fibrinolytic system, PAI-1 and t-PA, increased with increasing fasting glucose levels even in subjects with normal glucose tolerance. This observation may help to explain the increased risk of CVD with increasing values of fasting glucose in the normal range.

Routine diagnosis of Type 2 diabetes mellitus in general practice and hospitals: how do patients differ?

OBJECTIVE: To study how Type 2 diabetic patients diagnosed by routine case-finding in primary care differ from patients diagnosed in secondary care with regard to clinical characteristics, symptom-burden and prevalence of complications. RESEARCH DESIGN AND METHODS: A Danish population-based sample of 1633 newly diagnosed Type 2 diabetic patients, of whom we had detailed information of sociodemographic and clinical characteristics, biochemical measurements, and complications among 1381. Blood and urine analyses were centralized. RESULTS: Of the patients, 76.8% were diagnosed in general practice. Compared with those diagnosed in secondary care, patients diagnosed in general practice on average had higher levels of cardiovascular risk factors (BMI: 29.8 vs. 28.5 kg/m2, P < 0.001; systolic blood pressure: 149.4 vs. 143.2 mmHg, P < 0.001; diastolic blood pressure: 85.2 vs. 82.5 mmHg, P < 0.001; haemoglobin A(1c): 10.1 vs. 8.4%, P < 0.0001; total cholesterol: 6.4 vs. 6.1 mmol/l, P < 0.01), more frequently presented with hyperglycaemic symptoms (80.1 vs. 63.4%, P < 0.0001), while fewer had macrovascular complications (28.5 vs. 43.6%, P < 0.0001). CONCLUSIONS: Judged from their risk profile, Type 2 diabetic patients diagnosed in primary care are at no less risk of developing diabetic complications than those diagnosed in secondary care.

Impaired fasting glycaemia resembles impaired glucose tolerance with regard to cardiovascular risk factors: population-based, cross-sectional study of risk factors for cardiovascular disease.

AIMS: To compare subjects with impaired glucose tolerance and impaired fasting glucose in relation to risk factors for developing cardiovascular disease. METHODS: A total of 1374 patients (678 female, 696 male) listed with a general practice clinic in Denmark were given an oral glucose tolerance test, a physical examination, and a self-administered questionnaire. Risk factors for cardiovascular disease were assessed for 90 participants (48 female, 42 male) with impaired glucose tolerance (including 12 subjects (1 female and 11 male), who also fulfilled criteria for impaired fasting glycaemia) and 51 subjects (20 female, 31 male) with impaired fasting glycaemia (World Health Organization 1999 criteria). RESULTS: There were no statistical differences with regard to known risk factors for cardiovascular disease between participants with isolated impaired fasting glycaemia and those with impaired glucose tolerance. CONCLUSIONS: We found noticeable similarities in the cardiovascular risk factor profile in subjects with impaired fasting glycaemia and in subjects with impaired glucose tolerance in our population. When planning screening initiatives, it seems relevant to take into account people with impaired fasting glycaemia as well as those with impaired glucose tolerance.

Renal involvement is related to body height in newly diagnosed diabetic women aged 40 years or over.

We scrutinized the relation between body height and renal involvement in a large population-based sample of newly diagnosed diabetic patients aged 40 years or over. The urinary albumin concentration (UAC) was measured in freshly voided morning urine in 1,284 newly diagnosed diabetic patients. The course of insulin treatment showed that at least 97.6% of the patients could be regarded as Type 2 diabetic. Linear regression analyses were done with log UAC as dependent variable, and height, age, HbA1c, smoking habits, education, occupation, body weight and systolic blood pressure as independent variables. Median age was 65.3 years. In bivariate analyses UAC increased with decreasing height for women (R (S) =- 0.090, p =0.028), but not for men (R (S) =- 0.049, p =0.20). After backwards elimination in the regression models, height remained in the model for women only (p =0.041). Our finding of a relationship between short stature and renal involvement in Type 2 diabetic female patients adds to existing evidence from studies with non-diabetic and Type 1 diabetic subjects.

[Five-year survival in persons aged 40 years or over with newly diagnosed diabetes mellitus]. / Femårsoverlevelsen for personer på 40 år eller derover med nyopdaget diabetes mellitus.

The five- to six-year all-cause mortality is analysed in 1323 newly diagnosed diabetic patients aged 40 years or over. The median age at diagnosis is lower for males (63.6 years) than for females (67.5 years), but more males (24.7%) than females (20.0%) have died (p = 0.04). This male excess mortality can mainly be attributed to the 60-79-year old males. With increasing diabetes duration both male and female diabetic patients exhibit an increasing excess mortality in comparison with the Danish population. For males this excess mortality becomes statistically significant four years after diagnosis for the 40-59 year-olds and after six years for the 60-79 year-olds. For females and very old males no statistically significant excess mortality is observed, but after two to four years there is a tendency for the survival curve of 40-79-year old females to separate from that of the Danish female population to show an excess mortality. In this population-based study the disadvantageous mortality experience of even newly-diagnosed diabetic patients is clearly demonstrated.

Day-of-the-week effect on doctors' response to a postal questionnaire.

OBJECTIVE: To test a possible day-of-the-week effect on doctors' response rate to a postal questionnaire. DESIGN: Dispatch of postal questionnaire randomized to Thursday or Saturday. SETTING: A nationwide survey on doctors' attitudes. SUBJECTS: 200 general practitioners and 260 practising specialists/consultants. MAIN OUTCOME MEASURES: Response rate and Kaplan-Meier survival curve for no-response. RESULTS: The probability of response was not influenced by receiving the questionnaire just before or just after a week-end. CONCLUSION: Response rates in postal surveys sent to doctors cannot be improved by their receiving the questionnaire just before a week-end.

Epidemiology of renal involvement in newly-diagnosed middle-aged and elderly diabetic patients. Cross-sectional data from the population-based study "Diabetes Care in General Practice", Denmark.

We report on a study in which 487 Danish general practitioners participated with the purpose of including all newly-diagnosed diabetic patients aged 40 years or more from a well-defined catchment population during a well-defined time period. A total of 1267 diabetic patients with a median age of 65.3 years were included. Renal involvement was assessed from the albumin/creatinine ratio in a morning urine sample. Albumin/creatinine ratio was < 2/2- < 20/ > or = 20 mg/mmol in 59.8/33.6/6.6% of male and 66.6/28.8/4.6% of female patients. The level of albumin/creatinine ratio increased with age and the observed overall male predominance was almost confined to diabetic patients with an albumin/creatinine ratio of 5 mg/mmol or greater. By taking into account the confounding effect of age and sex, a positive association between smoking and albumin/creatinine ratio was disclosed. Moreover, high systolic blood pressure, hypertriglyceridaemia, hypercholesterolaemia (males only) and high HbA1c, but not body mass index or diastolic blood pressure were identified as correlates of elevated albumin/creatinine ratio. Glucosuria was positively correlated with albumin/creatinine ratio even when the influence of HbA1c, sex and age was taken into account. A positive correlation between serum creatinine and albumin/creatinine ratio was seen in males, but not in females. In addition, renal involvement was associated with the presence of peripheral angiopathy and diabetic retinopathy and with high resting heart rate. The cross-sectional data presented highlight the importance of reducing the overall burden of modifiable risk factors in newly-diagnosed Type 2 diabetic patients.