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Query: UMLS:C0011849 (diabetes)
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During the tenth biennial examination of the Framingham Study, 1315 participants who were free of cardiovascular disease had fibrinogen levels measured. During the ensuing 12 years, cardiovascular disease developed in 165 men and 147 women. For both sexes, the risk of cardiovascular disease was correlated positively to antecedent fibrinogen values higher than the 1.3 to 7.0 g/L (126 to 696 mg/dL) range. The magnitude of the risk diminished with advancing age in women but not in men. Risk for coronary heart disease also was significantly related to fibrinogen level. Here, the magnitude of risk displayed diminishing impact with age, again only in women. Risk of stroke increased progressively with fibrinogen level in men but not in women. The impact of fibrinogen value, considered as a separate variable, on cardiovascular disease was comparable with the major risk factors, such as blood pressure, hematocrit, adiposity, cigarette smoking, and diabetes. Fibrinogen values were also significantly related to these risk factors. Taking all these into account in a multivariate analysis, fibrinogen level was still significantly related to the incidence of cardiovascular disease in men and marginally significant in women. For coronary heart disease, the fibrinogen level was significant for both men and women. Elevated fibrinogen level is a predictor of cardiovascular disease that should be added to the cardiovascular risk factor profile.
JAMA 1987 Sep 04
PMID:Fibrinogen and risk of cardiovascular disease. The Framingham Study. 362 1

From 1965 to 1968, the Honolulu Heart Program began following up a cohort of men in a prospective study of cardiovascular disease. For this report, we examined the 12-year risk of stroke in 690 diabetic and 6908 nondiabetic subjects free of coronary heart disease and a history of stroke at study entry. In 12 years of follow-up, 62.3 per 1000 diabetic men and 32.7 per 1000 nondiabetic men experienced a stroke. The relative risk of thromboembolic stroke for those with diabetes compared with those without diabetes was 2.0 (95% confidence limits, 1.4 to 3.0). Although diabetes was usually associated with an atherogenic risk profile, control of hypertension, complicating myocardial infarction, and other risk factors failed to diminish the effect of diabetes on stroke. Among those without diabetes, the relative risk of thromboembolic stroke for those at the 80th percentile of serum glucose level compared with those at the 20th percentile (199 vs 115 mg/dL [11.0 vs 6.4 mmol/L]) was 1.4 (95% confidence limits, 1.1 to 1.8). In the nondiabetic sample, the relative risk of thromboembolic stroke for those with glucosuria compared with those without glucosuria was 2.7 (95% confidence limits, 1.6 to 4.5). There was no association between diabetes, or measures of glucose intolerance, and hemorrhagic stroke. We conclude that diabetes, even in a possibly undiagnosed subset of hyperglycemic individuals, imparts an additional independent risk of stroke unexplained by clinically measured risk factors.
JAMA 1987 Feb 20
PMID:Diabetes and the risk of stroke. The Honolulu Heart Program. 380 77

A longitudinal investigation was conducted from 1977 to 1984 on 178 families in which one or more of the children had insulin-dependent diabetes mellitus. Of 351 nondiabetic sibs followed up for an average of 54 months, ten have, thus far, become diabetic. Eight sibs were HLA identical to their diabetic proband and nine had HLA-DR3 and/or HLA-DR4. Islet cell surface antibody and islet cell cytoplasmic antibody were found from two to 74 months before the onset of clinical diabetes in 100% and 90%, respectively, of the children. A decrease in insulin secretion was observed in all of these children on entry into the study and was detected in the absence of elevated plasma glucose concentrations. The data suggest that the triad of HLA identity, pancreatic islet cell antibodies, and depressed insulin secretion identifies those sibs who are at high risk of developing insulin-dependent diabetes mellitus.
JAMA 1985 Sep 20
PMID:Triad of markers for identifying children at high risk of developing insulin-dependent diabetes mellitus. 389 93

Twenty-four children, teenagers, and young adults (8 to 26 years old) with insulin-dependent diabetes mellitus were treated with continuous subcutaneous insulin infusion (CSII). Criteria for using CSII included persistent high glycohemoglobin (GHb) values and/or wide swings in blood glucose values despite arduous efforts to improve glycemia. Thirty percent discontinued CSII. Improvement was significant by three months for GHb and blood glucose values, but plateaued thereafter. Only three patients attained a normal GHb value. No predictors for degree of control were identified. Diabetic ketoacidosis did not occur more frequently with CSII. Electromechanical problems with the devices, patient errors, or local skin problems occurred in 50% of patients, although none produced ketoacidosis or severe hypoglycemia. Dietary noncompliance and decreased intensive home monitoring were contributory factors. Better ways to predict success or failure are needed if normalization or even near-normalization is a goal of CSII in younger patients with insulin-dependent diabetes mellitus followed up in a nonresearch setting.
JAMA 1986 Feb 07
PMID:Insulin pump treatment in insulin-dependent diabetes mellitus. Children, adolescents, and young adults. 394 61

Acute renal failure has been observed in patients undergoing angiography in which a hypertonic triiodinated contrast medium is used. To ascertain the incidence of renal dysfunction and the clinical risk factors, we did a prospective study in which creatinine clearance was measured before and immediately after 120 arteriographic procedures. Thirty-seven patients (31%) sustained a significant reduction in creatine clearance after arteriography. No specific risk factor could be determined. Our findings, however, indicate that patients with preexisting renal insufficiency or diabetes mellitus are not at a higher risk for sustaining a fall in creatinine clearance after angiography.
JAMA 1985 Feb 15
PMID:Renal dysfunction after arteriography. 396 22

The modifying influence of individual risk factors on the relation between myocardial infarction (MI) and cigarette smoking was evaluated in a case-control study of women younger than 50 years of age. Data from 555 women who survived first MIs were compared with those of 1,864 hospital controls of similar ages. The risk of MI increased with the number of cigarettes smoked, both in the presence and absence of factors that predispose to an infarction. In particular, the association was apparent at all ages, at all levels of total serum cholesterol and high-density lipoprotein cholesterol, and in the presence and absence of oral contraceptive use, hypertension, diabetes mellitus, blood group A, tendency to type A behavior, and family history of MI. The relative increase in risk was generally greater the lower the underlying predisposition to MI. There was clear evidence, however, that recent oral contraceptive use substantially augmented the increased risk for smokers, and hypercholesterolemia may have had the same effect.
JAMA
PMID:Myocardial infarction and cigarette smoking in women younger than 50 years of age. 399 77

A total of 117 (101 primary and 16 secondary) renal transplants were performed on 101 diabetic patients. The mean duration of diabetes mellitus to the onset of end-stage renal disease was 17.5 years. After primary transplantation, overall one- and five-year patient survival was 77% and 55%, respectively; for grafts, it was 58% and 45%, respectively. One- and five-year living-related donor graft survival was 66% and 53%, respectively; for cadaveric kidneys, it was 45% and 33, respectively. One- and five-year graft survival for 20 HLA-identical living-related donor kidneys was 85% and 77%, respectively. Among the 16 recipients of secondary grafts, patient survival at one and five years was 65% and 29%, respectively; graft survival at one year was 24%. Acceptable patient and graft survival continues with primary renal transplantation. In view of the poor results with secondary transplantation in the diabetic patient, however, its continued application should be questioned.
JAMA 1983 Jan 28
PMID:Primary and secondary renal transplantation in diabetic patients. 633 8

Twelve type I diabetic patients with established diabetic nephropathy were treated for 12 months with the insulin pump to determine whether glucoregulation would influence the clinical course of proteinuria. All of the subjects were known to have arterial hypertension and were receiving antihypertension medication. Despite good glucose control, as assessed by total glycosylated hemoglobin level, two clinical courses were observed: six patients demonstrated a progression in proteinuria and six appeared to experience a reduction in proteinuria. The group demonstrating a progression had significantly higher mean arterial pressure at six and 12 months of study compared with the group with a reduction in proteinuria. These results suggest that arterial hypertension is an important risk factor in the progression of diabetes nephropathy. Further studies should be designed to recognize early proteinuria and hypertension to determine whether mean normal glucose values and BP over a prolonged period will prevent renal failure.
JAMA 1983 Apr 15
PMID:Diabetic nephropathy. Clinical course in patients treated with the subcutaneous insulin pump. 633 60

Prospective studies have shown that children and adolescents with diabetes have a high prevalence of serious complications and a sharp reduction in life expectancy. Recently, self-monitoring of blood glucose levels has become available and, for the first time, provides a method for determining the concentration of blood glucose with considerable accuracy. We have introduced this method of control assessment to our pediatric diabetic patient population in conjunction with a program of intensified insulin administration (two or more injections per day). This is a report of the ready acceptance of these methods by children and adolescents and their parents (53/63, or 84%). The effectiveness of this program is evidenced by a progressive and significant reduction in the percentage of glycosylated hemoglobin during a period of 18 months in a majority of the subjects. These observations suggest that improved glycemic control can be achieved in young diabetics by using multiple insulin injections and self-monitoring of blood glucose levels. Whether such control can lead to a better long-term outlook for diabetics remains to be seen.
JAMA 1983 Jun 03
PMID:Self-monitoring of blood glucose levels and intensified insulin therapy. Acceptability and efficacy in childhood diabetes. 634 48

Measurement of illness severity is required to evaluate diagnostic efficiency of physicians, assess quality of care, understand utilization of health services, design clinical trials, and reimburse hospitals on the basis of output. "Staging" is a method for measuring severity of specific, well-defined diseases. Staging defines discrete points in the course of individual diseases that are clinically detectable, reflect severity in terms of risk of death or residual impairment, and possess clinical significance for prognosis and choice of therapeutic modality. Medical staging criteria have been developed for 420 diagnoses and converted into "coded" criteria for the major diagnostic coding systems. Coded criteria can be efficiently applied to computerized hospital discharge abstracts to derive a comprehensive case-mix classification system. Uses of staging in epidemiologic, case-mix, and utilization analyses are illustrated for diabetes mellitus.
JAMA 1984 Feb 03
PMID:Staging of disease. A case-mix measurement. 641 3


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