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Incidence rates and risk factors for type 2 diabetes in low-risk populations are not well documented. We investigated these in white individuals who were aged 40-79 years and from the population of Bruneck, Italy. Of an age- and sex-stratified random sample of 1,000 individuals who were identified in 1990, 919 underwent an oral glucose tolerance test (OGTT) and an assessment of physiological risk factors for diabetes, including insulin resistance (homeostasis model assessment, HOMA-IR), and postchallenge insulin response (Sluiter's Index). Diabetes at baseline by fasting or 2-h OGTT plasma glucose (World Health Organization criteria, n = 82) was excluded, leaving 837 individuals who were followed for 10 years. Incident cases of diabetes were ascertained by confirmed diabetes treatment or a fasting glucose >or=7.0 mmol/l. At follow-up, 64 individuals had developed diabetes, corresponding to a population-standardized incidence rate of 7.6 per 1,000 person-years. Sex- and age-adjusted incidence rates were elevated 11-fold in individuals with impaired fasting glucose at baseline, 4-fold in those with impaired glucose tolerance, 3-fold in overweight individuals, 10-fold in obese individuals, and approximately 2-fold in individuals with dyslipidemia or hypertension. Incidence rates increased with increasing HOMA-IR and decreasing Sluiter's Index. As compared with normal insulin sensitivity and normal insulin response, individuals with low insulin sensitivity and low insulin response had a sevenfold higher risk of diabetes. Baseline impaired fasting glucose, BMI, HOMA-IR, and Sluiter's Index were the only independent predictors of incident diabetes in multivariate analyses. We conclude that approximately 1% of European white individuals aged 40-79 years develop type 2 diabetes annually and that "subdiabetic" hyperglycemia, obesity, insulin resistance, and impaired insulin response to glucose are independent predictors of diabetes.
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PMID:Population-based incidence rates and risk factors for type 2 diabetes in white individuals: the Bruneck study. 1522 Feb 2

Obesity is the one of the fundamental problems in societies of the highly developed countries. In the Framingham study almost linear dependence between cardiovascular mortality and overweight was proven. Moreover, obesity often coexists with different illnesses, such as type 2 diabetes, myocardial ischaemia, essential hypertension, dyslipidemia, arteriosclerosis, renal insufficiency, degenerative changes of joints, cholelithiasis, or some neoplasms. Among methods of treatment of obesity the most known and safe is the low calories content diet. In pharmacotherapy of obesity two medications of new generation i.e. sibutramin and orlistat make up basis at present. The present study is concentrated onto Sibutramin, which acts in the central nervous system. Authors introduce mechanisms of action of the medicine, its participation in termogenesis as well as therapeutic effectiveness. Special attention is dedicated for clinical situations in which decrease of body mass is the key element of therapy, that is essential hypertension, diabetes and hyperlipidemia.
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PMID:[Sibutramine in treatment of obesity. Therapeutic premises in patients with essential hypertension, diabetes, hyperlipidemia]. 1523 Jan 49

Cardiovascular disease is one of the leading causes of death worldwide and is responsible for 45% of deaths in the western world and 24.5% of deaths in the developing countries. In the 21st century these diseases will continue to dominate the disease spectrum and death statistics in both the industrialised and developing worlds. Since 1975 mortality from cardiovascular disease has decreased by about 24 to 28% in most countries. About 45% of this reduction can be attributed to an improvement in treatment of coronary heart disease and around 55% are attributable to a reduction in risk factors, in particular, stopping smoking and control of hypertension. However, especially in the case of ischaemic heart disease, it is not clear whether the reduction in mortality reflects a reduction in incidence of this disease. Due to the aging population and the reduction in age-related mortality, it is expected that the absolute number of people with heart disease will increase. Furthermore, the increase in prevalence of obesity, metabolic syndrome, type II diabetes as well as the higher prevalence of female smokers compared with thirty years ago could result in an increase in mortality over the next years and decades. It has been shown that prevention strategies, such as education campaigns aimed at the general public, can potentially greatly contribute to a reduction in incidence of cardiovascular disease at every stage. In order for such campaigns to be effective, it is necessary to understand and reduce the risk factors for cardiovascular disease. A large proportion of these risk factors are associated with lifestyle and are therefore modifiable. These modifiable risk factors include smoking, hypertension, poor diet, dyslipidemia, lack of exercise, overweight, adiposity and diabetes mellitus and optimisation of these should be a key aim for all adults. Gender differences also play a role in the incidence and prevention of cardiovascular disease. Incidence of myocardial infarction in women increases significantly after the menopause, and mortality through coronary heart disease is higher amongst women than men. Hormonal status, use of oral contraceptives and pregnancy all influence risk for cardiovascular disease in women. Due to the enormity of the problem that cardiovascular disease presents to society and the great potential for management of risk factors for cardiovascular disease through preventive medicine, a number of health promotion and prevention programmes have been initiated by various national and global organisations. This paper presents an analysis of modifiable risk factors for cardiovascular disease together with a review of targeted prevention programmes aiming at reducing these risks.
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PMID:[Risk management of coronary heart disease-prevention]. 1528 2

Patients with rheumatoid arthritis (RA) have an increased prevalence of coronary heart disease and a high cardiovascular mortality rate. The causes of increased coronary heart disease in RA patients are poorly understood. Conventional cardiovascular risk factors, such as inactivity, overweight or dyslipidemia may play a role, but they do not seem to be wholly responsible for the increased cardiovascular risk. RA is associated with a high incidence of inflammation and vascular endothelial injuries. Endothelial dysfunction is one of the key steps in the pathogenesis of atherosclerosis in non-RA patients. Therefore, we hypothesized that inflammation-induced vascular endothelial injuries may be responsible for the increased risk of coronary heart disease and high rates of cardiovascular mortality in patients with RA.
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PMID:Rheumatoid arthritis increases the risk of coronary heart disease via vascular endothelial injuries. 1528 64

The authors present the history of selecting and understanding the essence of the metabolic syndrome (X syndrome, Reaven's syndrome) related to insulin resistance as well as its contemporary working definition allowing diagnosing affected individuals. They describe the cycle of their own study investigating the prevalence of metabolic syndrome elements in patients treated because of their thyrotoxicosis. It has been observed that 4 weeks after thyrostatic treatment is started, many of these patients are affected by the growth of their body mass and total cholesterol level (mostly at the cost of LDL-cholesterol). After 2 years the growth of body mass is significant, many patients develop arterial hypertension. After 15 years of obesity, diabetes type 2 (DM-2), arterial hypertension, dyslipidemia, hyperinsulinaemia and full metabolic syndrome are found much more frequently than in the control group. In the research carried in the 1987--1989 period, we found the following in 11,546 subjects from the Lublin region (villagers aged over 18): overweight in 36% women and 34% of men, and obesity in 30% of women and 10% of men, and arterial hypertension in 24.2% and DM 2 in 2.7% of the whole examined group. Within the research carried out between 1998 and 2000 we examined 3,782 persons (63%) out of 6,000 persons aged over 35 carefully selected from the Lublin town and the Lublin region villages. DM 2 was found in 17.6% of the examined in the countryside and in 14.1% from the town (newly diagnosed diabetes--75% and 56% respectively). Obesity (BMI > or = 30 kg/m2) was found in 30.8% of the examined from villages and 30.1% town dwellers, arterial hypertension (RR > or = 140/90 mmHg) was found in 69.4% villagers and 68.6% subjects from the town. Total serum cholesterol > or = 5.2 mmol/l (200 mg/dl) was found in 66.4% of the examined from the countryside and in 60% from the town, LDL-cholesterol > or = 3.5 mmol/l (135 mg/dl) was found in 57.3% and 52.6% respectively, and triglycerides > or = 1.7 mmol/l (150 mg/dl) in 33,3% and 44.8 respectively. Hypo-HDL-cholesterolaemia was found in 21.7% of the examined from villages and in 31.4% of the examined from Lublin. 76.5% of the examined from the countryside and 72.7% from the town had a raised WHR index.
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PMID:Metabolic syndrome. 1531 27

Overweight/obesity represent an underestimated risk factor of renal disease. The incidence of obesity-related glomerulopathy (ORG) tremendously increased within the last decade. The first sign of renal damage in overweight conditions is microalbuminuria or proteinuria, indicating the potential risk of its progression to renal insufficiency and the development of premature cardiovascular events. In the early stage of obesity renal hemodynamics are characterized by a renal hypercirculation and glomerular hyperfiltration, particularly in the presence of hypertension. The hyperfiltration is especially harmful in patients with pre-existing inflammatory and metabolic renal disease, or under the conditions of reduced renal mass. Histopathologically, ORG is characterized by glomerulomegaly with/without signs of focal segmental glomerulosclerosis. Pathogenetically, numerous factors are involved, e.g. enhanced glomerular capillary pressure, adrenergic nerve overactivity, inappropriate activation of the renin-angiotensin-aldosterone system, insulin resistance, hyperinsulinemia and hyperleptinemia, dyslipidemia, enhanced clotting tendency and sodium retention. Diabetic nephropathy is one of the most serious complications of obesity-induced diabetes. In the industrial nations type 2 diabetes is the single most frequent cause of end-stage renal disease. After kidney transplantation, overweight/obesity is associated with a less favourable prognosis for the survival of the graft and the patient. Incidence of renal cell carcinomas is enhanced in overweight/obesity. Obesity-related renal disease may be prevented/postponed by an early weight reduction, by dietary intervention combined with physical exercise. In the advanced stages of renal disease benefits of weight reduction are minimal. Concomitant administration of angiotensin-converting-enzyme inhibitors or angiotensin II receptor 1 blockers exerts antiproteinuric effects and thereby aid in retarding the disease progression. Aimed prevention and treatment of obesity represent a challenge for the healthcare system. The concerted action of physicians, patients and the public health authorities is needed.
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PMID:[Overweight and obesity--risk factors in the development and progression of renal disease]. 1532 63

Screening for diabetes makes good sense in particular in patients with overweight, hypertension or dyslipidemia. For type 2 diabetes is often not recognized until sequelae have put in an appearance. Consideration must be given to the possible presence of neuropathy, micro- and macroangiopathy and cardiovascular and cerebral disease. The primary therapy recommendations for type 2 diabetics comprise diet, weight loss and increased exercise. Depending on the success of these measures and the patient's constitution, medication with biguanides, sulfonylureas, glinides, glitazones alpha-glucosidase inhibitors or, where indicated, insulin, is then applied.
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PMID:[Newly diagnosed diabetes mellitus--what to look out for]. 1534 29

Children and adolescents who are overweight and have additional risk factors (ie, high-risk ethnic group or signs of insulin resistance) should be screened for diabetes every 2 years (strength of recommendation [SOR]: C). Management of type 2 diabetes in all age groups requires a multifactorial approach that addresses not only glycemic control (A1C <7%) but also other cardiovascular risk factors such as hypertension, dyslipidemia, and obesity (SOR: A). Most patients with type 2 diabetes will eventually require combination therapy with 2 or more agents to attain and maintain glycemic control (SOR: A). Combining an insulin secretagogue (ie, sulfonylurea or meglitinide) and an insulin sensitizer (ie, metformin or a glitazone) capitalizes on unique mechanisms of action and results in significant A1C lowering (SOR: C). If a patient is unable to achieve glycemic control on 2 oral agents, insulin therapy is an appropriate consideration and should be added to oral agents (rather than substituted) (SOR: B).
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PMID:Optimizing combination therapy for type 2 diabetes in adolescents and adults: a case-based approach. 1546 78

Childhood obesity is a major risk factor, especially for the metabolic syndrome and further cardiovascular diseases. The metabolic syndrome is defined by a combination of obesity, arterial hypertension, hyperlipidemia and dyslipidemia, insulin resistance or type 2 diabetes mellitus. Obesity in early childhood further increases the risk of premature illnesses and early death, therefore raising public health concerns. About one third of overweight or obese children and adolescents exhibit features of early metabolic syndrome. In view of the increasing issue of early-onset obesity, effective family- and school-based primary care programs in addition to sufficient weight-reducing therapeutic approaches are necessary in order to achieve a modification of our sedentary lifestyle. Local long-term therapeutic programs for obese young patients are an important tool to establish a more active and health-oriented life style in children and their families and to reduce the individual and public burden of obesity in childhood.
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PMID:[Obesity and the metabolic syndrome in children and adolescents]. 1552 25

Hispanics comprise one of the fastest-growing segments of the U.S. population. Mexican-American adults are more likely to be overweight, physically inactive, diabetic, and to have higher levels of hypertension than are white adults. However, studies addressing the relationship between physical fitness and coronary artery disease (CAD) risk factors among Mexican-Americans are much less conclusive. Therefore, understanding the etiology of factors influencing resting systolic (SBP) and diastolic blood pressure (DBP) in Hispanic women was the aim of this investigation. SBP, DBP, peak oxygen uptake (peak VO (2)), weekly physical activity, waist (WC) and hip circumference, blood glucose, and levels of plasma lipids (triglyceride, total cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol) of 39 Hispanic women age 22 - 51 years were measured. Factors with significant correlation to SBP were age, WC, sagittal diameter, and weight. Similarly, significant correlations were observed between anthropometric indices, age, and DBP. Peak VO (2) ( r = - 0.53, p < 0.01) and heart rate at maximal effort ( r = - 0.34, p </= 0.05) were inversely associated to DBP. There was also a strong inverse correlation ( r = - 0.53, p < 0.01) between peak VO (2) and CAD risk profile (created from one or the combination of: hypertension, obesity, hyperglycemia, dyslipidemia, smoking). Stepwise multiple linear regression revealed that 33 % of the variance in SBP is attributed to age (25 %), and WC (8 %), while DBP is explained by WC alone (26 %). The addition of peak VO (2) did not make significant contributions to the variances in SBP or DBP. The findings of this study suggest that central adiposity is an important predictor of resting blood pressure in Hispanic women. The inverse association between aerobic fitness and diastolic blood pressure as well as CAD risk factors suggests that recommendations regarding prevention of hypertension in this population should be based on the interrelationships between physical fitness and obesity.
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PMID:Central adiposity, aerobic fitness, and blood pressure in premenopausal Hispanic women. 1553 3


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