OBJECTIVE -To examine prospectively the relationship between diabetes, glycemic control, and spirometric measures. RESEARCH DESIGN AND METHODS-From a community-based cohort, 495 Europid (i.e., of European descent) patients with type 2 diabetes who had no history of pulmonary disease underwent baseline spirometry between 1993 and 1994. A subset of 125 patients was restudied a mean of 7.0 years later. The main outcome measures included forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1 ), vital capacity (VC), and peak expiratory flow (PEF) corrected for body temperature, air pressure, and water saturation and were expressed either in absolute terms or as percentage-predicted value for age, sex, and height.RESULTS -Mean percentage-predicted values of each spirometric measure were decreased Ͼ10% in the whole cohort at baseline and absolute measures continued to decline at an annual rate of 68, 71, and 84 ml/year and 17 l/min for FVC, FEV 1 , VC, and PEF, respectively, in the 125 prospectively studied patients. Declining lung function measures were consistently predicted by poor glycemic control in the form of a higher updated mean HbA 1c , follow-up HbA 1c , or follow-up fasting plasma glucose. In a Cox proportional hazards model, decreased FEV 1 percentage-predicted value was an independent predictor of all-cause mortality.CONCLUSIONS -Reduced lung volumes and airflow limitation are likely to be chronic complications of type 2 diabetes, the severity of which relates to glycemic exposure. Airflow limitation is a predictor of death in type 2 diabetes after adjusting for other recognized risk factors.
Three groups of subjects were asked to judge the probability that they and several target others (a friend, an acquaintance, a parent, a child) would experience various risks. Subjects were middle-class adults, their teenage children, and high-risk adolescents from treatment homes. All three groups saw themselves as facing somewhat less risk than the target others. However, this perception of relative invulnerability was no more pronounced for adolescents than for adults. Indeed, the parents were viewed as less vulnerable than their teenage children by both the adults and those teens. These results are consistent with others showing small differences in the cognitive decision-making processes of adolescents and adults. Underestimating teens' competence can mean misdiagnosing the sources of their risk behaviors, denying them deserved freedoms, and failing to provide needed assistance.
Duration of insulin treatment was confirmed as an independent risk factor for severe hypoglycemia. The novel association with educational attainment suggests knowledge-driven intensive glycemic self-management. The positive relationship between frequency and glycosylated hemoglobin may identify patients with unstable glycemic control.
OBJECTIVE -The purpose of this study was to examine the natural history of peripheral arterial disease (PAD) complicating type 2 diabetes, in particular the influence of PAD on the risk of cardiac death and the adequacy of PAD risk factor management.RESEARCH DESIGN AND METHODS -The Fremantle Diabetes Study (FDS) was a prospective community-based observational study of diabetic patients recruited between 1993 and 1996. The present sample comprised the 1,294 FDS type 2 diabetic patients and a subgroup of 531 of these who had valid data at baseline and five or more subsequent consecutive annual reviews. Assessments consisted of a range of clinical and biochemical variables including the ankle/brachial index (ABI). PAD was defined as an ABI Յ0.90 at two consecutive reviews or any PAD-related lower-extremity amputation.RESULTS -The prevalence of PAD at study entry was 13.6% and the incidence of new PAD was 3.7 per 100 patient-years. Both prevalent and incident PAD was strongly and independently associated with increasing age, systolic blood pressure, total serum cholesterol, and especially smoking. Risk factor management improved but remained suboptimal during follow-up. An ABI of Յ0.90 was independently associated with an increased risk of cardiac death of 67%.CONCLUSIONS -Measurement of the ABI is a simple means of identifying PAD in diabetic patients. PAD is common in diabetic patients and predicts cardiac death. These data further support the role of regular screening for PAD in diabetes so that intensive management of vascular risk factors can be pursued. Diabetes Care 29:575-580, 2006S tudies in the general population indicate that peripheral arterial disease (PAD) is associated with increased risk of death from cardiovascular disease, and subgroup analyses suggest that PAD carries a particularly poor prognosis in diabetes (1-3). The role of the ankle/brachial index (ABI) in the detection of asymptomatic PAD, including that in diabetic individuals, is well established (4,5). Although screening for asymptomatic PAD using the ABI is recommended in diabetes, this recommendation has not been universally embraced. There is some evidence that PAD is underdiagnosed and that risk factor management is suboptimal in those most at risk (6 -8).Clinicians may underestimate the significance of PAD in diabetic patients because there are few data relating to its natural history. Early studies (1,9) relied on absent foot pulses or the presence of claudication to identify individuals with PAD. These indexes lack sensitivity for early and asymptomatic PAD, both of which have important prognostic implications (2). Although there have been a number of cross-sectional studies of PAD prevalence in diabetes based on the ABI (5,10,11), there is only one large study, the U.K. Prospective Diabetes Study (UKPDS) from which valid incidence and outcome data have been published (12). However, a limitation of the UKPDS was the exclusion of patients most at risk of prevalent and incident PAD, namely those with known coronary heart disease (CHD...
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