Association of Differing Dietary, Metabolic, and Clinical Risk Factors with Macrovascular Complications of Diabetes: A Prevalence Study of 503 Mexican Type II Diabetic Subjects. I

Abstract

Macrovascular and microvascular complications of diabetes may be associated with different environmental factors. To investigate this further, a prevalence study of 503 Mexican type II diabetic subjects was carried out while their patterns of nutrition were constrained by government food subsidies. Average daily dietary intakes were 1866 kcal; 46.5% as carbohydrate, 13.7 mmol cholesterol, 8.7 g fiber, and a polyunsaturated/saturated fat ratio of 0.98. With respect to macrovascular disease, 49.3% of patients had evidence of peripheral vascular disease, and 21.6% myocardial ischemia, 6.0% angina, 10.8% EKG evidence of ischemia, 4.8% EKG evidence of myocardial infarction. Only 1.2% (six patients) had a clear history of completed stroke, and all were hypertensive. Six patients had also undergone amputations for diabetic gangrene. Tabulation of the means of clinical characteristics according to presence or absence of myocardial ischemia showed that higher cholesterol, calorie, and fat intake, higher mean blood pressure, higher serum cholesterol, and serum triglyceride levels were found in those with myocardial ischemia. Patients with peripheral vascular disease were more commonly smokers. Stepwise logistic regression revealed significant positive associations between myocardial ischemia and dietary cholesterol, serum cholesterol, and mean blood pressure. In contrast, the presence of peripheral vascular disease was significantly related only to smoking and retinopathy. There were no associations between macrovascular complications and duration of diabetes in the multivariate analysis, and they occurred with equal frequency in men and women. Prospective studies of atherosclerosis in maturity-onset diabetes should assess and seek to modify dietary cholesterol, serum cholesterol, and hypertension.

Progression of Lower-Extremity Arterial Occlusive Disease in Type II Diabetes Mellitus

“…Although palpation for peripheral pulses is a commonly used method in LEAOD prevalence studies in diabetes (15,17,19,20), pulse palpation is unfortunately unreliable (8,22). Even though the method is thought to be appropriate for epidemiological studies by some authors (23), the data supporting pulse palpation show that the concordance between the findings of two observers observing absent peripheral pulses is not much greater than chance.…”

“…A history of claudication has also been used to identify and monitor lower-extremity ischemia in diabetes (16)(17)(18)(19)(20)(21). Claudication history is insensitive because exercise-induced leg pain due to ischemia is often undetected by the patient with diabetes because the pain is often masked by coexisting peripheral neuropathy that is also common in diabetes (8).…”

The Course of Peripheral Vascular Disease in Non-insulin-dependent Diabetes

“…W hile it is generally recognized that diabetes predisposes to obliterative peripheral vascular disease (PVD) of the lower extremities, estimates of the scope of the problem vary widely 1 " 37 (Table 1). Most, but not all, 2931 of the reported studies underestimate the problem because they are based on retrospective data from which prevalence rather than cumulative incidence or risk of PVD can be determined.…”

Efficacy and safety of rosiglitazone plus metformin in Mexicans with type 2 diabetes

“…Furthermore, this survey identified that the prevalence of type 2 diabetes increased three-fold with every 10-year increment in age such that prevalence between 50 and 60 years of age was 28%, and 33% between 60 and 70 years. Diabetes is considered the second most common cause of mortality in Mexico and, in addition, a high and rising rate of cardiovascular disease has been recognized in Mexicans [3][4][5][6]. In the early 1980s a study of 503 Mexican patients with type 2 diabetes showed a prevalence of 53% with retinopathy and 16% with nephropathy [7].…”