Onset of NIDDM occurs at Least 4–7 yr Before Clinical Diagnosis

Harris, Maureen I.; Klein, Ronald; Welborn, T.A.; Knuiman, Matthew

doi:10.2337/diacare.15.7.815

Cited by 1,175 publications

(764 citation statements)

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“…If they have Type I diabetes, this will convey the message that screening is important. If they have Type II diabetes, STDR could be already present [11,12]. After puberty, all patients wih Type I diabetes and Type II diabetes should be screened at least every other year, if no retinopathy is present at the last visit.…”

Section: Methodsmentioning

confidence: 99%

“…PDR is not likely to develop within the first 10 years of diabetes but its incidence reaches about 30 out of 1000 patients per year rapidly afterwards [9,10]. Type II diabetes mellitus can remain unrecognized for years, and this could be why from 7% to as many as 38% of patients already have DR, sometimes STDR, when diabetes is finally diagnosed [11,12]. CSME is a major cause of visual impairment in these patients [13].…”

Section: Prevalence and Risk Factorsmentioning

confidence: 99%

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Diabetic retinopathy

2002

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Abstract. Easy observation of the fundus oculi makes retinopathy the most frequently reported chronic complication of diabetes and, consequently, the one we know best in terms of epidemiology and natural history. Achieving near-normal levels of blood glucose and blood pressure provides empirical though powerful tools for clinicians to delay the onset and progression of diabetic retinopathy. Even when these measures have failed and retinopathy becomes sight-threatening, laser photocoagulation has proven remarkably effective. Nonetheless, retinopathy remains a leading cause of blindness and there is little evidence that diabetes-related visual loss is decreasing in industrialized countries. This may result from the mixed blessing of prolonged survival of patients who had become diabetic when metabolic control was pursued less fastidiously than today. Screening for sight-threatening retinopathy is the most cost-effective medical procedure known and should help optimise the use of diagnostic and therapeutic resources, but its widest deployment still meets with inertia and lack of interest within most health care systems. Improving clinical skills and technology, however, allow us to take a more optimistic look at the future, as pathogenesis-targeted forms of treatment are being developed and tested through appropriately powered clinical trials. [Diabetologia (2002[Diabetologia ( ) 45:1617[Diabetologia ( -1634

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Section: Methodsmentioning

confidence: 99%

Section: Prevalence and Risk Factorsmentioning

confidence: 99%

Diabetic retinopathy

2002

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“…It has been estimated that a person may have undiagnosed [31]. In our study population, the maximum follow-up period from baseline was 7.9 years and the average was 4.4 years.…”

Section: Discussionmentioning

confidence: 90%

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

et al. 2006

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Aims/hypothesis Risk estimates for stroke in patients with diabetes vary. We sought to obtain reliable risk estimates for stroke and the association with diabetes, comorbidity and lifestyle in a large cohort of type 2 diabetic patients in the UK. Materials and methods Using the General Practice Research Database, we identified all patients who had type 2 diabetes and were aged 35 to 89 years on 1 January 1992. We also identified five comparison subjects without diabetes and of the same age and sex. Hazard ratios (HRs) for stroke between January 1992 and October 1999 were calculated, and the association with age, sex, body mass index, smoking, hypertension, atrial fibrillation and duration of diabetes was investigated. Results The absolute rate of stroke was 11.91 per 1,000 person-years (95% CI 11.41-12.43) in people with diabetes (n=41,799) and 5.55 per 1,000 person-years (95% CI 5.40-5.70) in the comparison group (n=202,733). The ageadjusted HR for stroke in type 2 diabetic compared with non-diabetic subjects was 2.19 (95% CI 2.09-2.32) overall, 2.08 (95% CI 1.94-2.24) in men and 2.32 (95% CI 2.16-2.49) in women. The increase in risk attributable to diabetes was highest among young women (HR 8.18; 95% CI 4.31-15.51) and decreased with age. No investigated comorbidity or lifestyle characteristic emerged as a major contributor to risk of stroke. Conclusions/interpretation This study provides risk estimates for stroke for an unselected population from UK general practice. Patients with type 2 diabetes were at an increased risk of stroke, which decreased with age and was higher in women. Additional risk factors for stroke in type 2 diabetic patients included duration of diabetes, smoking, obesity, atrial fibrillation and hypertension.

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“…We were unable to asses the duration of diabetes prior to initiation of GLM in our study. However, it is reasonable to assume that patients starting GLM therapy may have had diabetes for approximately 7 to 10 years [19,29]. We were also unable to accurately differentiate between type 1 and type 2 diabetes, but prior studies have shown that the risk of cardiovascular morbidity and mortality appears to be the same, regardless of type of diabetes when adjusted for age and sex [1].…”

Section: Strengths and Limitationsmentioning

confidence: 85%

Changes in short- and long-term cardiovascular risk of incident diabetes and incident myocardial infarction—a nationwide study

et al. 2010

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Aims/hypothesis We assessed secular trends of cardiovascular outcomes following first diagnosis of myocardial infarction (MI) or diabetes in an unselected population. Methods All Danish residents aged ≥30 years without prior diabetes or MI were identified by individual-level linkage of nationwide registers. Individuals hospitalised with MI or claiming a first-time prescription for a glucose-lowering medication (GLM) during the period from 1997 to 2006 were included. Analyses were by Poisson regression models. Primary endpoints were death by all causes, cardiovascular death and MI. Results The study included 3,092,580 individuals, of whom 77,147 had incident MI and 118,247 new-onset diabetes. MI patients had an increased short-term risk of all endpoints compared with the general population. The rate ratio (RR) for cardiovascular death within the first year after MI was 11.1 (95% CI 10.8-11.5) in men and 14.8 (14.3-15.3) in women, respectively. The risk rapidly declined and 1 year after the index MI, RR was 2.11 (2.00-2.23) and 2.8 (2.64-2.97) in men and women, respectively. Patients with diabetes carried a constantly elevated risk of all endpoints compared with the general population. The cardiovascular death RR was 1.90 (1.77-2.04) and 1.92 (1.78-2.07) in men and women, respectively during the first year after GLM initiation. Conclusions/interpretation Incident MI is associated with high short-term risk, which decreases rapidly over time. Incident diabetes is associated with a persistent excessive cardiovascular risk after initiation of GLM therapy. This further strengthens the necessity of early multi-factorial intervention in diabetes patients for long-term benefit.

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Onset of NIDDM occurs at Least 4–7 yr Before Clinical Diagnosis

Cited by 1,175 publications

References 0 publications

Diabetic retinopathy

Diabetic retinopathy

Risk of stroke in people with type 2 diabetes in the UK: a study using the General Practice Research Database

Changes in short- and long-term cardiovascular risk of incident diabetes and incident myocardial infarction—a nationwide study

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