Diabetes Epidemiology : collaborative analysis of diagnostic criteria in Asia and Europe
| Project/Area Number |
15590958
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Metabolomics
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| Research Institution | Tokyo Women's Medical University |
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Principal Investigator |
NAKAGAMI Tomoko Tokyo Women's Medical University, Diabetes Center, Medical assistant, 医学部, 助手 (70237220)
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| Co-Investigator(Kenkyū-buntansha) |
SATO Asako Tokyo Women's Medical University, Diabetes Center, Senior lecturer, 医学部, 講師 (60205896)
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| Project Period (FY) |
2003 – 2004
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| Project Status |
Completed (Fiscal Year 2004)
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| Budget Amount *help |
¥3,000,000 (Direct Cost: ¥3,000,000)
Fiscal Year 2004: ¥500,000 (Direct Cost: ¥500,000)
Fiscal Year 2003: ¥2,500,000 (Direct Cost: ¥2,500,000)
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| Keywords | DECODE-A / Multi-center study / ethnicity / Prevalence / Type 2 diabetes mellitus / body mass index / Cardiovascular disease / Post-challenge glucose / 心血管疾患 / 新規糖尿病 / 高血圧 / 高コレステロール血症 / メタボリックシンドローム / インスリン抵抗性 / 糖尿病リスクスコア / メタアナリーシス / 糖尿病疫学 / 多国籍研究 / 糖負荷後血糖 / 心血管死亡 / 危険因子 |
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| Research Abstract |
(1)
The prevalence of type 2 diabetes varies between regions and ethnic groups after age adjustment to a standardized world population. The aim of the study was to assess the impact of ethnicity on the association between age and body mass index(BMI) on the prevalence of diabetes. We selected population-based studies performed after 1980 in the DECODE/A studies representing different ethnic groups : 11 European, 1 Maltese, 3 Indian, 2 Chinese and 3 Japanese surveys. Total numbers of subjects were 14,240 men and 15,129 women aged 30-89 years old. Diabetes was diagnosed according to the 1999-World Health Organization-criteria based on a standard 75g oral glucose tolerance test.
Gender specific prevalence of diabetes by age and BMI stratified by ethnic group, in particular the interaction of ethnicity on the associations between age/BMI and the prevalence of diabetes. The prevalence of diabetes was higher in studies from India and Malta compared to Japan, China, and the rest of Europe. The
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association between BMI and diabetes, adjusted for age, showed marked differences between the ethnic groups with an increase in prevalence starting at a BMI between 15 and 20 kg/m^2 in the Maltese and Indian populations compared to 25 kg/m^2 in Europeans. The effect of BMI on the age-adjusted prevalence of type 2 diabetes was modified by ethnicity with markedly lower thresholds in Indians and Maltese compared to the rest of Europe. This difference should be reflected in national and international recommendations regarding "optimal" BMI.
(2)
To assess the predictive values of fasting(FPG) and 2-hour plasma glucose(2-h PG) on a 75-gram oral glucose tolerance test(OGTT) with regard to cardiovascular disease(CVD) and all-cause mortality in Asians. 6817 subjects of Japanese and Asian Indian origin from five prospective studies in five countries were followed for 5-10 years. Hazard ratios for death from all-causes/CVD were estimated using Cox proportional hazard models adjusting for FPG/2-h PG and established risk factors. -Multivariate Cox regression analysis showed that an increase in FPG from 7.0 to 8.0 mmol/l(increase of 0.76 standard deviation [SD]) gave an increase in relative risk (95% confidence interval) of 1.16(1.07-1.26)/1.25(1.12-1.41) for all-cause/CVD mortality, respectively. An increase in 2-h PG of 0.76 SD from 9.0 to 11.9 mmol/l increased the relative risk by. 1.31(1.20-1.44)/1.38(1.21-1.58). The inclusion of 2-h PG in the model based on FPG significantly improved the prediction of death (p<.001) while FPG did not add significant information to the prediction over and above 2-h PG (p>.10). In a model containing both FPG and 2-h PG, hazards ratios in subjects with IGT/diabetes for 2-h PG were 1.39(1.06-1.81)/2.94(2.11-4.08) for all-cause and 1.30(0.88-1.94)/3.27(2.06-5.19) for CVD mortality, compared with the normal 2-h PG group. Compared with the normal FPG group, the respective hazards ratio in subjects with IFG/diabetes for FPG were 0.89(0.64-1.24)/0.91(0.64-1.36) for all-cause and 0.98(0.62-1.54)/0.92(0.53-1.58) for CVD mortality. -For prediction of premature death, 2-h PG was superior to FPG in several Asian populations. Less
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