Macrovascular and Other Complications Of Type 2 Diabetes Mellitus

Diabetes, Digestive, Kidney Diseases

Investigators

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Abstract

We follow a population-based cohort of Pima Indians who are invited every two years to participate in a research examinination. The methods for this longitudinal study are described in detail in Project Numbers Z01 DK069097-01 and Z01 DK069000-42. Electrocardiograms are obtained and serum total cholesterol, HDL cholesterol, and triglycerides are measured at each of these examinations. Participants with amputations are identified and the level of amputation is recorded. A death registry is maintained and underlying causes of death are determined by review of clinical records, autopsy reports and death certificates. Terminology and codes of the International Classification of Disease, Ninth Revision (ICD-9), are used to classify causes of death. [unreadable] [unreadable] In the past year, we described the effect of youth-onset type 2 diabetes on mortality in mid-life (ages 25-54 years). We found that the death rate in the youth-onset group was 3 times as high as in nondiabetic subjects of the same age distribution. In studies of Pima Indian adults, we found that major ischemic abnormalities on electrocardiograms predicted deaths from cardiovascular disease after accounting for other cardiovascular risk factors, including proteinuria. The death rate from ischemic heart disease remained stable in nondiabetic Pima Indians but increased among those with diabetes, suggesting that in the absence of diabetes, the underlying susceptibility to ischemic heart disease in this population has not changed. Homocysteine was positively associated with all-cause mortality and deaths from nephropathy and infectious diseases, but not with cardiovascular deaths.[unreadable] [unreadable] In the coming year, we will characterize, among other things, the impact of heart rate and prolonged QT interval on mortality. Changes in management of diabetes will be examined to determine whether improvements in health services are reflected by improvements in blood pressure, glycemic, and lipid control. [unreadable] [unreadable] The Look AHEAD clinical trial of weight loss to prevent complications of type 2 diabetes has completed at least one year of observation on all participants. The study met its feasibility criteria of adequate weight loss in the first year.