Prevalence, incidence, predictors and outcome of type 2 diabetes in Turkey
Küçük Resim Yok
Tarih
2006
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Türk erkek ve kadınlarını temsil eden bir örneklemde, tip 2 diyabetin insidansı, bazı öngördürücüleri ile akıbetini prospektif biçimde, prevalansını da kesitsel olarak araştırmak. Yöntemler: Ortalama yaşı 48 (±12) olan 3401 kişilik bir örneklem 19,050 kişi-yılı tutan bir izlemede öne dönük olarak değerlendirildi. Diyabetes mellitüs'lü (DM) bireylerin tanısı Amerikan Diyabet Cemiyeti kriterlerine göre kondu. Fatal ve fatal olmayan koroner kalp hastalığı (KKH) klinik bulgu ve istirahat elektrokardiyografisinin Minnesota kodlarıyla belirlendi. Abdominal obezite için erkekte ?95 cm, kadında ?91 cm'lik sınırlar uygulandı. Öne dönük değerlendirmelerde, başlangıçtaki DM ve KKH vakaları dışlandı. Bulgular: Nüfusu ?35 yaş olan kesim için %11.0'e karşılık gelen bir DM prevalansı (tahminen 2.89 milyon) saptandı. Ortalama 5.9 yıllık takipte 223 kişide yeni DM gelişmesi karşılığında, 1000 kişi-yılında kadında 11.0, erkekte 12.4'lük bir insidans hesaplandı; bu da ülke bazında yılda 300 bin kişilik insidans ifade eder. Geri kalanlara kıyasla, yeni gelişen diyabetli kişilerde başlangıçtaki HDL-kolesterol benzer olup şu risk değişkenleri anlamlı farklıydı: Yaş (5 yıl), bel çevresi (7 cm), kan basıncı (12/6 mmHg), apolipoprotein B (7 mg/dl), total kolesterol (14 mg/dl), açlık trigliseridleri (yalnız kadında, 52 mg/dl). Diyabetes mellitüs'ün anlamlı bağımsız öngördürücüleri olarak abdominal obezite (RR 2.61 [%95GA 1.87; 3.63]) ile yaş her iki cinsiyette, erkekte ise hipertansiyon (RR 1.81 [%95GA 1.10; 2.98]) ve düşük HDL-kolesterol ortaya çıktı. Cinsiyet, yaş, hipertansiyon, bel çevresi, total kolesterol ve sigara içimi için ayarlandıktan sonra, DM 1.81'lik (%95GA 1.19; 2.75) bir nisbi risk ile fatal ve fatal olmayan KKH'nın anlamlı bağımsız bir öngördürücüsüydü. Sonuçlar: Halkımızda halen 305 bin olan DM insidansı hızla artmakta, prevalansı da benzer şekilde yükselmektedir. Diyabetin kadınlarda esas belirleyicisi abdominal obezite iken, insülin direnci bu bağlamda daha zayıf görünmektedir. Çok değişkenli ayarlamada DM, fatal ve fatal olmayan KKH'nın anlamlı bağımsız öngördürücüsüdür. Bu gözlemler, göbeklilik “salgını”nı durdurucu veya tersine dönüştürücü önlemlere şiddetle ihtiyaç olduğunun altını çizmektedir.
Objectives: To investigate prospectively the incidence, certain predictors and outcomes of type 2 diabetes (DM), as well as to determine its prevalence cross-sectionally, in a representative sample of Turkish men and women. Methods: Prospective evaluation of 3401 male and female participants (aged 48.2 ±12 years). Follow-up constituted 19,050 person-years. Individuals with DM were diagnosed with criteria of the American Diabetes Association. Fatal and nonfatal coronary heart disease (CHD) was identified by clinical findings and Minnesota coding of resting electrocardiograms. Cut-points of ≥95 cm in males and ≥91 cm in females were selected for abdominal obesity. For prospective evaluations, cases with DM or CHD were excluded. Results: Prevalence of DM in Turkish adults was estimated as 2.89 million (11.0% of the population aged ≥35 years). Over a mean follow-up of 5.9 years, incident DM developed in 223 subjects, yielding an incidence per 1000 person-years of 11.0 in women and 12.4 in men. This corresponded to a 300,000 annual incidence. Following risk parameter levels but not HDL-cholesterol were significantly elevated at baseline in subjects developing DM compared to those without: age (5 years), waist girth (7 cm), blood pressure (12/6 mmHg), apolipoprotein B (7 mg/dl), total cholesterol (14 mg/dl), and fasting triglycerides (only in women, 52 mg/dl). Abdominal obesity (RR 2.61 [95%CI 1.87; 3.63]) and age in both genders, hypertension (RR 1.81 [95%CI 1.10; 2.98]) and low HDL-cholesterol in men alone were significant independent predictors of DM. Diabetes mellitus was a significant and independent predictor of fatal and nonfatal CHD, with a RR of 1.81 (95%CI 1.19; 2.75), after adjustment for sex, age, hypertension, waist circumference, serum total cholesterol and smoking status. Conclusions: The annual incidence of DM in Turkey rises very rapidly, currently stands at 300,000, and, hence, its prevalence also rises correspondingly. Insulin resistance appears to be a weak determinant of DM in Turkish women while abdominal obesity is the main determinant. Multivariately adjusted DM is a significant independent predictor of fatal and nonfatal CHD. These observations emphasize that measures to reverse or stop the “epidemic” of abdominal obesity are severely required.
Objectives: To investigate prospectively the incidence, certain predictors and outcomes of type 2 diabetes (DM), as well as to determine its prevalence cross-sectionally, in a representative sample of Turkish men and women. Methods: Prospective evaluation of 3401 male and female participants (aged 48.2 ±12 years). Follow-up constituted 19,050 person-years. Individuals with DM were diagnosed with criteria of the American Diabetes Association. Fatal and nonfatal coronary heart disease (CHD) was identified by clinical findings and Minnesota coding of resting electrocardiograms. Cut-points of ≥95 cm in males and ≥91 cm in females were selected for abdominal obesity. For prospective evaluations, cases with DM or CHD were excluded. Results: Prevalence of DM in Turkish adults was estimated as 2.89 million (11.0% of the population aged ≥35 years). Over a mean follow-up of 5.9 years, incident DM developed in 223 subjects, yielding an incidence per 1000 person-years of 11.0 in women and 12.4 in men. This corresponded to a 300,000 annual incidence. Following risk parameter levels but not HDL-cholesterol were significantly elevated at baseline in subjects developing DM compared to those without: age (5 years), waist girth (7 cm), blood pressure (12/6 mmHg), apolipoprotein B (7 mg/dl), total cholesterol (14 mg/dl), and fasting triglycerides (only in women, 52 mg/dl). Abdominal obesity (RR 2.61 [95%CI 1.87; 3.63]) and age in both genders, hypertension (RR 1.81 [95%CI 1.10; 2.98]) and low HDL-cholesterol in men alone were significant independent predictors of DM. Diabetes mellitus was a significant and independent predictor of fatal and nonfatal CHD, with a RR of 1.81 (95%CI 1.19; 2.75), after adjustment for sex, age, hypertension, waist circumference, serum total cholesterol and smoking status. Conclusions: The annual incidence of DM in Turkey rises very rapidly, currently stands at 300,000, and, hence, its prevalence also rises correspondingly. Insulin resistance appears to be a weak determinant of DM in Turkish women while abdominal obesity is the main determinant. Multivariately adjusted DM is a significant independent predictor of fatal and nonfatal CHD. These observations emphasize that measures to reverse or stop the “epidemic” of abdominal obesity are severely required.
Açıklama
Anahtar Kelimeler
Kalp ve Kalp Damar Sistemi
Kaynak
Anadolu Kardiyoloji Dergisi
WoS Q Değeri
Scopus Q Değeri
N/A
Cilt
6
Sayı
4
