AIMS: to examine the incidence rate of progression to Type 2 diabetes and baseline prognostic risk factors, focusing on hypertension and antihypertensive medication, in a cohort (n=207) with impaired glucose tolerance (IGT). METHODS: after 2 and 4.6 (1. 9-6.4) years new cases of diabetes were diagnosed by the oral glucose tolerance test (OGTT). Hypertension (BP 160/95 or antihypertensive medication) was included in multiple regression analyses to assess the effect of risk factors on the development of diabetes. RESULTS: diabetes developed in 32 subjects (19%), an incidence of 41/1000 (95% CI 28-57/1000) person-years. In univariate analyses, progression to diabetes was associated with a high (>9.0 mmol/l) 2-h OGTT value (P=0.008), a high fasting insulin (>12.0 mU/l) level (P=0.000), a high triglyceride (>/=1.3 mmol/l) level (P=0.028), a high BMI (>/=28.0 kg/m(2)) (P=0.013) and hypertension (P=0.003). The risk for the development of diabetes was not increased in hypertensive subjects without antihypertensive medication compared with normotensive subjects (OR 0.8, 95% CI 0.3-2. 6). However, it was increased in subjects with on medication, especially diuretics alone or in combination with other drugs. Hypertensive subjects on diuretics had higher levels of fasting insulin and triglycerides and higher BMIs at baseline than normotensive subjects. After adjustment for 2-h OGTT, fasting insulin, triglycerides and BMI, the OR for diabetes was 7.7 (95% CI 2.1-28.2) in hypertensive subjects using diuretics alone or in combination with other drugs and 2.6 (95% CI 1.0-6.7) in those using other drugs compared with normotensive subjects. The OR of diabetes corresponding to a one-unit increase in the 2-h OGTT concentration was 2.5 (95% CI 1.6-4.0) in the whole cohort. CONCLUSIONS: the rate of progression from IGT to Type 2 diabetes in this population was similar to that seen in other studies among Caucasian populations. The use of antihypertensive medication, especially diuretics, and a high 2-h OGTT level were significant predictors of subsequent deterioration to diabetes.
The aim of the present study was to evaluate the associations of ultrasonographic manifestations of carotid atherosclerosis with systolic (SBP) and diastolic blood pressure (DBP) and pulse pressure (PP) in 65-year-old Finns drawn from a population-based cohort. Carotid ultrasonographic measurements were performed on 54 diabetic subjects, 97 subjects with impaired glucose tolerance (IGT) and 57 normoglycaemic subjects (NGT). The subjects were classified into four quartiles of SBP, DBP and PP. SBP, DBP, PP and the use of antihypertensive drugs increased along with the deterioration of glucose status. The maximal intima-media thickness (IMT) of the common carotid artery (CCA) from the lowest to the highest quartiles of SBP was 0.98+/-0.34, 1.00+/-0.35, 1.03+/-0.29, 1.18+/- 0.52 mm (P=0.038), respectively. SBP was higher (161+/-22 mmHg) in the subjects with severe intima-media thickening (maximal IMT CCA > or =1.2 mm) than in those with maximal IMT CCA of or =170 mmHg) and 20% in the subjects with lower SBP (P=0.008). In multiple regression analysis, the adjusted OR for severe intima-media thickening was 2.9 (95% CI 1.1-7.9) in the subjects in the highest SBP quartile compared to the subjects with lower SBP. In the present study, high SBP was associated with severe carotid intima-media thickening. We suggest that the results can be generalized to apply to elderly Finnish subjects with DM and IGT, but not to normoglycaemic subjects, on the basis of this study.
Blood pressure and atherosclerotic plaques in carotid, aortic and femoral arteries in elderly Finns with diabetes mellitus or impaired glucose tolerance.
The aim of the study was to evaluate the occurrence of atheromatous plaques in carotid, aortic and femoral arteries, focusing on blood pressure (BP). The study subjects consisted of 65-year-old Finns drawn from a population-based cohort. Ultrasonographic measurements were performed on 54 diabetic subjects, 97 subjects with impaired glucose tolerance (IGT) and 57 normoglycaemic subjects (NGT). High systolic BP (SBP) was defined as >or=160 mmHg and high diastolic BP as >or=95 mmHg. High pulse pressure (PP) was defined as the highest tertile (>or=75 mmHg) of PP and high mean BP (MBP) as the highest tertile (>or=111 mmHg) of MBP. The prevalence of atheromatous plaques was 77% (160/208) in carotid arteries, 94% (195/208) in aorta and 77% (161/208) in femoral arteries. A total of 64% (134/208) of the subjects had plaques in both carotid and femoral arteries, and they were compared with those who had plaques in 0-1 of these arteries. In addition to male gender and long-lasting smoking, the occurrence of plaques in both carotid and femoral arteries were associated with high SBP and high MBP. According to the results of multiple regression analyses, the adjusted odds ratio for plaques in both carotid and femoral arteries was 3.1 (95% CI 1.5-6.5) in subjects with high SBP compared to those with lower SBP. When SBP was replaced by high MBP, the adjusted odds ratio for it was 2.3 (95% CI 1.1-4.8).
The association between insulin resistance (IR) and depression is a subject of growing research interest, especially as previous population-based studies have presented conflicting findings. The present study extends our understanding about the putative impact of the severity of depressive symptoms on this association and it provides further epidemiological evidence in support of earlier findings, suggesting that the association between IR and depression is present already in young adult males. To determine the impact of the severity of depressive symptoms on the putative association between IR and depression in young adult males, we were given access to the Northern Finland 1966 Birth Cohort database. During the 31-year follow-up survey of this genetically homogeneous birth cohort, IR was assessed by 'Qualitative Insulin Sensitivity Check Index' (QUICKI), and severity of depressive symptoms by 'Hopkins' Symptom Checklist-25' (HSCL-25). This study involved 2609 male cohort members with complete variable information. In men, the means of the QUICKI-values decreased (i.e., IR increased) in line with the increased severity of depressive symptoms as assessed by HSCL-25 subgroups (analysis of covariance P-value for trend, P=0.003). In multivariate generalized logistic regression analyses, after adjusting for confounders, IR was positively associated with current severe depressive symptoms, the odds ratio (OR) being over threefold (adjusted OR 3.15, 95% confidence interval 1.48-6.68) and the value of OR increased in parallel with a tighter definition of IR (P-value for trend=0.007). The results indicate that in young males, a positive association exists specifically with severe depressive symptoms.Molecular Psychiatry advance online publication, 9 May 2006; doi:10.1038/sj.mp.4001838.
PURPOSE: To compare local ophthalmic blood flow changes with flow changes in carotid and vertebral arteries in diabetic patients with retinopathy of different grades. MATERIAL AND METHODS: Ten patients with proliferative or preproliferative retinopathy, 10 with mild retinopathy, and 10 matched controls were prospectively studied with ultrasound. Color and duplex Doppler imaging was used to quantitate blood flow in the central retinal arteries (CRA), ophthalmic arteries (OA), common carotid (CCA) and vertebral arteries (VA). Peak systolic velocity (PSV), mean velocity (MV), and resistance index (RI) in CRA, OA, CCA and VA, and volume flow (VF) were measured in CCA and VA. RESULTS: There was a non-significant increase in the CRA and OA velocities in mild retinopathies, a decrease of about 30% in MV, and a slightly increased RI in proliferative or preproliferative retinopathies. There was a decrease of about 15% in the carotid MV and a 20% decrease in the vertebral MV and a decrease of about 30% in VF in the CCA and VA in severe retinopathies. The MV ratio of CRA/CCA was lower in the severe retinopathy group than in the controls. CONCLUSION: The study showed a non-significant increase of ocular blood flow velocities in mild diabetic retinopathy and a significant decrease of flow velocities in severe diabetic retinopathy. This decrease in flow primarily seems to reflect the general decrease of blood flow in the cervical arteries.
OBJECTIVE: The aim of this study was to assess mortality and causes of death in subjects with visual impairment caused by diabetic retinopathy (DR). Only limited data are available concerning the mortality of subjects with DR, and to our knowledge, no data so far have been published on the mortality of subjects with visual impairment caused by DR. RESEARCH DESIGN AND METHODS: We identified 34 men and 73 women living in northern Finland with visual impairment caused by DR on 31 December 1993. The median age of the subjects was 71 years (range 27-88). The mortality of these 107 diabetic subjects was followed up for 4 years, until 31 December 1997, and compared with the mortality rates of 3 age- and sex-matched control groups. The first control group consisted of subjects treated for DR by laser coagulation from 1990 to 1993. The second control group consisted of diabetic subjects who had had fundus photographs taken from 1991 to 1992. The third control group comprised nondiabetic subjects selected from the population register. Information on deaths was obtained from official death certificates. RESULTS: A total of 91 diabetic and 10 nondiabetic subjects died during the follow-up. Of the deaths, 51 occurred in the subjects with visual impairment caused by DR, with a 4-year mortality rate of 477/1,000 (95% CI 382-571/1,000). Mortality rates were 224/1,000 (145-303/1,000) for the diabetic subjects with retinopathy treated by laser coagulation; 150/1,000 (82-217/1,000) for the diabetic subjects who had undergone fundus photography; and 94/1,000 (46-165/1,000) for the nondiabetic subjects. Cardiovascular diseases were the underlying cause of death in 55% of the subjects with visual impairment. Nephropathy was mentioned as the immediate cause of death for only 10% of the subjects. Compared with the nondiabetic control subjects, the odds ratios (ORs) for all-cause mortality were 5.1 (2.6-11) in the diabetic subjects with visual impairment caused by DR, and 5.6 (2.1-19) for mortality caused by diseases of the circulatory system. The ORs for all-cause mortality were 2.4 (1.1-5.6) in the diabetic subjects with retinopathy treated by laser coagulation and 1.6 (0.68-4.0) in the diabetic subjects with fundus photographs taken. CONCLUSIONS: The survival of diabetic subjects with visual impairment caused by DR was poor. The high mortality rate was attributed mainly to cardiovascular diseases. Therefore, severe retinopathy proves to be a risk marker of cardiovascular death in diabetic patients.
In 1990-1992, a population-based study was carried out in the city of Oulu in northern Finland, to assess the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in a middle-aged population. We report the mortality of the study population until 31 December 1998. Altogether 831 subjects (82%) (369 men) participated in the baseline examinations, in which the prognostic risk factors were determined. Special attention was given to the effect of hyperglycemia on mortality. The WHO 1985, ADA 1997 and WHO 1999 criteria for diabetes, IGT and impaired fasting glucose (IFG) were used. Forty-one subjects (32 men) died during the average follow-up of 6.7 years, and the mortality rate was hence 7.7/1000 person-years. The results suggest that both fasting and post-load hyperglycemia are important predictors of mortality. Estimated by the Cox proportional hazards regression, the unadjusted hazard ratio (HR) for death was 2.5 (95% CI 0.9-6.6) in the subjects classified as diabetic according to the WHO 1999 criteria compared to normoglycemic subjects. The corresponding HR of the subjects with IFG was 2.5 (95% CI 0.7-8.8) and that of the subjects with IGT 1.5 (0.6-3.7). In addition, a high mortality was predicted by smoking (HR 4.2, 95% CI 2.0-8.8), male gender (HR 3.5, 95% CI 1.6-7.9) and hypertension (HR 2.3, 95% CI 1.1-5.1).
The aim of the study was to analyse the data obtained from a 2-year follow-up study of middle-aged Finnish subjects (n = 183) with a previous history of impaired glucose tolerance (IGT) in order to elucidate the longitudinal relationships between hypertension, fasting hyperinsulinaemia and obesity. Hypertension was defined as either a systolic blood pressure (BP) of > or =160 mm Hg or a diastolic BP of > or =95 mm Hg or being on anti-hypertensive medication regardless of the BP value. Multiple logistic regression analysis adjusted for glucose tolerance status, serum lipids, exercise behaviour and alcohol consumption shows that the odds ratios of one unit (mU/l) increase in the baseline fasting insulin concentration were 1.13 (95% confidence interval 1.00-1.28) for the 2-year incidence of hypertension in subjects with IGT at baseline. Baseline body mass index (BMI) also predicted the 2-year incidence of hypertension, with an odds ratio of 1.20 (95% CI 1.02-1.42). BMI correlated positively with fasting insulin level (r = 0.54, P
The purpose of the present study was to describe the associations between long-term disorders of musculoskeletal system and work career in elderly workers. The data were obtained by a postal questionnaire and clinical examinations. The study group consisted of 778 elderly urban persons, who were 55 years old and who lived in the city of Oulu in northern Finland. Long-term musculoskeletal disorders were reported by 62% of the women and 57% of the men. The high prevalence of musculoskeletal disorders was significantly associated with heavy physical work. However, job mobility and declining work career were correlated with the occurrence of long-term musculoskeletal disorders in women whereas advanced work career was connected with a low prevalence of long-term musculoskeletal disorders.
The relationships between depression, measured as high rates of depressive symptoms (Zung Self-Rating Depression Scale, ZSDS), and musculoskeletal pains (Kuorinka et al. 1987) were described in a 55-year-old Finnish population consisting of all the 1008 persons born in 1935 and living in the city of Oulu on 1 October 1990. Three hundred forty-five men (76%) and 435 women (79%) participated in the examinations. Of the men 6.8% and of the women 12.1% scored 45 raw sum points or more on the ZSDS. In several anatomical regions, pains were more common among the depressed than the non-depressed population, and many of the depressed persons suffered from multiple pains. One of the most common regions of pain was the neck; during the past 12 months, 56.5% of the depressed men and 65.4% of the depressed women had suffered from frequent pains in the neck. The corresponding prevalences among the non-depressed men and women were 35.2% and 45.5%, respectively. In the non-depressed population, musculoskeletal pains were more common among women than men, whereas no great gender differences existed in the depressed population. The possible confounding variables were standardized in the logistic regression analysis, and the results showed an independent association between pains in the small joints and depression among men, on one hand, and pains in the neck and shoulder and depression among women, on the other hand.
