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A1C variability predicts incident cardiovascular events, microalbuminuria, and overt diabetic nephropathy in patients with type 1 diabetes.

https://arctichealth.org/en/permalink/ahliterature149324
Source
Diabetes. 2009 Nov;58(11):2649-55
Publication Type
Article
Date
Nov-2009
Author
Johan Wadén
Carol Forsblom
Lena M Thorn
Daniel Gordin
Markku Saraheimo
Per-Henrik Groop
Author Affiliation
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland. per-henrik.groop@helsinki.fi
Source
Diabetes. 2009 Nov;58(11):2649-55
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Adult
Albuminuria - epidemiology
Autoanalysis - methods
Biological Markers - blood
Blood pressure
Cardiovascular Diseases - epidemiology - mortality
Diabetes Mellitus, Type 1 - blood
Diabetic Angiopathies - epidemiology - mortality
Diabetic Nephropathies - epidemiology - mortality
Female
Finland - epidemiology
Follow-Up Studies
Glucose - metabolism
Hemoglobin A, Glycosylated - metabolism
Humans
Kidney Failure, Chronic - epidemiology
Lipids - blood
Male
Middle Aged
Patient Selection
Predictive value of tests
Risk factors
Survival Rate
Abstract
Recent data from the Diabetes Control and Complications Trial (DCCT) indicated that A1C variability is associated with the risk of diabetes microvascular complications. However, these results might have been influenced by the interventional study design. Therefore, we investigated the longitudinal associations between A1C variability and diabetes complications in patients with type 1 diabetes in the observational Finnish Diabetic Nephropathy (FinnDiane) Study.
A total of 2,107 patients in the FinnDiane Study had complete data on renal status and serial measurements of A1C from baseline to follow-up (median 5.7 years), and 1,845 patients had similar data on cardiovascular disease (CVD) events. Intrapersonal SD of serially measured A1C was considered a measure of variability.
During follow-up, 10.2% progressed to a higher albuminuria level or to end-stage renal disease, whereas 8.6% had a CVD event. The SD of serial A1C was 1.01 versus 0.75 (P
Notes
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PubMed ID
19651819 View in PubMed
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Cardiovascular morbidity and early mortality cluster in parents of type 1 diabetic patients with diabetic nephropathy.

https://arctichealth.org/en/permalink/ahliterature47857
Source
Diabetes Care. 2000 Jan;23(1):30-3
Publication Type
Article
Date
Jan-2000
Author
L. Tarnow
P. Rossing
F S Nielsen
J A Fagerudd
O. Poirier
H H Parving
Author Affiliation
Steno Diabetes Center, Gentofte, Denmark. lise.tarnow@dadlnet.dk
Source
Diabetes Care. 2000 Jan;23(1):30-3
Date
Jan-2000
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Albuminuria
Cardiovascular Diseases - epidemiology - mortality
Denmark - epidemiology
Diabetes Mellitus, Type 1 - mortality - physiopathology
Diabetic Angiopathies - epidemiology - mortality
Diabetic Nephropathies - epidemiology - mortality - physiopathology
Female
Glomerular Filtration Rate
Humans
Male
Middle Aged
Morbidity
Parents
Prevalence
Survival Rate
Abstract
OBJECTIVE: A familial predisposition was proposed to be a determinant of the increased morbidity and mortality from cardiovascular disease in type 1 diabetic patients with diabetic nephropathy. The insertion allele of an insertion/deletion polymorphism in the ACE (ACE/ID) gene seems to protect against coronary heart disease in nondiabetic and diabetic subjects. The aim of the present study was to evaluate these hypotheses in parents of a large group of type 1 diabetic patients with and without diabetic nephropathy. RESEARCH DESIGN AND METHODS: We investigated cardiovascular morbidity and mortality of parents of 163 type 1 diabetic patients with nephropathy and parents of 163 sex- and age-matched normoalbuminuric patients with type 1 diabetes. RESULTS: Kaplan-Meier curves showed that total parental mortality was significantly increased in parents of type 1 diabetic patients with nephropathy (121 of 244 [ approximately 50%] ) as compared with parents of normoalbuminuric type 1 diabetic patients (119 of 269 [approximately 44%]) (P = 0.008 [log-rank test]) partially due to an increase in cardiovascular deaths (48 of 244 [approximately 20%] vs. 42 of 269 [approximately 16%], P
PubMed ID
10857964 View in PubMed
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Declining incidence of severe retinopathy and persisting decrease of nephropathy in an unselected population of Type 1 diabetes-the Linköping Diabetes Complications Study.

https://arctichealth.org/en/permalink/ahliterature30241
Source
Diabetologia. 2004 Jul;47(7):1266-72
Publication Type
Article
Date
Jul-2004
Author
M. Nordwall
M. Bojestig
H J Arnqvist
J. Ludvigsson
Author Affiliation
Division of Paediatrics and Diabetes Research Centre, Department of Molecular and Clinical Medicine, University Hospital, Linköping, Sweden. Maria.Nordwall@lio.se
Source
Diabetologia. 2004 Jul;47(7):1266-72
Date
Jul-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Age of Onset
Child
Cohort Studies
Diabetes Mellitus, Type 1 - epidemiology - physiopathology
Diabetic Nephropathies - epidemiology - mortality - prevention & control
Diabetic Retinopathy - epidemiology - mortality - prevention & control
Female
Humans
Incidence
Male
Puberty
Research Support, Non-U.S. Gov't
Survival Analysis
Sweden - epidemiology
Abstract
AIMS/HYPOTHESIS: In a previous study conducted over the last decades we found a decreased incidence of nephropathy but unchanged incidence of severe retinopathy among patients with Type 1 diabetes diagnosed in childhood and with 20 years duration of diabetes. The aim of our current study was to investigate the incidence 5 to 10 years later in the same population. METHODS: We studied all 269 patients in whom Type 1 diabetes was diagnosed in childhood between 1961 and 1985 in a district in southeastern Sweden. Ninety-one percent were monitored for retinopathy until at least 1997 and 95% were monitored for nephropathy. Severe retinopathy was defined as laser-treated retinopathy and nephropathy as persistent proteinuria. Survival analysis was used and the patients divided into five cohorts according to the time of onset of diabetes. RESULTS: The cumulative proportion of severe retinopathy had declined ( p=0.006). After 25 years it was 47% (95% CI 34-61), 28% (15-40) and 24% (12-36) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years it was 53% (40-66) and 44% (28-59) in the oldest cohorts. The cumulative proportion of nephropathy after 25 years duration was 30% (18-42), 8% (1-16) and 13% (4-23) in the cohorts 1961 to 1965, 1966 to 1970 and 1971 to 1975 respectively. After 30 years, it was 32% (20-44) and 11% (2-20) for the oldest cohorts ( p
PubMed ID
15235773 View in PubMed
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Diabetic nephropathy in Type 1 (insulin-dependent) diabetes: an epidemiological study.

https://arctichealth.org/en/permalink/ahliterature48904
Source
Diabetologia. 1983 Dec;25(6):496-501
Publication Type
Article
Date
Dec-1983
Author
A R Andersen
J S Christiansen
J K Andersen
S. Kreiner
T. Deckert
Source
Diabetologia. 1983 Dec;25(6):496-501
Date
Dec-1983
Language
English
Publication Type
Article
Keywords
Age Factors
Denmark
Diabetes Mellitus, Type 1 - drug therapy - physiopathology
Diabetic Nephropathies - epidemiology - mortality
Female
Follow-Up Studies
Humans
Insulin - administration & dosage
Male
Proteinuria - epidemiology
Research Support, Non-U.S. Gov't
Sex Factors
Time Factors
Abstract
A follow-up of 1475 Type 1 (insulin-dependent) diabetic patients diagnosed before 1953 (815 males, 660 females) and before the age of 31 years was conducted. All patients were seen at the Steno Memorial Hospital and were referred from all parts of Denmark; 91 (6%) could not be traced. The rest (94%) were followed until death or for at least 25 years; 249 (17%) were followed for greater than 40 years. Clinical diabetic nephropathy developed in 531 (41%) of the 1303 patients in whom sufficient information was available regarding proteinuria. Other causes of proteinuria were found in 3%, and 57% did not develop persistent proteinuria. The prevalence of diabetic nephropathy was 21% after 20-25 years of diabetes duration followed by a decline to 10% after 40 years. Two incidence peaks of the onset of proteinuria were seen, one after 16 and another after 32 years duration of diabetes and was low after 35 years duration. The cumulative incidence was 45% after 40 years of diabetes. A male preponderance was seen among patients with nephropathy. A significant difference in the pattern of annual incidence rates of diabetic nephropathy was seen, when groups with onset of diabetes before 1933, between 1933-1942, and 1943-1952, respectively, were compared. An association between daily insulin requirement and nephropathy incidence was found. Patients with nephropathy had a much poorer survival than those without proteinuria; 40 years after onset of diabetes, only 10% of patients who developed nephropathy were alive, whereas greater than 70% of patients who did not develop nephropathy survived.(ABSTRACT TRUNCATED AT 250 WORDS)
PubMed ID
6363177 View in PubMed
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Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes mellitus: a competing-risks analysis.

https://arctichealth.org/en/permalink/ahliterature105878
Source
CMAJ. 2014 Feb 4;186(2):103-9
Publication Type
Article
Date
Feb-4-2014
Author
Ying Jiang
Nathaniel Osgood
Hyun-Ja Lim
Mary Rose Stang
Roland Dyck
Source
CMAJ. 2014 Feb 4;186(2):103-9
Date
Feb-4-2014
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Cost of Illness
Diabetes Mellitus - epidemiology - mortality
Diabetic Nephropathies - epidemiology - mortality
Female
Health Status Disparities
Humans
Indians, North American
Kidney Failure, Chronic - epidemiology - mortality
Male
Middle Aged
Retrospective Studies
Risk assessment
Saskatchewan
Abstract
Diabetes-related end-stage renal disease disproportionately affects indigenous peoples. We explored the role of differential mortality in this disparity.
In this retrospective cohort study, we examined the competing risks of end-stage renal disease and death without end-stage renal disease among Saskatchewan adults with diabetes mellitus, both First Nations and non-First Nations, from 1980 to 2005. Using administrative databases of the Saskatchewan Ministry of Health, we developed Fine and Gray subdistribution hazards models and cumulative incidence functions.
Of the 90 429 incident cases of diabetes, 8254 (8.9%) occurred among First Nations adults and 82,175 (90.9%) among non-First Nations adults. Mean age at the time that diabetes was diagnosed was 47.2 and 61.6 years, respectively (p
Notes
Cites: BMC Med Res Methodol. 2010;10:9720964855
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Comment In: CMAJ. 2014 Feb 4;186(2):93-424295866
PubMed ID
24295857 View in PubMed
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Excess Mortality in Patients With Type 1 Diabetes Without Albuminuria-Separating the Contribution of Early and Late Risks.

https://arctichealth.org/en/permalink/ahliterature293024
Source
Diabetes Care. 2018 04; 41(4):748-754
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
04-2018
Author
Per-Henrik Groop
Merlin Thomas
Maija Feodoroff
Carol Forsblom
Valma Harjutsalo
Author Affiliation
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland per-henrik.groop@helsinki.fi.
Source
Diabetes Care. 2018 04; 41(4):748-754
Date
04-2018
Language
English
Geographic Location
Finland
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Age of Onset
Albuminuria - epidemiology - mortality
Case-Control Studies
Child
Child, Preschool
Diabetes Mellitus, Type 1 - complications - mortality
Diabetic Nephropathies - epidemiology - mortality
Female
Finland - epidemiology
Humans
Male
Middle Aged
Myocardial Ischemia - complications - epidemiology
Risk factors
Young Adult
Abstract
The current study investigated whether the risk of mortality in patients with type 1 diabetes without any signs of albuminuria is different than in the general population and matched control subjects without diabetes.
We studied a nationwide, population-based Finnish register of 10,737 patients diagnosed with type 1 diabetes during 1980-2005 and followed for 10 years and 2,544 adults with long-standing diabetes drawn from the Finnish Diabetic Nephropathy Study (FinnDiane). Mortality was compared with the general Finnish population and 6,655 control subjects without diabetes.
The standardized mortality ratio (SMR) was increased during the first 10 years after the diagnosis (2.58 [95% CI 2.07-3.18], P
Notes
CommentIn: Diabetes Care. 2018 Apr;41(4):662-663 PMID 29559452
PubMed ID
29378776 View in PubMed
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Renal replacement therapy in patients with diabetic nephropathy, 1980-1985. Report from the European Dialysis and Transplant Association Registry.

https://arctichealth.org/en/permalink/ahliterature25994
Source
Nephrol Dial Transplant. 1988;3(5):585-95
Publication Type
Article
Date
1988
Author
F P Brunner
H. Brynger
S. Challah
W. Fassbinder
W. Geerlings
N H Selwood
G. Tufveson
A J Wing
Author Affiliation
European Dialysis and Transplant Association Registry, St Thomas's Hospital London, UK.
Source
Nephrol Dial Transplant. 1988;3(5):585-95
Date
1988
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Cohort Studies
Diabetic Nephropathies - epidemiology - mortality - therapy
Europe
Hemofiltration
Humans
Kidney Failure, Chronic - epidemiology - mortality - therapy
Kidney Transplantation
Middle Aged
Peritoneal dialysis
Registries
Renal Dialysis
Research Support, Non-U.S. Gov't
Retrospective Studies
Societies, Medical
Abstract
Diabetic nephropathy, a rarely listed cause of end-stage renal failure (ESRF) among patients starting renal replacement therapy (RRT) in the early seventies, has progressively gained in importance and become one of the major reasons for the continuous growth of the patient population on RRT in most European countries. Amongst new patients commencing RRT in 1985, the acceptance rate varied between 3 and 12 per million population for type I diabetes mellitus and between one and four per million population for type II diabetes mellitus. Nordic countries, particularly Sweden and Finland, had the highest acceptance rate of young patients with type I diabetes mellitus whose median ages were 38-42 years. In most central and southern European countries the median age of patients with type I diabetes mellitus varied between 50 and 58 years. The high number of young patients with type I diabetes mellitus and ESRF in Nordic countries point to a different natural history of this disease. It cannot be excluded, however, that the higher median age in other countries might result from doctors mistakenly diagnosing type I disease in patients with type II disease who need insulin treatment. Patients with type II diabetes mellitus had a similar age distribution at start of RRT throughout Europe and their median ages clustered around 60 years in most countries. The contribution of haemodialysis, peritoneal dialysis and renal transplantation was analysed for diabetic compared to non-diabetic ESRF. Despite large geographical differences in the proportional use of methods of treatment, a general trend to apply CAPD more frequently in diabetic as compared to non-diabetic patients was observed, and this was true for countries with both predominant haemodialysis and predominant transplant programmes. Transplantation without prior dialysis was performed in 17% of Swedish and 30% of Norwegian patients with type I diabetes mellitus. In order to better explain the mortality of patients with diabetic ESRF, the proportional distribution of causes of death was analysed. Myocardial ischaemia and infarction was confirmed to be the leading cause of death in patients with diabetes mellitus on RRT. The coronary death rate was estimated to be 10 times greater in young patients with type I diabetes mellitus as compared to their non-diabetic counterparts. Other cardiovascular as well as infectious causes were recorded in a similar proportion of deaths in diabetics as in non-diabetics. Cancer deaths, however, appeared to be definitely less frequent in patients on RRT due to diabetic nephropathy.
PubMed ID
3146713 View in PubMed
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Results from the Canadian Renal Failure Registry.

https://arctichealth.org/en/permalink/ahliterature229165
Source
Am J Kidney Dis. 1990 May;15(5):397-401
Publication Type
Article
Date
May-1990
Author
G A Posen
J R Jeffery
S S Fenton
G S Arbus
Author Affiliation
Division of Nephrology, Ottawa Civic Hospital, Canada.
Source
Am J Kidney Dis. 1990 May;15(5):397-401
Date
May-1990
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Canada
Child
Child, Preschool
Diabetic Nephropathies - epidemiology - mortality - therapy
Female
Humans
Infant
Infant, Newborn
Kidney Failure, Chronic - epidemiology - mortality - therapy
Kidney Transplantation - mortality
Male
Middle Aged
Peritoneal Dialysis - mortality
Prevalence
Registries - standards
Renal Dialysis - mortality
Sex Factors
Abstract
This report encompasses data collected from all Canadian patients starting treatment for end-stage renal failure (ESRF) from 1981 until the end of 1987. Gross mortality showed an initial decline, but has stabilized since 1985. The year of entry into the system did not change the survival rate. There was an increase in the rate of acceptance of new patients between 1982 and 1987. The largest increases were in the older age groups, and resulted in a concomitant increase in the number of registered patients in older age groups. Survival on dialysis by age group declined with age. There was no difference in patient survival on hemodialysis or peritoneal dialysis. The probability of death for all patients entering the ESRF system remained constant notwithstanding year of entry into the system. It was slightly higher for males than females, much higher for patients with diabetes or renal vascular disease, higher with age, and much higher for patients not undergoing transplant.
PubMed ID
2333861 View in PubMed
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Trends in the epidemiology of IDDM during 1970-2020 in Fyn County, Denmark.

https://arctichealth.org/en/permalink/ahliterature34703
Source
Diabetes Care. 1996 Aug;19(8):801-6
Publication Type
Article
Date
Aug-1996
Author
A. Green
A K Sjølie
O. Eshøj
Author Affiliation
Genetic Epidemiology Research Unit, Odense University Hospital, Denmark.
Source
Diabetes Care. 1996 Aug;19(8):801-6
Date
Aug-1996
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Blindness - epidemiology - mortality
Child
Child, Preschool
Denmark - epidemiology
Diabetes Mellitus, Type 1 - epidemiology - mortality
Diabetic Nephropathies - epidemiology - mortality
Diabetic Retinopathy - epidemiology - mortality
Forecasting
Humans
Infant
Models, Theoretical
Prevalence
Abstract
OBJECTIVE: To present an epidemiological model applicable to diabetes based on which prevalence rates are estimated from assumed rates of incidence and mortality of diabetes. Furthermore, this study illustrates the model by analyzing epidemiological data on IDDM in a Danish population during 1970-1990, with predictions of prevalence rates for 1990-2020. RESEARCH DESIGN AND METHODS: The epidemiological model assumes known prevalence rates as well as incidence rates and mortality at a given time. Under assumed rates of incidence and mortality of IDDM and its complications, the prevalence rate is the dependent variable, estimated as a function of calendar time. We use epidemiological data on IDDM (operationally defined as insulin-treated diabetes with onset before age 30 years), blindness, and nephropathy, as well as mortality, as reported for 1973 and 1987 in Fyn County, Denmark. RESULTS: During 1970-1990, the prevalence of IDDM increased steadily because of increasing incidence and decreasing risk of complications and mortality. The relative prevalence of patients with nephropathy increased, whereas that of blind patients decreased considerably. Under specified assumptions regarding the future levels of incidence of disease, complications, and mortality, it is estimated that the prevalence rate of IDDM in the year 2020 will be 45-60% higher than the level in the year 1990. The relative prevalence of patients with nephropathy will increase further, whereas the relative prevalence of blind patients will remain constant at a low level. CONCLUSIONS: IDDM will represent an increasing public health problem in Denmark during the next decades, with increasing overall prevalence rates and a rising proportion of patients with nephropathy. The major determinant of this trend is increasing incidence combined with declining mortality and declining risk of complications. It is strongly recommended that epidemiological models like the one presented here be further developed and implemented at regional levels to provide data for the dimensioning of the current and future diabetes care systems.
PubMed ID
8842594 View in PubMed
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9 records – page 1 of 1.