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Healthy lifestyle behaviours and risk of mortality among adults with and without diabetes in the U.s.
abstract
began at ISSSTE, a social security provider with an affiliation of almost 11 million people with national coverage in Mexico. Multidisciplinary teams were established at each clinic, including general practitioners, nurses, dietitians, psychologists and social workers. Healthcare delivery was improved to reduce waiting times, rotation of staff, and to increase the time for baseline and follow-up visits. Resources were devoted to provide all the clinics with A1c measurements and medications, online continuing education is delivered every month, and an electronic file was created to receive information in real time. results: At the first quarter of 2009, 89 diabetes clinics have been established in every state of the country, in which 7,902 patients are currently treated. Acceptance of the program has been universal, and has led to introduction of additional programs for chronic disease care. Improvements in glycemic control have been documented, with 59.2 percent of the patients achieving A1c levels below 7%. conclusions: Less than two years after its creation, the National Diabetes Program at ISSSTE is the largest in Mexico. Milestones include: 1) real, effective national coverage; 2) multidisciplinary approach; 3) a patient centered approach, active participation of patients and their families; 4) the first national program in Mexico to use A1c measurement as marker of glycemic control; 5) the first electronic chart of diabetes in the country; 6) introduction of self-care diabetes education as an essential component of the program. According to UKPDS estimations, the levels of glycemic control achieved in patients treated at ISSSTE are in concordance with the main objective of the program, i.e. a 20 percent reduction in mortality by 2011.
with and without DM who reported physical activity >= 6 MET per week had a significantly lower mortality rate than those reporting low or sedentary levels [with DM: RH 0.50 (95% CI 0.33, 0.75); without DM: RH 0.65 (95% CI 0.51, 0.82)]. Moderate alcohol comsumption was associated with decreased mortality (RH 0.46, 95%CI 0.23, 0.93) among persons with DM but not among those without DM. Among adults without DM, current smoking was associated with increased mortality (RH 1.81,95% CI 1.47, 2.21) compared to not smoking; higher HEI was associated with lower mortality (RH 0.76, 95% CI 0.65, 0.90) compared to lower HEI. conclusions: Our findings underscore the central role healthy lifestyle behaviors play in preventing premature mortality among people with and without diabetes. Promoting and sustaining such behaviors should continue to be a priority for public health interventions.
National and local plans and initiatives
aims: Single nucleotide polymorphism rs2383206 on 9p21 gene has been previously associated with coronary artery disease (CAD) in the general population and individuals with type 2 diabetes. We thus assessed the relationship between this polymorphism and CAD and mortality in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood onset type 1 diabetes. Methods: EDC participants with DNA available (baseline mean age 27 and duration 19 years) were studied for the incidence of CAD or mortality (n=482). CAD was defined as EDC-physician diagnosed angina, ischemic changes by electrocardiogram, stenosis >50%, revascularization, confirmed myocardial infarction, or CAD death. results: The proportions of the cohort with the rs2383206 AA, AG, and GG genotypes were 26.6%, 45.5%, and 27.9% respectively. During 18 years, there were 132 (29.4%) incident cases of CAD and 81 (16.8%) individuals died. Univariately, the proportion of CAD events was lower in those with the GG compared to those with the AA/ AG genotypes (21.9 vs. 31.9, p=0.04) although no differences were observed for mortality (p=0.89). This inverse relationship with CAD persisted in multivariable Cox models (HR=0.65, 95% CI=0.42-1.02), whereas a non-significant increased risk was seen for mortality (HR=1.45, 95% CI=0.83-2.53). To eliminate survival bias we repeated analyses by baseline diabetes duration (cutoff 25 years) and diagnosis year (cutoff 1962). Results were not altered for CAD but, surprisingly, a non-significant inverse association for GG vs. AA/AG was now observed for mortality in those with a duration >25 years (HR=0.87, 95% CI=0.32-2.36). However, an increased risk was still observed for GG in those with <25 years duration (HR= 1.87, 95% CI=0.94-3.70, p=0.07). Similar trends were observed for analyses by diagnosis year, suggesting that the GG genotype may truly confer susceptibility to early mortality, appearing protective in longer duration individuals. Indeed, the GG genotype was present with a higher frequency in those with <25 years diabetes duration (26.9% vs. 20.9%, p=0.18) or those diagnosed after 1962 (27.7 vs. 20.0, p=0.06). conclusion: These findings suggest that the GG genotype of the rs2383206 polymorphism may increase early mortality risk in type 1 diabetes.
No conflict of interest O-0196 Healthy lifestyle behaviours and risk of mortality among adults with and without diabetes in the U.s. S. Saydah1, K. Bullard2, G. Imperatore2, E. Gregg2 Centers for Disease Control and Prevention, Division of Diabetes Translation, Hyattsville, USA 2 Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, USA
1
aim: Few studies have quantified healthy lifestyle behaviors’ impact on longevity of the diabetic population. We examined the association between healthy behaviors and all-cause mortality among adults with and without diagnosed diabetes (DM). Methods: We used data from the Third National Health and Nutrition Examination Survey, a nationally representative survey of noninstitutionalized U.S. residents, conducted from 1988-1994 with follow-up for mortality status through 2001 (follow-up mean 8.4 years, maximum 13 years). Diabetes status was self-reported (n with diabetes = 1177, n without diabetes = 15217). We examined 5 self-reported healthy behaviors at baseline: physical activity >= 6 MET per week, not smoking, higher healthy eating index (HEI), moderate alcohol consumption (1-2 drinks/week), and maintaining weight or trying to lose weight in the past 12 months. We used proportional hazards models to determine the impact of a composite estimate of healthy behaviors, as well as each healthy behavior, with all-cause mortality, after adjusting for age, sex, race/ethnicity, education, body mass index (BMI), self-reported health status and heart attack history. results: All-cause mortality rate was significantly higher among adults with DM (43.7 per 1000 person years) than adults without DM (9.4 per 1000 person years). A higher summary score of healthy behaviors was associated with lower risk of all-cause mortality among both adults with DM (Relative Hazard (RH) 0.85, 95% Confience Interval (CI) 0.80, 0.91) and without DM (RH 0.83, 95% CI 0.79, 0.86) after controlling for demographics, BMI, self-reported health status and heart attack history. People in the top 20% of healthy behaviors summary score had an adjusted 58% lower mortality rate than those in the bottom 40%. In models with individual healthy behaviors, persons
Complications - cardiovascular disease No conflict of interest O-0197 rs2383206 and its association with mortality in a cohort of individuals with type 1 diabetes T. Costacou1, R.E. Ferrell2, T.J. Orchard1 1 University of Pittsburgh, Department of Epidemiology, Pittsburgh, USA 2 University of Pittsburgh, Department of Human Genetics, Pittsburgh, USA
Complications - cardiovascular disease No conflict of interest
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began at ISSSTE, a social security provider with an affiliation of almost 11 million people with national coverage in Mexico. Multidisciplinary teams were established at each clinic, including general practitioners, nurses, dietitians, psychologists and social workers. Healthcare delivery was improved to reduce waiting times, rotation of staff, and to increase the time for baseline and follow-up visits. Resources were devoted to provide all the clinics with A1c measurements and medications, online continuing education is delivered every month, and an electronic file was created to receive information in real time. results: At the first quarter of 2009, 89 diabetes clinics have been established in every state of the country, in which 7,902 patients are currently treated. Acceptance of the program has been universal, and has led to introduction of additional programs for chronic disease care. Improvements in glycemic control have been documented, with 59.2 percent of the patients achieving A1c levels below 7%. conclusions: Less than two years after its creation, the National Diabetes Program at ISSSTE is the largest in Mexico. Milestones include: 1) real, effective national coverage; 2) multidisciplinary approach; 3) a patient centered approach, active participation of patients and their families; 4) the first national program in Mexico to use A1c measurement as marker of glycemic control; 5) the first electronic chart of diabetes in the country; 6) introduction of self-care diabetes education as an essential component of the program. According to UKPDS estimations, the levels of glycemic control achieved in patients treated at ISSSTE are in concordance with the main objective of the program, i.e. a 20 percent reduction in mortality by 2011.
with and without DM who reported physical activity >= 6 MET per week had a significantly lower mortality rate than those reporting low or sedentary levels [with DM: RH 0.50 (95% CI 0.33, 0.75); without DM: RH 0.65 (95% CI 0.51, 0.82)]. Moderate alcohol comsumption was associated with decreased mortality (RH 0.46, 95%CI 0.23, 0.93) among persons with DM but not among those without DM. Among adults without DM, current smoking was associated with increased mortality (RH 1.81,95% CI 1.47, 2.21) compared to not smoking; higher HEI was associated with lower mortality (RH 0.76, 95% CI 0.65, 0.90) compared to lower HEI. conclusions: Our findings underscore the central role healthy lifestyle behaviors play in preventing premature mortality among people with and without diabetes. Promoting and sustaining such behaviors should continue to be a priority for public health interventions.
National and local plans and initiatives
aims: Single nucleotide polymorphism rs2383206 on 9p21 gene has been previously associated with coronary artery disease (CAD) in the general population and individuals with type 2 diabetes. We thus assessed the relationship between this polymorphism and CAD and mortality in the Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood onset type 1 diabetes. Methods: EDC participants with DNA available (baseline mean age 27 and duration 19 years) were studied for the incidence of CAD or mortality (n=482). CAD was defined as EDC-physician diagnosed angina, ischemic changes by electrocardiogram, stenosis >50%, revascularization, confirmed myocardial infarction, or CAD death. results: The proportions of the cohort with the rs2383206 AA, AG, and GG genotypes were 26.6%, 45.5%, and 27.9% respectively. During 18 years, there were 132 (29.4%) incident cases of CAD and 81 (16.8%) individuals died. Univariately, the proportion of CAD events was lower in those with the GG compared to those with the AA/ AG genotypes (21.9 vs. 31.9, p=0.04) although no differences were observed for mortality (p=0.89). This inverse relationship with CAD persisted in multivariable Cox models (HR=0.65, 95% CI=0.42-1.02), whereas a non-significant increased risk was seen for mortality (HR=1.45, 95% CI=0.83-2.53). To eliminate survival bias we repeated analyses by baseline diabetes duration (cutoff 25 years) and diagnosis year (cutoff 1962). Results were not altered for CAD but, surprisingly, a non-significant inverse association for GG vs. AA/AG was now observed for mortality in those with a duration >25 years (HR=0.87, 95% CI=0.32-2.36). However, an increased risk was still observed for GG in those with <25 years duration (HR= 1.87, 95% CI=0.94-3.70, p=0.07). Similar trends were observed for analyses by diagnosis year, suggesting that the GG genotype may truly confer susceptibility to early mortality, appearing protective in longer duration individuals. Indeed, the GG genotype was present with a higher frequency in those with <25 years diabetes duration (26.9% vs. 20.9%, p=0.18) or those diagnosed after 1962 (27.7 vs. 20.0, p=0.06). conclusion: These findings suggest that the GG genotype of the rs2383206 polymorphism may increase early mortality risk in type 1 diabetes.
No conflict of interest O-0196 Healthy lifestyle behaviours and risk of mortality among adults with and without diabetes in the U.s. S. Saydah1, K. Bullard2, G. Imperatore2, E. Gregg2 Centers for Disease Control and Prevention, Division of Diabetes Translation, Hyattsville, USA 2 Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, USA
1
aim: Few studies have quantified healthy lifestyle behaviors’ impact on longevity of the diabetic population. We examined the association between healthy behaviors and all-cause mortality among adults with and without diagnosed diabetes (DM). Methods: We used data from the Third National Health and Nutrition Examination Survey, a nationally representative survey of noninstitutionalized U.S. residents, conducted from 1988-1994 with follow-up for mortality status through 2001 (follow-up mean 8.4 years, maximum 13 years). Diabetes status was self-reported (n with diabetes = 1177, n without diabetes = 15217). We examined 5 self-reported healthy behaviors at baseline: physical activity >= 6 MET per week, not smoking, higher healthy eating index (HEI), moderate alcohol consumption (1-2 drinks/week), and maintaining weight or trying to lose weight in the past 12 months. We used proportional hazards models to determine the impact of a composite estimate of healthy behaviors, as well as each healthy behavior, with all-cause mortality, after adjusting for age, sex, race/ethnicity, education, body mass index (BMI), self-reported health status and heart attack history. results: All-cause mortality rate was significantly higher among adults with DM (43.7 per 1000 person years) than adults without DM (9.4 per 1000 person years). A higher summary score of healthy behaviors was associated with lower risk of all-cause mortality among both adults with DM (Relative Hazard (RH) 0.85, 95% Confience Interval (CI) 0.80, 0.91) and without DM (RH 0.83, 95% CI 0.79, 0.86) after controlling for demographics, BMI, self-reported health status and heart attack history. People in the top 20% of healthy behaviors summary score had an adjusted 58% lower mortality rate than those in the bottom 40%. In models with individual healthy behaviors, persons
Complications - cardiovascular disease No conflict of interest O-0197 rs2383206 and its association with mortality in a cohort of individuals with type 1 diabetes T. Costacou1, R.E. Ferrell2, T.J. Orchard1 1 University of Pittsburgh, Department of Epidemiology, Pittsburgh, USA 2 University of Pittsburgh, Department of Human Genetics, Pittsburgh, USA
Complications - cardiovascular disease No conflict of interest
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