- Email: [email protected]
Risk profile of Tehran inhabitants: Interim report from Tehran lipid and glucose study (TLGS)
Track 3. Diabetes
impaired fasting glucose (IFG). In the analysis of data in men with NG vs. IGT the following features were selected: free fatty acids 30’ in OGTT, C-peptide 120 in OGTT, the maximal carotid intima-media thickness and plasma glucose area under the curve (AUC) 30’ to 120’ in GGTT; for women - fasting free fatty acids, C-peptide 120’ in OG’IT, alcohol consumption and plasma glucose AUC 30’ to 120’ in OG’IT. The results found by means of interactive visualisation and analysis could be regarded as a modem and interesting complement to the hitherto existing knowledge. In future these new methods might be applied to other questions in medicine. In 4 months we will be able to validate the predictive power of our model with the follow-up results of the RIAD study.
P13% Apolipoprotein E Polymorphism as a Cardiovascular Risk Factor in First-Degree Relatives of Diabetic Patients: The Ranch0 Rernardo Study, 1984-1987 JEE-YOUNG OH, Denise G. VonMuhlen, Elizabeth Barrett-Connor. Family and Preventitive Medicine, University San Diego, CA, United States of America
ofCalifornia,San
Diego,
Cardiovascular disease and type 2 diabetes mellitus (DM) are leading causes of death in Western countries. Apolipoprotein (apo) E polymorphism is related to lipoprotein metabolism and cardiovascular disease. To evaluate the role of apoE polymorphism as a cardiovascular risk factor in first-degree relatives of diabetic patients, we cross-sectionally compared 199 first-degree relatives (relatives, mean age 67yr, M/F 75/124), to 1098 individuals without a family history of diabetes (controls, mean age 7Oyr, M/F 458/m), all of whom had no past history of diabetes. Although the mean age of relatives was significantly lower (pdO.01) than controls, the prevalence of newly diagnosed type 2 DM was significantly higher (13.6% vs 9.1%. ~~0.05). Genotypic distribution of apoE was not significantly different in both groups. We compared cardiovascular risk factors according to apoE4+ (E3/4, E4/4, E2/4) and non-apoE4+ (E2/3, E3/3), and found that among relatives, low density lipoprotein cholesterol (LDL-C) was significantly higher in the apoE+t+ group compared to non-apoE4+ group (pt0.05, Table 1). In apoE4+ controls, total cholesterol (TC) and LDL-C were significantly higher than non-apoE4+ group (pt0.05, Table 1). After adjustment for age, body mass index, smoking, medication histories of estrogen, antihypertensives and diuretics, apoE genotype was significantly associated with increased LDL-C and TC/HDL-C ratio in relatives (~~0.05). Among controls, apoE genotype was significantly associated with increased TC, LDL-C and TC/HDL-C ratio (p
Age (yea) TC(mmoU1) LDLC(mmolA) *p
C0ntKh
apoEa+ (G49)
non-apoEa+ (Wl50)
vc1+ (n=278)
67.8f8.5 6.1zkl.O 3.9*1.0*
67.4zk9.0 5.8fl.l
69.3SJ.9 5.9*1.0* 3.7zkO.9’
3.5fl.O
ll0E+E4+ (n=820) 69.5k9.2 5.7il.l 3.5zto.9
“S non-apoE4+.
These results suggest that apoE polymorphism is associated with dyslipidemia, but not a major genetic factor of type 2 DM in first-degree relatives of diabetic patients.
s353
in Society
P1397 Unique Susceptibility of a Unique Population: A Dramatic Increase in the Frequency of ‘Ijpe I and Qpe II Diabetes in Yemenite Jews in Israel PNINA VARDI’, Elliot Sprecher’, Shosh Israel*, Chaim Brautbar’, Ran Avidan3, Konstantin Bloch t, Michael Weingarten3. ‘Diabetes, Haifa County, FMRC, Tel-Aviv University, Tel Aviv, Israel; ’ lissue Typing Unit, Hadassah, Hebrew University Jerusalem, Israel: 3 Dept. Family Medicine, Rabin Medical Center; Tel-Aviv University, Tel-Aviv, Israel
In most populations, no association has been found between changes in frequency of type I and type II diabetes. However, in the Yemenite Jews in Israel, unique and dramatic corresponding changes occurred in both, as estimated by type II prevalence and type I incidence, over fifty years following immigration to Israel in 1951; type I incidence (age < 18yrs.) rose from near 0 to 18.5/100,000 (others 7.7/100,000), and type II prevalence (age >30yrs.) from 0.05% to 13% (others 6%). reaching 30% over the age of 65yrs. The aim of the present study is to examine the nature of these changes, and to suggest a common underlying cause for development of both diseases. Methods Historical medical details in Yemen and Israel were obtained during structured interviews with 196 elders of the community and from documented observations. In addition, molecular HLA typing of both type I (n=52), type II (n=120) diabetic patients, and 78 controls were performed. Correspondence analysis of HLA typing of Yemenite Jews and other distinct Israeli ethnic populations was performed in order to investigate unique and distinguishing genetic backgrounds of the groups. Results The interviews supported the rarity of diabetes, and commonplace infant exposure to cow’s milk in Yemen. Over the last fifty years the Yemenites experienced a near 90% increase in BMI, compared to only about 15% in other ethnic groups. Molecular HLA typing showed an exceptionally high odds ratio (OR=140) for the DRB1*0301 l,DQA1*05, DQB1*02/JXB1*0402,DQA1*03 genotype in type I diabetic patients, with no such association in type II disease. Correspondence analysis of HLA genotyping, in particular of DRBl, disclosed the distinctiveness of the Yemenite genetic profiles. Conclusion A possible explanation for the dramatic parallel increase in the frequencies of type I and II diabetes among Yemenite Jews is that shared non-HLA diabetogenic genes, characteristic of this group, are triggered by the dramatic increase in BMI, leading to development of diabetes.
P1398 Risk Profile of Tehran Inhabitants: Interim Report Lipid and Glucose Study(TLGS) PARVIN MIRMIRAN, Maziar Rahmani, Mohammad Sima Allahverdian, Habib Emami, Arash Ghanbarian, Fereidoun A&i. Endocrine Research Center, Tehran,
from Tehran Madjid, Rambod Hajipour, Iran (Islamic
Republic Of) TLGS is a prospective study on a random sample of urban inhabitants of Tehran. In the baseline examination, 17000 male and female subjects aged 3-69 yrs would be evaluated for coronary artery disease and its major risk factors with emphasis on diabetes mellitus and dyslipidemia. A standard questionnaire is filled, followed by physical examination, FBS, 2-hr pp BS, and serum lipid determinations. So far 11198 individuals, [4757 (43%) male and 6441 (57%) female] have been evaluated. 24-hr dietary recall and food frequency have been collected in 1047 people and energy intake (EI) to basal metabolic rate (BMR) ratio was calculated. Standard protocols have been used for all measurements and comprehensive quality assurance system has been employed. Mean BMI in individuals over 20 yr was 25.7f4.1 for men, and 27.5f7.8 kg/m* for women (Pt0.001). In adults, overweight (BMI; 25-29.9 kg/m*) and obesity (BMI>30 kg/m*) were 42% and 15% in men and 38% and 30% in women respectively. According to WHO criteria, obesity was observed in 17% of people under 20 yr. Prevalence of known, newly diagnosed diabetes according to WHO and ADA criteria, IGT, and IFG
s354
Poster Session 2
were 3.8, 5.1, 6.1, 13.2, and 4.9% respectively. Twenty six, 29, and 18% of population z 20 yr had TC 1240 mg/dl, TGs 1200 mg/dl, LDL-C ~160 mg/dl, and 19% decreased HDL-C (~35 mg/dl). In population ~20 yr; 16.2, 6, 12.9, and 13.6% had TC 2200 mg/dl, TGs ~200 mg/dl, LDL-C ? 130 mg/dl, and HDL-C 135 mg/dl. Forty percent of individuals 220 yr exceeded 30% of total energy derived from fat and 18% of study population consumed more than 300 mg/day cholesterol. EYBMR ratio was cl.27 in 35% of women indicating underre.porting.Only 25% of adults(22% of men and 27% of women, P
P1399 Foot Onychomycosis with Diabetic Patients a Prospective Study on 60 Cases ZINEB SLAOUI. Endocrinology, University Hospital of IBN ROCHD, Casablanca, Morocco, Morocco
The Onychomycosis of toe-nails of diabetic patients is a risk factor for foot lesions in particular when it is associated with a peripheric sensitive neuropathy. The authors give the preliminary results of a prospective study done on 60 diabetic patients. The aim is to study the frequency and the type of foot onychomycosis of diabetic patients and establish a correlation with the presence of a peripheric sensitive neuropathy and the unexpected occurrence of foot lesions. The preliminary results about 40 patients show that they are about 30 women (75%) and 10 men (25%). The age of these patients varies between 16 and 80 years with a medium age of 50 years. The diabetes is of type II in 28 cases (70%) and of type 1 in 12 cases (30%). The mean age of diabetes is 7.7 years with extremes of 1 month and 20 years. The mycological removal of samples was done at the level of one of the nails affected by onychomycosis (70%). In case of absence of apparent lesions, the sample removal was systematically done at the level of the major toe (30%). The mythological study has been positive in 9 cases (22,5%). In 8 cases, the removed toe was affected. The isolated fungus was candida Albican in 7 cases out of 9, tnychophyton nubrum in one case and interdigital tnychophyton in one case. The comparison between the subjects having onychonycosis and sound patients has shown a significant difference in the frequency of peripheric sensitive neuropathy 77% Vs 35% (P
P1400 “Highest” International Prevalence of Incipient Diabetic Nephropathy (IDN) in Asian Indians with NIDDM: Genetic Predisposition Versus Social Deficiencies in Diabetes Care? S.S. SRIKANTA, S.R. Krishnaiengar, S. Suma, J. Hegde, N.C. Basavaraju, D.V. Rama, M.A. Srilakshmi, S. Joshi, A.S. Vinaya, G.S. Narayan, U. Dayashankar, B.S. Sudha, A.H. Mamatha, G. Raja, T. Kalpana, N. Sumithra, N. Ishrath, J. Srikanth, L. Punitha, C.G. Sreelatha, B.A. Mahesh, A. Sharda. A recent medline search confirmed our earlier clinical data (urinary albumin excretion [UAE] measured by immunoturbidometry, analysed at the time of initial referral to our speciality diabetes center), and literature review, that perhaps Asian Indians have the “highest” international preva-
lence of diabetic nephropathy, Representative examples: Country(year)
IDN%
lndia(l996) SAM I India( 1998) SAM n
68 42
UK Asian Indians(l998) UK Africans( 1998) UK Europeans( 1998)
40 36 28
both incipient (IDN) and overt (ODN).
Country (year)
IDN%
USA Pima Indians( 1995) USA Africms(l995) Nigeria(l992)
38 24
Korea( 1995) Gfmnany( 1995)
20 27
56
Between the Samatvam (SAM) I and II studies, there was a decline in the prevalence of IDN from 68% to 42% (from 1996 to 1998; possibly reflecting improved general physician awareness and diabetes care in the community, prior to speciality referral). In the SAM II study, prevalence of IDN and ODN was 42% and 12%. IDN and ODN were significantly associated with progressively increasing diabetes duration (p=O.O00017), systolic/diastolic blood pressure (p=O.OOOOO8/O.OM!04), total cholesterol (p=O.OOl) and triglycerides (p=O.OOl). Peripheral vascular disease (microalbuminuria mg/24hr; p value) (259; p= 0.003). loss of protective sensation (294; p=O.O2), and diabetic retinopathy: nonproliferative/proliferative (163/719; p=0.000008) were associated with significantly elevated UAE. Conclusions: Factors contributing to higher prevalence of DN in Asian Indians could include: (a) greater insulin resistance, hyperinsulinemia, hypertension etc (“syndrome x”), and (b) social deficiencies in comprehensive diabetes care (glycemic and BP control).
P1401 The Effect of Diabetes on Mortality in Patients with Established Atherothrombosis KRISTEN MIGLIACCIO-WALLE, Khajak J. Ishak, J. Jaime Care. For the CAPRA Study Group: Car0 Research, Concord, MA, United States of America Purpose:
To evaluate the additional burden of diabetes among patients diagnosed with atherothrombotic disease in actual practice. Methods: The impact of diabetes was examined using actual practice data on 50,734 residents of Saskatchewan, Canada diagnosed with a myocardial infarction (MI) or ischemic stroke between 1990-1995 or with peripheral arterial disease (PAD) between 1985-1995. Health care records provided data on patient characteristics and diabetes history back to January, 1980 and follow-up was available to March, 1998. Kaplan-Meier survival curves were estimated and Cox proportional hazards analyses were conducted to examine the effect of diabetes on survival controlling for other factors. Results: Patients were evenly distributed across diagnoses: 15,590 (31%) MI, 18,704 (37%) stroke, and 16,440 (32%) PAD. About half (55%) of patients were male, the majority (73%) were over 65 years of age at diagnosis and almost a quarter (22%) had a history of diabetes. Within 30 days of diagnosis, 0.3% of PAD patients, 1.I% with stroke and 6.4% with MI had died. Diabetes increased the risk of death, regardless of proximity to diagnosis, by 40%, 21%. and 37% in PAD, stroke and MI patients, respectively. Conclusions: Diabetes significantly increases the risk of death in patients with atherothrombosis. The impact of diabetes on survival is much greater in patients with PAD.
P1402 The Central Fat Distribution and Non Insulin Dependent Diabetes Mellitus in Urban Population of Astana ANNA V. BAZAROVA, Olga V. Uljanova. Introduction: There are no epidemiological data on the correlation of non-insulin dependent diabetes mellitus (NIDDM) and type of fat distr-
impaired fasting glucose (IFG). In the analysis of data in men with NG vs. IGT the following features were selected: free fatty acids 30’ in OGTT, C-peptide 120 in OGTT, the maximal carotid intima-media thickness and plasma glucose area under the curve (AUC) 30’ to 120’ in GGTT; for women - fasting free fatty acids, C-peptide 120’ in OG’IT, alcohol consumption and plasma glucose AUC 30’ to 120’ in OG’IT. The results found by means of interactive visualisation and analysis could be regarded as a modem and interesting complement to the hitherto existing knowledge. In future these new methods might be applied to other questions in medicine. In 4 months we will be able to validate the predictive power of our model with the follow-up results of the RIAD study.
P13% Apolipoprotein E Polymorphism as a Cardiovascular Risk Factor in First-Degree Relatives of Diabetic Patients: The Ranch0 Rernardo Study, 1984-1987 JEE-YOUNG OH, Denise G. VonMuhlen, Elizabeth Barrett-Connor. Family and Preventitive Medicine, University San Diego, CA, United States of America
ofCalifornia,San
Diego,
Cardiovascular disease and type 2 diabetes mellitus (DM) are leading causes of death in Western countries. Apolipoprotein (apo) E polymorphism is related to lipoprotein metabolism and cardiovascular disease. To evaluate the role of apoE polymorphism as a cardiovascular risk factor in first-degree relatives of diabetic patients, we cross-sectionally compared 199 first-degree relatives (relatives, mean age 67yr, M/F 75/124), to 1098 individuals without a family history of diabetes (controls, mean age 7Oyr, M/F 458/m), all of whom had no past history of diabetes. Although the mean age of relatives was significantly lower (pdO.01) than controls, the prevalence of newly diagnosed type 2 DM was significantly higher (13.6% vs 9.1%. ~~0.05). Genotypic distribution of apoE was not significantly different in both groups. We compared cardiovascular risk factors according to apoE4+ (E3/4, E4/4, E2/4) and non-apoE4+ (E2/3, E3/3), and found that among relatives, low density lipoprotein cholesterol (LDL-C) was significantly higher in the apoE+t+ group compared to non-apoE4+ group (pt0.05, Table 1). In apoE4+ controls, total cholesterol (TC) and LDL-C were significantly higher than non-apoE4+ group (pt0.05, Table 1). After adjustment for age, body mass index, smoking, medication histories of estrogen, antihypertensives and diuretics, apoE genotype was significantly associated with increased LDL-C and TC/HDL-C ratio in relatives (~~0.05). Among controls, apoE genotype was significantly associated with increased TC, LDL-C and TC/HDL-C ratio (p
Age (yea) TC(mmoU1) LDLC(mmolA) *p
C0ntKh
apoEa+ (G49)
non-apoEa+ (Wl50)
vc1+ (n=278)
67.8f8.5 6.1zkl.O 3.9*1.0*
67.4zk9.0 5.8fl.l
69.3SJ.9 5.9*1.0* 3.7zkO.9’
3.5fl.O
ll0E+E4+ (n=820) 69.5k9.2 5.7il.l 3.5zto.9
“S non-apoE4+.
These results suggest that apoE polymorphism is associated with dyslipidemia, but not a major genetic factor of type 2 DM in first-degree relatives of diabetic patients.
s353
in Society
P1397 Unique Susceptibility of a Unique Population: A Dramatic Increase in the Frequency of ‘Ijpe I and Qpe II Diabetes in Yemenite Jews in Israel PNINA VARDI’, Elliot Sprecher’, Shosh Israel*, Chaim Brautbar’, Ran Avidan3, Konstantin Bloch t, Michael Weingarten3. ‘Diabetes, Haifa County, FMRC, Tel-Aviv University, Tel Aviv, Israel; ’ lissue Typing Unit, Hadassah, Hebrew University Jerusalem, Israel: 3 Dept. Family Medicine, Rabin Medical Center; Tel-Aviv University, Tel-Aviv, Israel
In most populations, no association has been found between changes in frequency of type I and type II diabetes. However, in the Yemenite Jews in Israel, unique and dramatic corresponding changes occurred in both, as estimated by type II prevalence and type I incidence, over fifty years following immigration to Israel in 1951; type I incidence (age < 18yrs.) rose from near 0 to 18.5/100,000 (others 7.7/100,000), and type II prevalence (age >30yrs.) from 0.05% to 13% (others 6%). reaching 30% over the age of 65yrs. The aim of the present study is to examine the nature of these changes, and to suggest a common underlying cause for development of both diseases. Methods Historical medical details in Yemen and Israel were obtained during structured interviews with 196 elders of the community and from documented observations. In addition, molecular HLA typing of both type I (n=52), type II (n=120) diabetic patients, and 78 controls were performed. Correspondence analysis of HLA typing of Yemenite Jews and other distinct Israeli ethnic populations was performed in order to investigate unique and distinguishing genetic backgrounds of the groups. Results The interviews supported the rarity of diabetes, and commonplace infant exposure to cow’s milk in Yemen. Over the last fifty years the Yemenites experienced a near 90% increase in BMI, compared to only about 15% in other ethnic groups. Molecular HLA typing showed an exceptionally high odds ratio (OR=140) for the DRB1*0301 l,DQA1*05, DQB1*02/JXB1*0402,DQA1*03 genotype in type I diabetic patients, with no such association in type II disease. Correspondence analysis of HLA genotyping, in particular of DRBl, disclosed the distinctiveness of the Yemenite genetic profiles. Conclusion A possible explanation for the dramatic parallel increase in the frequencies of type I and II diabetes among Yemenite Jews is that shared non-HLA diabetogenic genes, characteristic of this group, are triggered by the dramatic increase in BMI, leading to development of diabetes.
P1398 Risk Profile of Tehran Inhabitants: Interim Report Lipid and Glucose Study(TLGS) PARVIN MIRMIRAN, Maziar Rahmani, Mohammad Sima Allahverdian, Habib Emami, Arash Ghanbarian, Fereidoun A&i. Endocrine Research Center, Tehran,
from Tehran Madjid, Rambod Hajipour, Iran (Islamic
Republic Of) TLGS is a prospective study on a random sample of urban inhabitants of Tehran. In the baseline examination, 17000 male and female subjects aged 3-69 yrs would be evaluated for coronary artery disease and its major risk factors with emphasis on diabetes mellitus and dyslipidemia. A standard questionnaire is filled, followed by physical examination, FBS, 2-hr pp BS, and serum lipid determinations. So far 11198 individuals, [4757 (43%) male and 6441 (57%) female] have been evaluated. 24-hr dietary recall and food frequency have been collected in 1047 people and energy intake (EI) to basal metabolic rate (BMR) ratio was calculated. Standard protocols have been used for all measurements and comprehensive quality assurance system has been employed. Mean BMI in individuals over 20 yr was 25.7f4.1 for men, and 27.5f7.8 kg/m* for women (Pt0.001). In adults, overweight (BMI; 25-29.9 kg/m*) and obesity (BMI>30 kg/m*) were 42% and 15% in men and 38% and 30% in women respectively. According to WHO criteria, obesity was observed in 17% of people under 20 yr. Prevalence of known, newly diagnosed diabetes according to WHO and ADA criteria, IGT, and IFG
s354
Poster Session 2
were 3.8, 5.1, 6.1, 13.2, and 4.9% respectively. Twenty six, 29, and 18% of population z 20 yr had TC 1240 mg/dl, TGs 1200 mg/dl, LDL-C ~160 mg/dl, and 19% decreased HDL-C (~35 mg/dl). In population ~20 yr; 16.2, 6, 12.9, and 13.6% had TC 2200 mg/dl, TGs ~200 mg/dl, LDL-C ? 130 mg/dl, and HDL-C 135 mg/dl. Forty percent of individuals 220 yr exceeded 30% of total energy derived from fat and 18% of study population consumed more than 300 mg/day cholesterol. EYBMR ratio was cl.27 in 35% of women indicating underre.porting.Only 25% of adults(22% of men and 27% of women, P
P1399 Foot Onychomycosis with Diabetic Patients a Prospective Study on 60 Cases ZINEB SLAOUI. Endocrinology, University Hospital of IBN ROCHD, Casablanca, Morocco, Morocco
The Onychomycosis of toe-nails of diabetic patients is a risk factor for foot lesions in particular when it is associated with a peripheric sensitive neuropathy. The authors give the preliminary results of a prospective study done on 60 diabetic patients. The aim is to study the frequency and the type of foot onychomycosis of diabetic patients and establish a correlation with the presence of a peripheric sensitive neuropathy and the unexpected occurrence of foot lesions. The preliminary results about 40 patients show that they are about 30 women (75%) and 10 men (25%). The age of these patients varies between 16 and 80 years with a medium age of 50 years. The diabetes is of type II in 28 cases (70%) and of type 1 in 12 cases (30%). The mean age of diabetes is 7.7 years with extremes of 1 month and 20 years. The mycological removal of samples was done at the level of one of the nails affected by onychomycosis (70%). In case of absence of apparent lesions, the sample removal was systematically done at the level of the major toe (30%). The mythological study has been positive in 9 cases (22,5%). In 8 cases, the removed toe was affected. The isolated fungus was candida Albican in 7 cases out of 9, tnychophyton nubrum in one case and interdigital tnychophyton in one case. The comparison between the subjects having onychonycosis and sound patients has shown a significant difference in the frequency of peripheric sensitive neuropathy 77% Vs 35% (P
P1400 “Highest” International Prevalence of Incipient Diabetic Nephropathy (IDN) in Asian Indians with NIDDM: Genetic Predisposition Versus Social Deficiencies in Diabetes Care? S.S. SRIKANTA, S.R. Krishnaiengar, S. Suma, J. Hegde, N.C. Basavaraju, D.V. Rama, M.A. Srilakshmi, S. Joshi, A.S. Vinaya, G.S. Narayan, U. Dayashankar, B.S. Sudha, A.H. Mamatha, G. Raja, T. Kalpana, N. Sumithra, N. Ishrath, J. Srikanth, L. Punitha, C.G. Sreelatha, B.A. Mahesh, A. Sharda. A recent medline search confirmed our earlier clinical data (urinary albumin excretion [UAE] measured by immunoturbidometry, analysed at the time of initial referral to our speciality diabetes center), and literature review, that perhaps Asian Indians have the “highest” international preva-
lence of diabetic nephropathy, Representative examples: Country(year)
IDN%
lndia(l996) SAM I India( 1998) SAM n
68 42
UK Asian Indians(l998) UK Africans( 1998) UK Europeans( 1998)
40 36 28
both incipient (IDN) and overt (ODN).
Country (year)
IDN%
USA Pima Indians( 1995) USA Africms(l995) Nigeria(l992)
38 24
Korea( 1995) Gfmnany( 1995)
20 27
56
Between the Samatvam (SAM) I and II studies, there was a decline in the prevalence of IDN from 68% to 42% (from 1996 to 1998; possibly reflecting improved general physician awareness and diabetes care in the community, prior to speciality referral). In the SAM II study, prevalence of IDN and ODN was 42% and 12%. IDN and ODN were significantly associated with progressively increasing diabetes duration (p=O.O00017), systolic/diastolic blood pressure (p=O.OOOOO8/O.OM!04), total cholesterol (p=O.OOl) and triglycerides (p=O.OOl). Peripheral vascular disease (microalbuminuria mg/24hr; p value) (259; p= 0.003). loss of protective sensation (294; p=O.O2), and diabetic retinopathy: nonproliferative/proliferative (163/719; p=0.000008) were associated with significantly elevated UAE. Conclusions: Factors contributing to higher prevalence of DN in Asian Indians could include: (a) greater insulin resistance, hyperinsulinemia, hypertension etc (“syndrome x”), and (b) social deficiencies in comprehensive diabetes care (glycemic and BP control).
P1401 The Effect of Diabetes on Mortality in Patients with Established Atherothrombosis KRISTEN MIGLIACCIO-WALLE, Khajak J. Ishak, J. Jaime Care. For the CAPRA Study Group: Car0 Research, Concord, MA, United States of America Purpose:
To evaluate the additional burden of diabetes among patients diagnosed with atherothrombotic disease in actual practice. Methods: The impact of diabetes was examined using actual practice data on 50,734 residents of Saskatchewan, Canada diagnosed with a myocardial infarction (MI) or ischemic stroke between 1990-1995 or with peripheral arterial disease (PAD) between 1985-1995. Health care records provided data on patient characteristics and diabetes history back to January, 1980 and follow-up was available to March, 1998. Kaplan-Meier survival curves were estimated and Cox proportional hazards analyses were conducted to examine the effect of diabetes on survival controlling for other factors. Results: Patients were evenly distributed across diagnoses: 15,590 (31%) MI, 18,704 (37%) stroke, and 16,440 (32%) PAD. About half (55%) of patients were male, the majority (73%) were over 65 years of age at diagnosis and almost a quarter (22%) had a history of diabetes. Within 30 days of diagnosis, 0.3% of PAD patients, 1.I% with stroke and 6.4% with MI had died. Diabetes increased the risk of death, regardless of proximity to diagnosis, by 40%, 21%. and 37% in PAD, stroke and MI patients, respectively. Conclusions: Diabetes significantly increases the risk of death in patients with atherothrombosis. The impact of diabetes on survival is much greater in patients with PAD.
P1402 The Central Fat Distribution and Non Insulin Dependent Diabetes Mellitus in Urban Population of Astana ANNA V. BAZAROVA, Olga V. Uljanova. Introduction: There are no epidemiological data on the correlation of non-insulin dependent diabetes mellitus (NIDDM) and type of fat distr-