Criteria For Type Diabetes And Cardiovascular Disease

The chronic hyperglycemia of diabetes is associated with long-term complications, especially in the eyes, kidneys, nerves, heart, and blood vessels. Individuals with undiagnosed type 2 diabetes are at high risk of coronary heart disease, stroke, and peripheral vascular disease. More than half of type 2 diabetic patients die of cardiovascular causes (29).

From the perspective of cardiovascular complications of DM the diagnostic criteria have been too high. Already the Whitehall study showed an increased risk of cardiovascular disease when the 2-hour level exceeded 5.5mmol/L, albeit after a 50 g glucose load (30). This study and several other population-based studies indicated that the risk for macrovascular complications starts at considerably lower levels of glycemia than has been included in the definition of diabetes.

Early diagnosis of diabetes aims to prevent long-term complications. Because cardiovascular disease is the main complication of type 2 diabetes recent studies have investigated the capability of new criteria to predict these complications. The association of hyperglycemia and cardiovascular disease is a crucial one on which to test the validity of the new criteria. The DECODE Study (31) showed that the 2-h criteria more accurately identifies people who are at increased risk of total and cardiovascular mortality compared to the ADA fasting criteria.

The DECODE study (31) analyzed 10 prospective European cohort studies including 15,388 men and 7,126 women, aged 30 to 89 years, who all had undergone a 2-h oral glucose tolerance test. The median follow-up was 8.8 years, and hazard ratios for deaths from all causes, cardiovascular disease, coronary heart disease, and stroke were estimated. Multivariate Cox regression analyses showed that the inclusion of fasting glucose did not add significant information on the prediction of 2-h glucose alone, whereas the addition of 2-h glucose to fasting glucose criteria significantly improved the prediction. Table 3 reports adjusted hazard ratios for deaths from cardiovascular disease, coronary heart disease, stroke,

TABLE 3 Adjusted Hazard Ratios from Cardiovascular Disease, Coronary Heart Disease, Stroke, and All Causes with Fasting and Two-Hour Glucose Categories in the Same Model: The DECODE Study3
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