EPIDEMIOLOGY OF DIABETIC COMPLICATIONS

糖尿病并发症仍然是糖尿病的主要来源。 发病率和早期死亡率，但尚未全面 从流行病学的角度进行研究。流行率、发病率和 七种主要并发症状态(即，死亡， 增殖性视网膜病变，微量白蛋白尿，临床肾病，肾脏 衰竭、神经病变、冠状动脉和下肢动脉疾病 胰岛素依赖型糖尿病(IDDM)及其危险因素有 在对诊断为IDDM的受试者进行为期十年的前瞻性研究中接受检查 在童年时。风险因素和并发症状态是根据 以两年期为基础。研究人群是IDDM的明确队列 匹兹堡儿童医院确诊的IDDM患者 登记显示为当地全县糖尿病患者的代表 人口。 这些并发症的患病率和四年发病率为 在这658名IDDM队列中，在基线检查(1986-88)中被确定 参与者的诊断介于1/1/50和5/31/80之间。在基线上，他们是 年龄8-48岁，糖尿病病程8-37岁 好几年了。目前正在进行为期六年的后续检查。在 在拟议的学习期间，还将有两个周期的两年一次的考试 对复杂终端使用相同的方法完成： 视网膜病变(立体眼底照相术)、肾病(AER来自三个 定时尿样)、神经病变(DCCT方案)、外周血管 疾病(静息状态下踝部/手臂血压比率)、心血管疾病 (有效的心肌梗死或心绞痛)。除了一般的风险因素(例如， HbA1、血脂、血压、行为危险因素(包括吸烟、 酒精和体力活动)，新的因素将在 建议的授权期包括低密度脂蛋白颗粒大小，高级糖基化 最终产物修饰的低密度脂蛋白和氧化的低密度脂蛋白。这些新的化验结果 到目前为止的研究结果表明，脂质和肾脏之间存在很强的联系。 同样，观察到，近L 30岁以上的人中有6%是 每年死于未被识别的心血管疾病导致 建议对动态心电图监测进行评估 无症状心肌缺血的检测。通过这种方式，我们将识别 导致并发症发生的风险因素 适当的预防策略。

The complications of diabetes mellitus continue to be a major source of morbidity and early mortality but have not yet been comprehensively studied from an epidemiological viewpoint. The prevalence, incidence and interrelationships between seven major complication states (i.e., death, proliferative retinopathy, microalbuminuria, overt nephropathy, renal failure, neuropathy, and coronary and lower extremity arterial disease of insulin-dependent diabetes mellitus (IDDM) and their risk factors are being examined in a ten-year prospective study of IDDM subjects diagnosed in childhood. Risk factors and complication status are determined on a biennial basis. The study population is a well-defined cohort of IDDM patients identified from the Children's Hospital of Pittsburgh IDDM Registry shown to be representative of the local county wide diabetic population. The prevalence and four-year incidence rates of these complications have been determined at baseline exam (1986-88) in this cohort of 658 IDDM participants diagnosed between 1/1/50 and 5/31/80. At baseline, they were aged 8-48 years and had a duration of diabetes spanning from 8 to 37 years. Six-year follow-up examinations are currently in progress. In the proposed study period, a further two cycles of biennial exams will be completed using the same methodology for complication endpoints: retinopathy (stereo fundus photography), nephropathy (AER from three timed urine samples), neuropathy (DCCT protocol), peripheral vascular disease (ankle/arm blood pressure ratios at rest), cardiovascular disease (validated MI or angina). In addition to general risk factors (e.g., HbA1, lipids, blood pressure, behavioral risk factors (including smoking, alcohol, and physical activity), new factors will be measured in the proposed grant period including LDL particle size, advanced glycosylated endproduct modified-LDL and oxidized LDL. These new assays are a result of findings to date which suggest a strong lipid-renal connection. Similarly, the observation that nearly l % of those aged 30+ years are dying annually from unrecognized cardiovascular disease has led to a proposed assessment of Holter (ambulatory ECG) monitoring for the detection of silent myocardial ischemia. In this way, we will identify risk factors responsible for complications enabling the development of appropriate preventive strategies.