EPIDEMIOLOGY OF DIABETIC COMPLICATIONS

糖尿病的并发症仍然是糖尿病的主要来源。 发病率和早期死亡率，但尚未进行全面研究 从流行病学的角度来看。患病率、发病率和 四个主要并发症之间的相互关系（即，视网膜病， 肾病、神经病和大血管疾病） 糖尿病（IDDM）及其危险因素正在研究中， 对儿童期确诊的IDDM受试者进行为期一年的前瞻性研究。风险 每两年确定一次因素和并发症状况。的 研究人群是一个明确定义的IDDM患者队列， 匹兹堡儿童医院胰岛素依赖型糖尿病登记处该登记册包括 阿勒格尼县70%的17岁以下确诊患者， 是全县儿童糖尿病患者的代表 确定了四种主要并发症的患病率 基线检查（1986-88）时，657例IDDM参与者队列中 诊断于1/1/50至5/31/80之间。基线时，他们的年龄为8-48岁 糖尿病的持续时间从8年到37年。周期II 目前正在进行检查。在拟议的研究期间， 另外两个周期的两年一度的考试将使用相同的 并发症终点的方法学：视网膜病变（立体眼底 摄影）、肾病（来自三次定时尿样的AER）、神经病变 (DCCT方案）、外周血管疾病（踝/臂血压 运动后比率）、心血管疾病（经验证的MI或心绞痛）。在 除了当前的风险因素[例如，脂质、载脂蛋白、血小板 聚集，GHb，血压，行为风险因素（包括 吸烟，酒精，体育活动和饮食）），新的因素将是 在拟议的赠款期内进行测量，包括钠-锂反向运输， Lp（a）.一项子研究还将检查颈动脉疾病 （超声检查）和动脉钙化（足部X光检查）。这样我们 将前瞻性地确定导致并发症的风险因素 并能够检查胰岛素依赖型糖尿病并发症的相互关系。这 应导致制定适当的预防战略。

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 the four major complications (i.e., retinopathy, nephropathy, neuropathy, and macrovascular 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 complications 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. This registry included 70% of patients diagnosed under the age of 17 years in Allegheny County and is representative of the county-wide childhood diabetic population. The prevalence rates of the four major complications have been determined at baseline exam (1986-88) in this cohort of 657 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. Cycle II 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 after exercise), cardiovascular disease (validated MI or angina). In addition to current risk factors [e.g., lipids, apolipoproteins, platelet aggregation, GHb, blood pressure, behavioral risk factors (including smoking, alcohol, physical activity, and diet)), new factors will be measured in the proposed grant period, including Na-Li countertransport and Lp(a). A substudy will also examine carotid artery disease (ultrasonography) and arterial calcification (foot x-rays). In this way, we will identify the risk factors responsible for complications prospectively and be able to examine the interrelationships of IDDM complications. This should lead to the development of appropriate preventive strategies.