PREDICTORS OF COMPLICATIONS IN A LARGE DIABETIC COHORT

心肌梗死、下肢截肢和慢性 糖尿病患者的肾衰竭发生率高于 非糖尿病患者 然而，很少有关于风险因素的纵向数据， 这些并发症在相当多的糖尿病患者中，特别是在非糖尿病患者中， 白色人群中，许多糖尿病相关并发症的风险 高于白人。 该提案描述了这些预测因素的纵向研究 凯撒医疗机构的10,068名成员中有3例并发症 报告多阶段糖尿病诊断的医疗护理计划 1954年至1984年的健康检查。 这个群体在同龄人中是独一无二的 糖尿病患者的大规模，包括2,528名黑人， 糖尿病，对于广泛的基线信息， 多阶段健康检查数据库，并提供完整的 平均近13年的门诊和住院医疗记录 的后续行动。 关注的结局（约1，000例心肌梗死患者） 梗塞，200例下肢截肢，160例慢性 肾衰竭）从计算机化的出院和结束- 分期肾病治疗文件并在病历审查时进行验证。 将研究的多相数据库中的预测因子包括 主要心血管疾病危险因素（吸烟、血液 血压和血清胆固醇），肥胖和体脂分布，家庭 高血压史、尿白蛋白试纸、种族和教育背景 水平 审查医疗记录将通过确定 糖尿病的类型、持续时间和治疗，通过评估血糖控制 并通过记录持续性蛋白尿和血压水平 在糖尿病发作之前。 每次分析将包括所有并发症病例和一个对照病例 每例病例（心肌梗死）或每例病例两个对照（较低 肢体截肢和慢性肾衰竭）。 这些分析将 作为匹配的巢式病例对照研究进行。 调查结果将提供 关于糖尿病并发症病因的新信息， 每一个都有风险增加的标志。 他们将是第一个这样的 黑色的纵向数据。 这些信息将有助于规划 并针对糖尿病高危人群进行干预。

Risks for myocardial infarction, lower extremity amputation, and chronic renal failure are increased in persons with diabetes compared with nondiabetics. Yet few longitudinal data are available on risk factors for these complications in sizable cohorts of diabetics, particularly in non- white populations where risk for many diabetes-related complications is higher than in whites. This proposal describes longitudinal studies of predictors of each of these three complications in a cohort of 10,068 members of the Kaiser Permanente Medical Care Program who reported a diagnosis of diabetes at a multiphasic health checkup between 1954 and 1984. This group is unique among cohorts of diabetics for its large size, for inclusion of 2,528 blacks with diabetes, for the extensive baseline information contained in the multiphasic health checkup database, and for availability of complete outpatient and inpatient medical records over an average of nearly 13 years of followup. The outcomes of interest (approximately 1,000 myocardial infarctions, 200 lower extremity amputations, and 160 cases of chronic renal failure) are identified from computerized hospital discharge and end- stage renal disease treatment files and verified at medical record review. Predictors from the multiphasic database that will be studied include the major cardiovascular disease risk factors (cigarette smoking, blood pressure, and serum cholesterol), obesity and body fat distribution, family history of hypertension, urine dipstick for albumin, race and educational level. Review of medical records will augment thee data by ascertaining type, duration, and treatment for diabetes, by assessing glucose control and by noting presence of persistent proteinuria and blood pressure level before onset of diabetes. Each analysis will include all cases of the complication and one control per case (for myocardial infarction) or two controls per case (for lower extremity amputation and chronic renal failure). These analyses will be conducted as matched, nested case-control studies. Findings will provide new information on the etiology of these complications in diabetes and on markers of increased risk for each. They will be the first such longitudinal data in blacks. This information will be useful in planning and targeting interventions to high-risk groups of diabetics.