PREDICTORS OF COMPLICATIONS IN A LARGE DIABETIC COHORT

点击翻译按钮获取中文摘要

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.