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，但尚未全面 从流行病学的角度来看。患病率、发病率和 七种主要并发症状态之间的相互关系（即，死亡， 增殖性视网膜病变，微量白蛋白尿，显性肾病，肾 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）及其危险因素是 在一项为期10年的胰岛素依赖型糖尿病患者前瞻性研究中， 在童年。风险因素和并发症状态是根据 每两年一次。研究人群是一个定义明确的胰岛素依赖型糖尿病队列 匹兹堡儿童医院确定的IDDM患者 登记处显示代表当地县范围内的糖尿病患者 人口 这些并发症的患病率和四年发病率 在基线检查（1986-88）时，在658例IDDM患者队列中确定了 参与者诊断为1/1/50和5/31/80之间。在基线时， 年龄8-48岁，糖尿病持续时间为8 - 37 年目前正在进行为期六年的后续检查。在 建议的研究期间，另外两个周期的两年一度的考试将 使用与并发症终点相同的方法完成： 视网膜病变（立体眼底摄影）、肾病（AER来自三个 定时尿样）、神经病变（DCCT方案）、外周血管 疾病（静息时踝/臂血压比）、心血管疾病 （经验证的MI或心绞痛）。 除了一般风险因素（例如， HbA 1、血脂、血压、行为风险因素（包括吸烟， 酒精和体力活动），新的因素将在 建议的资助期，包括LDL颗粒大小，晚期糖化 终产物修饰LDL和氧化LDL。这些新的检测方法 迄今为止的研究结果表明，脂肾关系密切。 同样，观察到近l %的30岁以上的人是 每年死于未被识别的心血管疾病导致了 拟定的霍尔特（动态心电图）监测评估 无症状心肌缺血的检测。 这样，我们就能识别 导致并发症的风险因素， 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.