PREDICTORS OF COMPLICATIONS IN A LARGE DIABETIC COHORT

心肌梗死、下肢截肢和慢性 与糖尿病患者相比，糖尿病患者肾功能衰竭增加 非糖尿病患者。然而，几乎没有关于以下风险因素的纵向数据 这些并发症在相当大的糖尿病患者队列中，特别是在非糖尿病患者中 许多糖尿病相关并发症风险高的白人人群 比白人高。 这项建议描述了对每一项预测因素的纵向研究 在10,068名皇帝永久成员队列中的三个并发症 医疗保健计划谁报告了糖尿病的多相诊断 1954年至1984年间的健康检查。这个群体在同龄人中是独一无二的 糖尿病患者的数量，因为它很大，包括2528名黑人 有关糖尿病的详细基线信息，请参阅 多阶段健康体检数据库，并提供完整的 平均近13年的门诊和住院病历 跟进的问题。关注的结果(大约1,000个心肌梗死 脑梗塞，200例下肢截肢，160例慢性 肾功能衰竭)从计算机化的出院和结束- 阶段性肾脏疾病治疗文件，并在病历审查中核实。 将研究的多阶段数据库的预测因素包括 主要心血管疾病危险因素(吸烟、血液 压力和血清胆固醇)、肥胖和体脂分布、家庭 高血压病史、尿白蛋白、种族和教育程度 水平。对医疗记录的审查将通过确定 通过评估血糖控制，糖尿病的类型、持续时间和治疗 并注意到持续性蛋白尿和血压水平的存在 在糖尿病发作之前。 每项分析将包括所有并发症病例和一个对照 每个病例(对于心肌梗死)或每个病例两个对照(对于更低的 截肢和慢性肾功能衰竭)。这些分析将是 作为配对、嵌套病例对照研究进行。调查结果将提供 糖尿病并发症的病因学研究新进展 每一种都是风险增加的标志。他们将是第一个这样的人 黑人的纵向数据。这些信息将在规划中有用 以及针对糖尿病高危人群的干预措施。

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.