The Verona diabetes study: a population-based survey on known diabetes mellitus prevalence and 5-year all-cause mortality (original) (raw)

Summary

This population-based survey aimed to determine the prevalence of known diabetes mellitus on 31 December 1986, and to assess all-cause mortality in the subsequent 5 years (1987–1991) in Verona, Italy. In the study of prevalence, 5996 patients were identified by three independent sources: family physicians, diabetes clinics, and drug prescriptions for diabetes. Mortality was assessed by matching all death certificates of Verona in 1987–1991 with the diabetic cohort. Overall diabetes prevalence was 2.61% (95% confidence interval 2.56–2.67). Prevalence of insulin-dependent and non-insulin-dependent diabetes mellitus was 0.069% (0.059–0.078) and 2.49% (2.43–2.54), respectively. Diabetes prevalence sharply increased after age 35 years up to age 75–79, and finally declined. Prevalence was higher in men up to age 69 years, in women after age 75 years. Of the diabetic cohort 1260 patients (592 men, 668 women) died by 31 December 1991, yielding an overall standardized mortality ratio of 1.46 (CI 1.38–1.54). Even though the differences narrowed with age, mortality rates in the diabetic cohort were higher than in the non-diabetic population at all ages. Women aged 65–74 years showed observed/expected ratio higher than men (2.27, CI 1.92–2.66, vs 1.50, CI 1.30–1.72), while in other age groups the sex-related differences were not significant. Pharmacological treatment of diabetes was associated with an excess mortality, while treatment with diet alone showed an apparent protective effect on mortality (observed/expected ratio 0.73, CI 0.58–0.92). In conclusion, in Verona diabetes has a prevalence similar to that of other European countries, and is associated with an excess mortality which is observed in both sexes, at all ages, and with any anti-diabetic pharmacologic treatment. Diet-treated diabetes seems to be associated with a significant reduction in the mortality risk.

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Abbreviations

SHU:

Social Health Unit

OHD:

oral hypoglycaemic drugs

CI:

confidence intervals

obs/exp:

observed to expected ratio

SMR:

standardized mortality ratio

References

  1. Papoz L (1991) Recent trends in the epidemiology of diabetes mellitus in European and Mediterranean countries. Acta Diabetol 28: 140–142
    PubMed Google Scholar
  2. Vaccaro O, Imperatore G, Ferrara A, Palombino R, Riccardi G (1992) Epidemiology of diabetes mellitus in Southern Italy: a case-finding method based on drug prescriptions. J Clin Epidemiol 45: 835–839
    Article PubMed Google Scholar
  3. Bruno G, Bargero G, Vuolo A, Pisu E, Pagano G (1992) A population-based prevalence survey of known diabetes mellitus in Northern Italy based upon multiple independent sources of ascertainment. Diabetologia 35: 851–856
    PubMed Google Scholar
  4. World Health Annual Statistics (1986) World Health Organization, Geneva, 1978–1985
  5. Fuller JH, Elford J, Goldblatt P, Adelstein AM (1983) Diabetes mortality: new light on an underestimated public health problem. Diabetologia 24: 336–341
    Article PubMed Google Scholar
  6. Ekoè JM (1988) Diabetes mellitus. Aspects of the worldwide epidemiology of diabetes mellitus and its long-term complications. Elsevier Science Publishers (Biomedical Division)
  7. National Diabetes Data Group (1979) Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 28: 1039–1057
    PubMed Google Scholar
  8. Coleman M, Douglas A, Hermon C, Peto J (1986) Cohort study analysis with a Fortran computer program. Int J Epidemiol 15: 134–137
    PubMed Google Scholar
  9. Breslow NE, Day NE (1986) Statistical methods in cancer research: the design and analysis of cohort studies. Volume II. IARC Scientific Publications, Lyon, pp 69–72
    Google Scholar
  10. Monson RR (1980) Occupational epidemiology. CRC Press, Boca Raton, Florida
    Google Scholar
  11. Mather HM, Keen H (1985) The Southall diabetes survey: prevalence of known diabetes in Asians and Europeans. BMJ 291: 1081–1084
    PubMed Google Scholar
  12. Neil H, Gatling W, Mather HM et al. (1987) The Oxford community diabetes study: evidence for an increase in the prevalence of known diabetes in Great Britain. Diabet Med 4: 539–543
    PubMed Google Scholar
  13. Croxson SCM, Burden AC, Bodington M, Botha JL (1990) The prevalence of diabetes in elderly people. Diabet Med 8: 28–31
    Google Scholar
  14. Toumilehto J, Nissinen A, Kivela SL et al. (1986) Prevalence of diabetes mellitus in elderly men aged 65 to 84 years in eastern and western Finland. Diabetologia 29: 611–615
    PubMed Google Scholar
  15. Eriksson J, Forsen B, Haggblom M, Teppo AM, Groop L (1992) Clinical and metabolic characteristics of type 1 and type 2 diabetes: an epidemiological study from the Narpes community in western Finland. Diabet Med 9: 654–660
    PubMed Google Scholar
  16. Laakso M, PyörÄlÄ K (1985) Age of onset and type of diabetes. Diabetes Care 8: 114–117
    PubMed Google Scholar
  17. Dorman JS, LaPorte RE, Kuller LH et al. (1984) The Pittsburgh insulin-dependent diabetes mellitus (IDDM) morbidity and mortality study. Mortality results. Diabetes 33: 271–276
    PubMed Google Scholar
  18. Borch-Johnson K, Kreiner S, Deckert T (1986) Mortality of type 1 (insulin-dependent) diabetes mellitus in Denmark: a study of relative mortality in 2930 Danish type 1 diabetic patients diagnosed from 1933 to 1972. Diabetologia 29: 767–772
    PubMed Google Scholar
  19. Songini N, Loche M, Muntoni S et al. (1993) Increasing prevalence of juvenile-onset type 1 (insulin-dependent) diabetes mellitus in Sardinia: the military service approach. Diabetologia 36: 547–552
    PubMed Google Scholar
  20. Green A, Andersen PK, Svendsen AJ, Mortensen K (1992) Increasing incidence of early onset type 1 (insulin-dependent) diabetes mellitus: a study of Danish male birth cohorts. Diabetologia 35: 178–182
    PubMed Google Scholar
  21. Pozza G, Garancini P, Gallus G (1994) Prevalence and incidence of NIDDM. In: Williams R, Papoz L, Fuller J (eds) Diabetes in Europe. John Libbey London, pp 21–38
    Google Scholar
  22. Panzram G (1987) Mortality and survival in type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 30: 123–131
    Article PubMed Google Scholar
  23. Balkau B, Papoz L (1992) Certification of cause of death in French diabetic patients. J Epidemiol Commun Health 46: 63–65
    Google Scholar
  24. Waugh NR, Dallas JH, Jung RT, Newton RW (1989) Mortality in a cohort of diabetic patients. Causes and relative risks. Diabetologia 32: 103–104
    PubMed Google Scholar
  25. Wong JSK, Pearson DWM, Murchison LE, Williams MJ, Narayan V (1991) Mortality in diabetes mellitus: experience of a geographically defined population. Diabet Med 8: 135–139
    PubMed Google Scholar
  26. Panzram G, Zabel-Langhennig R (1981) Prognosis of diabetes mellitus in a geographically defined population. Diabetologia 20: 587–591
    Article PubMed Google Scholar
  27. Garcia MJ, McNamara PM, Gordon T, Kannel WB (1974) Morbidity and mortality in diabetics in the Framingham population. Sixteen-year follow-up study. Diabetes 23: 105–111
    PubMed Google Scholar
  28. Goodkin G (1975) Mortality factors in diabetes. J Occup Med 17: 716–721
    PubMed Google Scholar
  29. Kleinman JC, Donahue RP, Harris MI, Finucane FF, Madans JH, Brock DB (1988) Mortality among diabetics in a national sample. Am J Epidemiol 128: 389–401
    PubMed Google Scholar
  30. Stengard JH, Tuomilehto J, Pekkanen J et al. (1992) Diabetes mellitus, impaired glucose tolerance and mortality among elderly men: the Finnish cohorts of the seven countries study. Diabetologia 35: 760–765
    PubMed Google Scholar
  31. Stamler J, Vaccaro O, Neaton JD, Wentworth D (1993) Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention study. Diabetes Care 16: 434–444
    PubMed Google Scholar
  32. Morrish NJ, Stevens LK, Head J, Fuller JH, Jarrett RJ, Keen H (1990) A prospective study of mortality among middle-aged diabetic patients (the London cohort of WHO multinational study of vascular disease in diabetics). I. Causes and death rates. Diabetologia 33: 538–541
    PubMed Google Scholar
  33. Head J, Fuller JH (1990) International variations in mortality among diabetic patients: the WHO multinational study of vascular disease in diabetics. Diabetologia 33: 477–481
    PubMed Google Scholar
  34. Rosengren A, Welin L, Tsipogianni A, Wilhemsen L (1989) Impact of cardiovascular risk factors on coronary heart disease and mortality among middle-aged diabetic men: a general population study. BMJ 299: 1127–1131
    PubMed Google Scholar
  35. Modan M, Karp M, Bauman B, Gordon O, Danon YL, Laron Z (1991) Mortality in Israeli Jewish patients with type 1 (insulin-dependent) diabetes mellitus diagnosed prior 18 years of age: a population based study. Diabetologia 34: 515–520
    PubMed Google Scholar
  36. Hirohata Y, MacMahon B, Root HF (1967) The natural history of diabetes. I. Mortality. Diabetes 16: 875–881
    PubMed Google Scholar
  37. Kessler II (1971) Mortality experience of diabetic patients-26 year follow-up study. Am J Med 51: 715–724
    Article PubMed Google Scholar
  38. Keil EK, Sutherland SE, Knapp RG et al. (1993) Mortality rates and risk factors for coronary disease in black as compared with white men and women. N Engl J Med 329: 73–78
    Article PubMed Google Scholar
  39. Dupree EA, Meyer MB (1980) Role of risk factors in complications of diabetes mellitus. Am J Epidemiol 112: 100–112
    PubMed Google Scholar

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Authors and Affiliations

  1. Institute of Metabolic Diseases, University of Verona, Verona, Italy
    M. Muggeo, E. Bonora, S. Girotto, M. Corbellini, M. L. Gemma, P. Moghetti, M. Zenere, V. Cacciatori & G. Zoppini
  2. Institute of Medical Statistics, University of Verona, Verona, Italy
    G. Verlato & R. De Marco
  3. Institute of Statistics, University of Verona, Verona, Italy
    F. Bressan

Authors

  1. M. Muggeo
  2. G. Verlato
  3. E. Bonora
  4. F. Bressan
  5. S. Girotto
  6. M. Corbellini
  7. M. L. Gemma
  8. P. Moghetti
  9. M. Zenere
  10. V. Cacciatori
  11. G. Zoppini
  12. R. De Marco

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Muggeo, M., Verlato, G., Bonora, E. et al. The Verona diabetes study: a population-based survey on known diabetes mellitus prevalence and 5-year all-cause mortality.Diabetologia 38, 318–325 (1995). https://doi.org/10.1007/BF00400637

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