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Risk factors for mortality in Type II (non-insulin-dependent) diabetes: Evidence of a role for neuropathy and a protective effect of HLA-DR4

To test the hypothesis that interaction between genetic, immunological, clinical and metabolic risk factors influences the outcome of Type II (non-insulin-dependent) diabetes mellitus, we examined which of the above factors present at baseline were associated with mortality in 134 Type II diabetic p... Full description

Journal Title: Diabetologia 1998, Vol.41 (11), p.1253-1262
Main Author: FORSBLOM, C. M
Other Authors: SANE, T , MATIKAINEN, E , TEPPO, A.-M , KOSKIMIES, S , GROOP, L , GROOP, P.-H , TÖTTERMAN, K. J , KALLIO, M , SALORANTA, C , LAASONEN, L , SUMMANEN, P , LEPÄNTALO, M , LAATIKAINEN, L
Format: Electronic Article Electronic Article
Language: English
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Publisher: Berlin: Springer
ID: ISSN: 0012-186X
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recordid: cdi_proquest_miscellaneous_70071975
title: Risk factors for mortality in Type II (non-insulin-dependent) diabetes: Evidence of a role for neuropathy and a protective effect of HLA-DR4
format: Article
creator:
  • FORSBLOM, C. M
  • SANE, T
  • MATIKAINEN, E
  • TEPPO, A.-M
  • KOSKIMIES, S
  • GROOP, L
  • GROOP, P.-H
  • TÖTTERMAN, K. J
  • KALLIO, M
  • SALORANTA, C
  • LAASONEN, L
  • SUMMANEN, P
  • LEPÄNTALO, M
  • LAATIKAINEN, L
subjects:
  • Adult
  • Aged
  • Albuminuria
  • Associated diseases and complications
  • Autoimmunity
  • Biological and medical sciences
  • Blood cholesterol
  • Blood circulation disorders
  • Blood Glucose - metabolism
  • Cardiovascular Diseases - mortality
  • Cause of Death
  • Coronary heart disease
  • Diabetes
  • Diabetes Mellitus, Type 2 - immunology
  • Diabetes Mellitus, Type 2 - mortality
  • Diabetes Mellitus, Type 2 - physiopathology
  • Diabetes. Impaired glucose tolerance
  • Diabetic Angiopathies - mortality
  • Diabetic Angiopathies - physiopathology
  • Diabetic Neuropathies - mortality
  • Diabetic Neuropathies - physiopathology
  • Diabetics
  • Endocrine pancreas. Apud cells (diseases)
  • Endocrinopathies
  • Fatty acids
  • Fatty Acids, Nonesterified - blood
  • Female
  • Finland - epidemiology
  • Follow-Up Studies
  • Glycated Hemoglobin A - analysis
  • Health aspects
  • HLA-DR Antigens - blood
  • HLA-DR4 Antigen - blood
  • Humans
  • Insulin
  • Low density lipoproteins
  • Male
  • Medical sciences
  • Middle Aged
  • Ophthalmology
  • Registries
  • Regression Analysis
  • Risk Factors
  • Survival Rate
  • Triglycerides
  • Triglycerides - blood
ispartof: Diabetologia, 1998, Vol.41 (11), p.1253-1262
description: To test the hypothesis that interaction between genetic, immunological, clinical and metabolic risk factors influences the outcome of Type II (non-insulin-dependent) diabetes mellitus, we examined which of the above factors present at baseline were associated with mortality in 134 Type II diabetic patients followed for 9 years. Thirty-eight patients (29%) died during the follow-up period; the majority of whom (68%) died from cardiovascular disease. At baseline, the deceased patients had higher HbA1c values (p = 0.002), higher LDL-triglycerides (p = 0.007), lower HDL-cholesterol (p = 0.007), higher non-esterified fatty acid (NEFA) concentrations (p = 0.014), and higher albumin excretion rate (p < 0.0001) than the patients who survived. In addition, the frequency of HLA-DR4 (21 vs 39%, p = 0.048) and of parietal cell antibodies (5 vs 14%, p = 0.016) were decreased in the deceased as compared to the living patients. Patients who died during follow-up also had more retinopathy (42 vs 16%, p = 0.002), neuropathy (57 vs 23%, p < 0.001), microalbuminuria (45 vs 6%, p < 0.0001), coronary heart disease (50 vs 13%, p < 0.0001), and peripheral vascular disease (27 vs 9%, p = 0.005) at baseline than patients who survived. In a multiple logistic regression analysis macroangiopathy (p = 0.004), neuropathy (p = 0.007), HbA1c (p = 0.018) and albumin excretion rate (p = 0.016) were independent risk factors for death. In patients free of cardiovascular disease at baseline, conventional risk factors such as LDL-cholesterol (p = 0.005) and age (p = 0.003) were associated with subsequent development of cardiovascular disease. In conclusion, in addition to coexisting macroangiopathy, increased albumin excretion rate, poor glycaemic control and neuropathy are risk factors for cardiovascular mortality in patients with Type II diabetes. The presence of HLA-DR4 and signs of autoimmunity may be associated with decreased risk of cardiovascular disease.
language: eng
source:
identifier: ISSN: 0012-186X
fulltext: no_fulltext
issn:
  • 0012-186X
  • 1432-0428
url: Link


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titleRisk factors for mortality in Type II (non-insulin-dependent) diabetes: Evidence of a role for neuropathy and a protective effect of HLA-DR4
creatorFORSBLOM, C. M ; SANE, T ; MATIKAINEN, E ; TEPPO, A.-M ; KOSKIMIES, S ; GROOP, L ; GROOP, P.-H ; TÖTTERMAN, K. J ; KALLIO, M ; SALORANTA, C ; LAASONEN, L ; SUMMANEN, P ; LEPÄNTALO, M ; LAATIKAINEN, L
creatorcontribFORSBLOM, C. M ; SANE, T ; MATIKAINEN, E ; TEPPO, A.-M ; KOSKIMIES, S ; GROOP, L ; GROOP, P.-H ; TÖTTERMAN, K. J ; KALLIO, M ; SALORANTA, C ; LAASONEN, L ; SUMMANEN, P ; LEPÄNTALO, M ; LAATIKAINEN, L
descriptionTo test the hypothesis that interaction between genetic, immunological, clinical and metabolic risk factors influences the outcome of Type II (non-insulin-dependent) diabetes mellitus, we examined which of the above factors present at baseline were associated with mortality in 134 Type II diabetic patients followed for 9 years. Thirty-eight patients (29%) died during the follow-up period; the majority of whom (68%) died from cardiovascular disease. At baseline, the deceased patients had higher HbA1c values (p = 0.002), higher LDL-triglycerides (p = 0.007), lower HDL-cholesterol (p = 0.007), higher non-esterified fatty acid (NEFA) concentrations (p = 0.014), and higher albumin excretion rate (p < 0.0001) than the patients who survived. In addition, the frequency of HLA-DR4 (21 vs 39%, p = 0.048) and of parietal cell antibodies (5 vs 14%, p = 0.016) were decreased in the deceased as compared to the living patients. Patients who died during follow-up also had more retinopathy (42 vs 16%, p = 0.002), neuropathy (57 vs 23%, p < 0.001), microalbuminuria (45 vs 6%, p < 0.0001), coronary heart disease (50 vs 13%, p < 0.0001), and peripheral vascular disease (27 vs 9%, p = 0.005) at baseline than patients who survived. In a multiple logistic regression analysis macroangiopathy (p = 0.004), neuropathy (p = 0.007), HbA1c (p = 0.018) and albumin excretion rate (p = 0.016) were independent risk factors for death. In patients free of cardiovascular disease at baseline, conventional risk factors such as LDL-cholesterol (p = 0.005) and age (p = 0.003) were associated with subsequent development of cardiovascular disease. In conclusion, in addition to coexisting macroangiopathy, increased albumin excretion rate, poor glycaemic control and neuropathy are risk factors for cardiovascular mortality in patients with Type II diabetes. The presence of HLA-DR4 and signs of autoimmunity may be associated with decreased risk of cardiovascular disease.
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1EISSN: 1432-0428
2DOI: 10.1007/s001250051062
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languageeng
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subjectAdult ; Aged ; Albuminuria ; Associated diseases and complications ; Autoimmunity ; Biological and medical sciences ; Blood cholesterol ; Blood circulation disorders ; Blood Glucose - metabolism ; Cardiovascular Diseases - mortality ; Cause of Death ; Coronary heart disease ; Diabetes ; Diabetes Mellitus, Type 2 - immunology ; Diabetes Mellitus, Type 2 - mortality ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetes. Impaired glucose tolerance ; Diabetic Angiopathies - mortality ; Diabetic Angiopathies - physiopathology ; Diabetic Neuropathies - mortality ; Diabetic Neuropathies - physiopathology ; Diabetics ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Fatty acids ; Fatty Acids, Nonesterified - blood ; Female ; Finland - epidemiology ; Follow-Up Studies ; Glycated Hemoglobin A - analysis ; Health aspects ; HLA-DR Antigens - blood ; HLA-DR4 Antigen - blood ; Humans ; Insulin ; Low density lipoproteins ; Male ; Medical sciences ; Middle Aged ; Ophthalmology ; Registries ; Regression Analysis ; Risk Factors ; Survival Rate ; Triglycerides ; Triglycerides - blood
ispartofDiabetologia, 1998, Vol.41 (11), p.1253-1262
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0FORSBLOM, C. M
1SANE, T
2MATIKAINEN, E
3TEPPO, A.-M
4KOSKIMIES, S
5GROOP, L
6GROOP, P.-H
7TÖTTERMAN, K. J
8KALLIO, M
9SALORANTA, C
10LAASONEN, L
11SUMMANEN, P
12LEPÄNTALO, M
13LAATIKAINEN, L
title
0Risk factors for mortality in Type II (non-insulin-dependent) diabetes: Evidence of a role for neuropathy and a protective effect of HLA-DR4
1Diabetologia
addtitleDiabetologia
descriptionTo test the hypothesis that interaction between genetic, immunological, clinical and metabolic risk factors influences the outcome of Type II (non-insulin-dependent) diabetes mellitus, we examined which of the above factors present at baseline were associated with mortality in 134 Type II diabetic patients followed for 9 years. Thirty-eight patients (29%) died during the follow-up period; the majority of whom (68%) died from cardiovascular disease. At baseline, the deceased patients had higher HbA1c values (p = 0.002), higher LDL-triglycerides (p = 0.007), lower HDL-cholesterol (p = 0.007), higher non-esterified fatty acid (NEFA) concentrations (p = 0.014), and higher albumin excretion rate (p < 0.0001) than the patients who survived. In addition, the frequency of HLA-DR4 (21 vs 39%, p = 0.048) and of parietal cell antibodies (5 vs 14%, p = 0.016) were decreased in the deceased as compared to the living patients. Patients who died during follow-up also had more retinopathy (42 vs 16%, p = 0.002), neuropathy (57 vs 23%, p < 0.001), microalbuminuria (45 vs 6%, p < 0.0001), coronary heart disease (50 vs 13%, p < 0.0001), and peripheral vascular disease (27 vs 9%, p = 0.005) at baseline than patients who survived. In a multiple logistic regression analysis macroangiopathy (p = 0.004), neuropathy (p = 0.007), HbA1c (p = 0.018) and albumin excretion rate (p = 0.016) were independent risk factors for death. In patients free of cardiovascular disease at baseline, conventional risk factors such as LDL-cholesterol (p = 0.005) and age (p = 0.003) were associated with subsequent development of cardiovascular disease. In conclusion, in addition to coexisting macroangiopathy, increased albumin excretion rate, poor glycaemic control and neuropathy are risk factors for cardiovascular mortality in patients with Type II diabetes. The presence of HLA-DR4 and signs of autoimmunity may be associated with decreased risk of cardiovascular disease.
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0Adult
1Aged
2Albuminuria
3Associated diseases and complications
4Autoimmunity
5Biological and medical sciences
6Blood cholesterol
7Blood circulation disorders
8Blood Glucose - metabolism
9Cardiovascular Diseases - mortality
10Cause of Death
11Coronary heart disease
12Diabetes
13Diabetes Mellitus, Type 2 - immunology
14Diabetes Mellitus, Type 2 - mortality
15Diabetes Mellitus, Type 2 - physiopathology
16Diabetes. Impaired glucose tolerance
17Diabetic Angiopathies - mortality
18Diabetic Angiopathies - physiopathology
19Diabetic Neuropathies - mortality
20Diabetic Neuropathies - physiopathology
21Diabetics
22Endocrine pancreas. Apud cells (diseases)
23Endocrinopathies
24Fatty acids
25Fatty Acids, Nonesterified - blood
26Female
27Finland - epidemiology
28Follow-Up Studies
29Glycated Hemoglobin A - analysis
30Health aspects
31HLA-DR Antigens - blood
32HLA-DR4 Antigen - blood
33Humans
34Insulin
35Low density lipoproteins
36Male
37Medical sciences
38Middle Aged
39Ophthalmology
40Registries
41Regression Analysis
42Risk Factors
43Survival Rate
44Triglycerides
45Triglycerides - blood
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1SANE, T
2MATIKAINEN, E
3TEPPO, A.-M
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5GROOP, L
6GROOP, P.-H
7TÖTTERMAN, K. J
8KALLIO, M
9SALORANTA, C
10LAASONEN, L
11SUMMANEN, P
12LEPÄNTALO, M
13LAATIKAINEN, L
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titleRisk factors for mortality in Type II (non-insulin-dependent) diabetes: Evidence of a role for neuropathy and a protective effect of HLA-DR4
authorFORSBLOM, C. M ; SANE, T ; MATIKAINEN, E ; TEPPO, A.-M ; KOSKIMIES, S ; GROOP, L ; GROOP, P.-H ; TÖTTERMAN, K. J ; KALLIO, M ; SALORANTA, C ; LAASONEN, L ; SUMMANEN, P ; LEPÄNTALO, M ; LAATIKAINEN, L
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1Aged
2Albuminuria
3Associated diseases and complications
4Autoimmunity
5Biological and medical sciences
6Blood cholesterol
7Blood circulation disorders
8Blood Glucose - metabolism
9Cardiovascular Diseases - mortality
10Cause of Death
11Coronary heart disease
12Diabetes
13Diabetes Mellitus, Type 2 - immunology
14Diabetes Mellitus, Type 2 - mortality
15Diabetes Mellitus, Type 2 - physiopathology
16Diabetes. Impaired glucose tolerance
17Diabetic Angiopathies - mortality
18Diabetic Angiopathies - physiopathology
19Diabetic Neuropathies - mortality
20Diabetic Neuropathies - physiopathology
21Diabetics
22Endocrine pancreas. Apud cells (diseases)
23Endocrinopathies
24Fatty acids
25Fatty Acids, Nonesterified - blood
26Female
27Finland - epidemiology
28Follow-Up Studies
29Glycated Hemoglobin A - analysis
30Health aspects
31HLA-DR Antigens - blood
32HLA-DR4 Antigen - blood
33Humans
34Insulin
35Low density lipoproteins
36Male
37Medical sciences
38Middle Aged
39Ophthalmology
40Registries
41Regression Analysis
42Risk Factors
43Survival Rate
44Triglycerides
45Triglycerides - blood
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1SANE, T
2MATIKAINEN, E
3TEPPO, A.-M
4KOSKIMIES, S
5GROOP, L
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7TÖTTERMAN, K. J
8KALLIO, M
9SALORANTA, C
10LAASONEN, L
11SUMMANEN, P
12LEPÄNTALO, M
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7TÖTTERMAN, K. J
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atitleRisk factors for mortality in Type II (non-insulin-dependent) diabetes: Evidence of a role for neuropathy and a protective effect of HLA-DR4
jtitleDiabetologia
addtitleDiabetologia
date1998
risdate1998
volume41
issue11
spage1253
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pages1253-1262
issn0012-186X
eissn1432-0428
abstractTo test the hypothesis that interaction between genetic, immunological, clinical and metabolic risk factors influences the outcome of Type II (non-insulin-dependent) diabetes mellitus, we examined which of the above factors present at baseline were associated with mortality in 134 Type II diabetic patients followed for 9 years. Thirty-eight patients (29%) died during the follow-up period; the majority of whom (68%) died from cardiovascular disease. At baseline, the deceased patients had higher HbA1c values (p = 0.002), higher LDL-triglycerides (p = 0.007), lower HDL-cholesterol (p = 0.007), higher non-esterified fatty acid (NEFA) concentrations (p = 0.014), and higher albumin excretion rate (p < 0.0001) than the patients who survived. In addition, the frequency of HLA-DR4 (21 vs 39%, p = 0.048) and of parietal cell antibodies (5 vs 14%, p = 0.016) were decreased in the deceased as compared to the living patients. Patients who died during follow-up also had more retinopathy (42 vs 16%, p = 0.002), neuropathy (57 vs 23%, p < 0.001), microalbuminuria (45 vs 6%, p < 0.0001), coronary heart disease (50 vs 13%, p < 0.0001), and peripheral vascular disease (27 vs 9%, p = 0.005) at baseline than patients who survived. In a multiple logistic regression analysis macroangiopathy (p = 0.004), neuropathy (p = 0.007), HbA1c (p = 0.018) and albumin excretion rate (p = 0.016) were independent risk factors for death. In patients free of cardiovascular disease at baseline, conventional risk factors such as LDL-cholesterol (p = 0.005) and age (p = 0.003) were associated with subsequent development of cardiovascular disease. In conclusion, in addition to coexisting macroangiopathy, increased albumin excretion rate, poor glycaemic control and neuropathy are risk factors for cardiovascular mortality in patients with Type II diabetes. The presence of HLA-DR4 and signs of autoimmunity may be associated with decreased risk of cardiovascular disease.
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pmid9833930
doi10.1007/s001250051062
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