The prevalence of type 2 diabetes and gestational diabetes mellitus in an inner city multi-ethnic population

Zeeburg', a multiethnic town borough in the Amsterdam-East region, has one of the city's highest rates of immigrants. In the total population of 19,825 Surinam (mainly Creole), Turkish, Moroccan, and Dutch adults the prevalence of known type 2 diabetes in 1994 and of gestational diabetes mellitus (GDM) between January 1992 and January 1997 was investigated. Based on World Health Organization (WHO) criteria of 1985, the age-standardized prevalence of type 2 diabetes was similar in men (6.4%; 95% confidence interval [CI]: 5.6-7.2) and women (6.4%: 95% CI: 5.8-7.0) for all ethnic groups combined. However, the age- and sex-standardized prevalence of type 2 diabetes was significantly greater in the non-Dutch inhabitants than in the Dutch inhabitants (17.3% [95% CI: 12.9-21.6] in Surinam inhabitants, 10.9% [95% CI: 9.7-12.2] in Turkish inhabitants, 12.4% [95% CI: 9.7-15.0] in Moroccan inhabitants, and 3.6% [95% CI: 3.2-3.9] in Dutch inhabitants). The odds ratios for type 2 diabetes for the separate immigrant groups relative to the Dutch group were 5.88 (95% CI: 4.54-7.69) for Surinam inhabitants, 4.00 (95% CI: 2.86-5.55) for Turkish inhabitants, and 4.17 (95% CI: 3.03-5.55) for Moroccan inhabitants. GDM was present in 2.59% of women of non-Dutch origin compared with 0.62% of women of Dutch origin. A significant positive association was found between the non-Dutch origin and the occurrence of GDM (chi2 = 6.7; p < 0.01). The study highlights a high prevalence of known type 2 diabetes and GDM in the immigrant inhabitants and emphasizes that appropriate interventions are necessarily with implications for health targets and capitation based budgets.     

Assessing the risk of gestational diabetes in twin gestation

This study examines the hypothesis that twin gestation is a risk factor for gestational diabetes. In a retrospective analysis, the incidence of gestational diabetes in twin and singleton pregnancies was determined in groups matched for maternal age, weight, and parity. One-hour oral glucose challenge tests (50 g) were used to screen 9185 pregnant women. Gestational diabetes was diagnosed when abnormal screens (> or = 130 mg/dL) were followed by two or more abnormal values on a 3-hour (100 g) glucose tolerance test using National Diabetes Data Group (NDDG) criteria. A twin gestation was identified in 1.5% (138/9185) of the pregnancies. Gestational diabetes was diagnosed in 5.8% (8/138) and 5.4% (439/9047) of the twin and singleton pregnancies, respectively. The incidence of gestational diabetes is similar for singleton and twin gestations.     

Management of otitis media in a high risk population

BACKGROUND: Rural and remote Aboriginal and Torres Strait Islander children have extremely high rates of otitis media and hearing loss. Despite considerable evidence, clinical practice continues to vary. This may be partly related to the failure of recent guidelines to be explicit about which factors should influence decision making. OBJECTIVE: To provide rural and remote GPs caring for young Aboriginal and Torres Strait Islander children with an evidence based guide to the principles that determine the clinical management of otitis media and hearing loss. DISCUSSION: While population health strategies are extremely important, the GP also needs to be able to advise families of affected children of the benefits and risks of the medical, surgical and audiological interventions available. The key to this process is the ability to distinguish between suppurative and non-suppurative disease, and a familiarity with the natural history and the likely hearing loss associated with different disease states in high risk populations.     

Cervical cancer survival in a high risk urban population

BACKGROUND: Cervical cancer remains an important public health problem, particularly for the urban minority population. To the authors' knowledge, determinants of cervical cancer survival have not been studied in this high risk population. METHODS: This study included all 158 women diagnosed and treated for invasive cervical cancer from January 1, 1986, through December 31, 1992, at the Grady Memorial Hospital and Clinics (Atlanta, GA). Medical records were abstracted to determine age at diagnosis, race, International Federation of Gynecology and Obstetrics (FIGO) clinical stage, treatment, and survival. Pathologic material was reviewed to confirm the diagnosis. RESULTS: Most patients (80%) were African American, and the stage distribution was similar for African American and white patients. Sixty-six (42%) had FIGO Stage I disease; 50%, Stage II or III; and 8%, Stage IV. Four-year actuarial survival differed significantly according to clinical stage (Ia = 94%, Ib = 79%, II = 39%, III = 26%, IV = 0%). Overall survival was lower for patients with glandular carcinomas than for those with squamous cell carcinomas (26% vs. 55%, P = 0.09). This difference was almost entirely due to increased mortality in patients with Stage Ib adenocarcinomas (53% vs. 88% for squamous cell carcinoma, Stage Ib, P = 0.03). CONCLUSIONS: The major prognostic markers for cervical cancer survival in this high risk patient population were clinical stage and histology, factors identical to those identified for other populations.     

The non-teratogenicity of gestational diabetes

Three patients with neuropathologically confirmed frontotemporal dementia, motor neuron disease type, manifested hallucinations. In this dementia, the superficial layers of the frontal and temporal cortices are predominantly affected. Hallucinations may emerge as release phenomena secondary to selective laminar cortical involvement.     

The impact of routine obstetric ultrasonographic screening in a low-risk population

OBJECTIVES: Our goal was to develop a framework for evaluating the current controversy regarding routine obstetric ultrasonography in a population of low-risk pregnancies. STUDY DESIGN: A retrospective chart review was performed for all low-risk pregnancies from a single obstetric practice during 1990 to 1994, to determine the accuracy of screening ultrasonography for fetal anomalies. All patients received a routine ultrasonographic examination at 18 to 20 weeks' gestation. Neonatal records for all patients were evaluated for the presence of both major and minor anomalies. The data were analyzed with attention to the classification of anomalies (all anomalies vs major anomalies, detectable vs nondetectable). RESULTS: A total of 860 fetuses in 854 pregnancies were evaluated. Anomalies were present in 5.35% (46/860); these were major anomalies in 1.16% (10/860) and minor anomalies in 4.19% (36/860). The sensitivity, specificity, and positive and negative predictive values for the diagnosis of all anomalies were 8.7%, 99.9%, 80%, and 95.7%, respectively. However, if only major anomalies detectable by ultrasonography are included, these values become 75%, 100%, 100%, and 99.9%, respectively. There was one false-positive diagnosis not affecting outcome, a small ventriculoseptal cardiac defect. Postnatal ascertainment of anomalies was excellent, as determined by an incidence of ventriculoseptal defects of 1 in 120. CONCLUSION: Distinguishing between major and minor anomalies and between ultrasonographically detectable versus nondetectable anomalies is essential in the evaluation of the diagnostic accuracy of screening ultrasonography. Any comparisons of studies examining the effectiveness of prenatal screening for congenital anomalies with ultrasonography should use the same outcome: major anomalies identifiable by ultrasonography.     

Drug abuse in an obstetric population of a midsized city

Drug abuse during pregnancy has attracted national attention, but most studies are from large cities. This study is concerned with the indigent pregnant patients in a midsized city in the southeastern United States. In a 23-month study, 2,442 patients were delivered of neonates. Using specific criteria, 511 patients were tested for drug abuse. A positive test was identified in 156 (31%), cocaine being the most common agent. During 2 months of random testing, 15 patients (16%) had positive drug screens. Comparison of drug-positive pregnant patients with general obstetric patients identified many adverse obstetric and perinatal outcome data. Drug-positive patients weighed less, were older, were prone to not seek prenatal care, and were more likely to deliver prematurely and have a growth-retarded infant. Drug abuse in this population had significant impact on the health of the patient and her unborn infant.     

Large-scale screening for early diagnosis of gestational diabetes mellitus (GDM)

The aim of study was to evaluate incidence of GDM in Poland. All 1500 pregnant women between 24-28 week's gestation consulted in 4 centers were offered a 50 g oral glucose test (screening test). Capillary blood glucose was measured at 60 min after glucose ingestion. When blood glucose > 140 mg/dl, 75 g OGTT according to WHO criteria was performed. 241 women have abnormal screening test and in 181 cases blood glucose were at range 140-160 mg/dl, in 39 at range 160-180 and 21 were > 180 mg/dl. Only 14 women in the first group (140-160 mg/dl) have diagnosed GDM (7.7%). In second group 24 pregnant women have GDM (61.5%). Overall GDM incidence is shown to be 3.7% (57 women). The mean age for the GDM was 28.8 +/- 0.9 years compared with 26.4 +/- 0.4 years (p < 0.05) uncomplicated pregnancy.     

Ectopic pregnancy diagnosis in very high risk patients

SETTING: Hepatosplenic abscesses in neutropenic patients, especially during the recovery phase, are almost always attributed to fungal infections. We report similar lesions due to Mycobacterium tuberculosis in neutropenic patients in a tertiary care centre in India. OBJECTIVE: To characterize the features of hepatosplenic tuberculosis in neutropenic patients. DESIGN: Retrospective comparison of disease pattern and response to treatment of hepatosplenic tuberculosis in febrile neutropenia patients (four of 30 with severe prolonged neutropenia) and in non neutropenic patients diagnosed during the same 12-month period (n = 4, control group). RESULTS: The disease in the neutropenic patients typically presented during the recovery phase of neutropenia, with ultrasonic abnormalities similar to those seen in hepatosplenic fungal infections. In contrast to the marked organomegaly and typical granulomatous response found in the control group, the disease in the neutropenic patients was characterised by an absence of organomegaly, non-involvement of other sites, poor inflammatory response and a high bacillary load. The initial response to therapy was satisfactory in both groups. CONCLUSION: Tuberculosis needs to be considered in the diagnostic work-up of hepatosplenic abscesses that occur during the recovery phase of neutropenia.     

Decreased stature in gestational diabetes mellitus

Short stature has been associated with various degrees of abnormal glucose tolerance in middle-aged people, where the effects of age and metabolic control would be difficult to exclude. We chose to examine body stature in women with gestational diabetes mellitus (GDM), a prediabetic state affecting a young group of people. A sample of 2772 Greek pregnant women, referred for GDM screening was examined. After a 100-g oral glucose tolerance test, 1787 women were classified as normal (N), 300 women were found with one abnormal glucose value (OAV) and 685 women with GDM. Basal insulin resistance was calculated in 640 women by homeostasis model assessment. In addition, 51 pregnant women with pre-existing Type II (non-insulin-dependent) diabetes mellitus and 109 with pre-existing Type I (insulin-dependent) diabetes mellitus were included in the study. There was a gradual decrease in mean height (cm) as glucose intolerance became more severe: N: 161.0 +/- 6.2, OAV:160.2 +/- 6.1, GDM:158.7 +/- 6.3, Type II diabetes 158.2 +/- 7.0 (p < 0.001, analysis of variance]. Height in Type I diabetes (160.1 +/- 5.9) did not differ from the normal group. The difference in height between the normal and GDM groups remained (p < 0.001) when body weight, age, birth before or after 1960 and educational status were also taken into account. An independent correlation was also found between height and insulin resistance (n = 640) adjusted for the above mentioned variables. In conclusion, short stature appears to be associated with glucose intolerance as an independent variable, even when this intolerance is both mild and temporary. The previously unrecognised independent association of stature with basal insulin resistance merits further investigation.     

The prevalence of non-insulin-dependent diabetes mellitus and the associated risk factors in a population of Mexico, D. F

Non-insulin-dependent diabetes mellitus (NIDDM) is a chronic disabling disease, that shortens length of life and implies a high burden for a community. Its prevalence goes from 0 per cent in Papua, New Guinea to 34 per cent in Pima Indians. There are very few prevalence studies in Mexico, and the strength of association of the known risk factors with the occurrence of the disease is not established. A prevalence cross sectional study was carried out with users of a first level medical care unit, with a meter measure of capillary glucose levels. Those with a previous diagnosis of diabetes or whose capillary glucose level were 200 mg or over were considered diabetics. Hyperglycemia was when the levels were recorded between 121 and 199 mg. The crude prevalence of NIDDM was 5.6 per cent (CI 95% 4.5-6.8), With almost no sex difference. Hyperglycemia prevalence was 2.9 per cent (CI 95% 2.0-3.7). Age was the main risk factor for the development of NIDDM. Those between 40 and 59 years showed a high risk (OR 10.8; CI 95% 5.4-22.0; p < 0.0001), and it was greater for the 60 years or elder (OR 20.6; CI 95% 9.8-44.1; p < 0.0001). Weight was also an important risk factor, with a 2.7 fold greater risk for obese persons (CI 95% 1.6-4.6; p < 0.0001). Other, risk factors were familiar history of diabetes (OR 1.5; CI 95% 0.9-2.3; p = 0.096), and overcrowding (OR 1.9; CI 95% 1.0-3.4; p = 0.03). In order to analyze independently each variable, a logistic regression model was applied, and a similar strength of association was observed for the crude model, but for obesity whose effect was modified by age. When only new cases were analyzed in the former model, the association with obesity was maintained. There is a need to develop prevalence studies of NIDDM in Mexico and to measure the strength of association with the known and the not jet well known risk factors of this disease in order to establish health policies according to the Mexican reality.     

The extent of undiagnosed gestational diabetes mellitus in New South Wales

Rapid, accurate seating of screw-retained implant abutment heads, where timing is controlled by internal or external hex designs, can be readily accomplished with individual, custom-cast abutment head location devices. The devices are especially useful when the abutment head-implant body complex is to be permanently cemented. The use and design of abutment seating jigs for single tooth implants and completely implant or implant and natural tooth-supported prostheses are described.     

Determinants of plasma anti-oxidant vitamin levels in a population at high risk for stomach cancer

A high-performance liquid chromatographic method was developed for the determination of a new antiulcer agent, YJA-20379-2, in human plasma and urine. The sample preparation was simple: 2.5-volume of acetonitrile was added to the biological sample to deproteinize. A 50-microliter aliquot of the supernatant was injected onto a C18 reversed-phase column. The mobile phase employed was methanol-0.1M S?rensen phosphate buffer of pH 7.0-H2O (75:2:25, v/v/v), and was run at a flow-rate of 1.0 ml/min. The column effluent was monitored by ultraviolet detector at 295 nm. The retention time for YJA-20379-2 was approximately 7.0 min. The detection limits for YJA-20379-2 in human plasma and urine were both 100 ng/ml. The coefficients of variation of the assay (within-day and between-day) were generally low (below 9.16%) for both the human plasma and urine. No interference from endogenous substances was found.     

Screening for gestational diabetes mellitus: a critical review

Bovine haptoglobin, which has been recognized as an acute phase protein following tissue injury and inflammation, was detected as a 33 k + 20 k Dalton fraction in the sera from calves transported by road for 2 days. The sera also possessed suppressive activity on lymphocyte proliferative response to concanavalin A. A significant correlation (r = 0.57, P < 0.05) was observed between haptoglobin concentrations and lymphocyte suppression in the sera. Furthermore, the haptoglobin fraction obtained from acute phase sera exerted dose-dependent suppression on lymphocyte blastogenesis. These circumstantial data suggest the possible involvement of bovine haptoglobin, at least in part, as an immunomodulator in serum suppression of lymphocyte blastogenesis in transported calves.     

Hysteroscopic endometrium ablation to avoid hysterectomy in "high risk" patients

Hysteroscopic endometrial ablation under maximal anaesthesiological surveillance was performed in 34 high-risk patients to avoid hysterectomy. It was a collective of patients with heavy thrombo-embolic or thrombotic disease, either under permanent anticoagulation due to residual disease or multiple endoprosthetic treatment, or with endogenous coagulopathy. In all these women, hysterectomy was either a relative or an absolute contraindication. In 22 patients, treatment resulted in complete amenorrhoea or at least hypomenorrhoea (without menometrorrhagia) respectively cyclic spotting. In 6 further patients, amenorrhoea was achieved after a repeat procedure. Endometrial ablation was thus successful in 28 of 34 cases. In these patients, hysterectomy with the risk of major or even lethal complications, could thus be avoided. Hysterectomy, however, had to be performed in 2 women with extensive adenomyosis uteri interna. Within two respectively three years after endometrial ablation, two other patients died from causes unrelated to the surgical intervention (cardiac infarction, cerebral haemorrhage). Follow-up ranged from 1 to 5 years. Hysteroscopic endometrial ablation proved an effective therapeutic option in this selected group of patients. Other indications require further study.     

Usefulness of a breakfast test in the management of women with gestational diabetes

OBJECTIVE: To assess the usefulness of a breakfast test in determining which women with gestational diabetes do not need self-monitoring of blood glucose levels (home monitoring). METHODS: A 1-hour post-standardized breakfast blood glucose below 7.8 mmol/L (140 mg/dL) was measured in 227 women and at or above 7.8 mmol/L in 115. Within each group, women were randomized to home monitoring with a meter or to clinic follow-up. Target glucose values were 5.3 mmol/L (95 mg/dL) fasting, 5.6 mmol/L (101 mg/dL) before meals, and 7.8 mmol/L (140 mg/dL) 1 hour postprandial. Up to these thresholds women on clinic follow-up were transferred to home monitoring. Insulin therapy was started on the same thresholds in women randomized or transferred to home monitoring. Large for gestational age (LGA) newborns represented the main outcome, with the transfer rate to home monitoring and need of insulin therapy the secondary ones. RESULTS: The LGA delivery rate was not significantly different in the two follow-up groups in women with a breakfast result below 7.8 mmol/L (9.8 versus 4.3%) but was higher in the clinic follow-up among women with a breakfast result at or above 7.8 mmol/L (13.3% versus 30.9%; P < .05). Fewer women with a breakfast result below 7.8 mmol/L were transferred to home monitoring (2.6 versus 52.7%; P < .001) or started on insulin therapy (3.6 versus 25.2%; P < .001). The breakfast test cutoff of 7.8 mmol/L predicted insulin need with a sensitivity of 91.0% and a specificity of 72.0% CONCLUSION: A breakfast test is useful in identifying a low-risk population in which clinic follow-up may be used safety.     

The association between a family history of type 2 diabetes and coronary artery disease in a type 1 diabetes population

The plasma protein beta2-glycoprotein I (beta2-GPI) is a major target of autoantibodies in patients with the antiphospholipid syndrome. To understand the physiological function of beta2-GPI and its potential role in the pathophysiology of the antiphospholipid syndrome, the binding of beta2-GPI to phospholipid membranes was characterized. The interaction of beta2-GPI with unilamellar vesicles containing varying amounts of acidic phospholipids with phosphatidylcholine (PC) was measured at equilibrium via relative light scattering. Analysis of binding isotherms gave apparent Kd values ranging from approximately 5.0 to 0.5 microM over a range of 5-20 mol % anionic phospholipid. Inhibition of binding by increasing ionic strength and Ca2+ ions suggests that binding is primarily electrostatic. These data indicate that beta2-GPI binding to membranes with physiological anionic phospholipid content is relatively weak in comparison to plasma coagulation proteins, suggesting that beta2-GPI does not function as a physiological anticoagulant based on its phospholipid-binding properties.