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- Östgren, Carl Johan, et al.
(författare)
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Associations between smoking and beta-cell function in a non-hypertensive and non-diabetic population. Skaraborg Hypertension and Diabetes Project
- 2000
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Ingår i: Diabetic Medicine. - : Wiley. - 1464-5491 .- 0742-3071. ; 17:6, s. 445-450
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: An increased risk for Type 2 diabetes in male and female smokers has been associated with insulin resistance. However, this might also be the result of an adverse effect on the beta-cell. The aim of the present study was to examine the association between smoking and beta-cell function. METHODS: A community-based, cross-sectional observation study. In 1994, a randomized age-stratified sample of men and women aged > or = 40 years in the city of Skara, Sweden, were invited to a survey of cardiovascular risk factors. In all, 1,109 subjects participated (80%). After the exclusion of subjects with known hypertension or diabetes mellitus, 874 subjects remained to explore. Samples were drawn after an overnight fast. Lifestyle (smoking, physical activity, alcohol consumption) was assessed using a questionnaire. Insulin resistance and insulin secretion were estimated using the homeostasis model assessment (HOMA). RESULTS: Cigarette smoking men (n = 101) had a lower HOMA beta-cell value (58.1), than never-smokers (n = 158, beta-cell value 90.1, P < 0.001). The difference remained with adjustments for age, body mass index, daily alcohol intake and physical exercise habits: 25.9 (95% confidence interval (CI) 9.7-38.8, P = 0.003). Correspondingly, in men the HOMA beta-cell value was lower in current smokers than in ex-smokers (difference 24.3, 95% CI 11.1-35.2, P < 0.001). In women, no significant difference appeared in beta-cell function vs. different smoking status. There was no association between smoking status and insulin resistance. CONCLUSIONS: At least in men, smoking may interfere with beta-cell function. The prevention of Type 2 diabetes should include strategies to stop smoking.
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| 3. |
- Östgren, Carl Johan, et al.
(författare)
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Atrial fibrillation and its association with type 2 diabetes and hypertension in a Swedish community.
- 2004
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Ingår i: Diabetes, Obesity and Metabolism. - : Wiley. - 1462-8902 .- 1463-1326. ; 6:5, s. 367-374
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore the prevalence of atrial fibrillation in patients with hypertension and type 2 diabetes and to identify possible mechanisms for the development of atrial fibrillation. Methods: A community-based, cross-sectional observational study was conducted in the primary health care in Skara, Sweden, and 1739 subjects (798 men, 941 women) were surveyed. Patients were categorized as those with hypertension only (n = 597); those with both hypertension and type 2 diabetes (n = 171), and those with type 2 diabetes only (n = 147). In the reference population, 824 normotensive subjects without diabetes were identified and used as controls. Participants were examined for cardiovascular risk factors including fasting blood glucose, serum insulin, blood pressure, lipids and anthropometric measures. Resting electrocardiogram (ECG) was recorded and Minnesota-coded. Insulin resistance was measured by the homeostasis model assessment (HOMA). Results: Age-adjusted prevalence of atrial fibrillation was 2% in patients with hypertension only, 6% in patients with both hypertension and type 2 diabetes, 4% in patients with type 2 diabetes only and 2% in controls, respectively. Age and sex adjusted odds ratios (OR) (95% CI) were; hypertension 0.7 (0.30-1.5), combined hypertension and type 2 diabetes 3.3 (1.6-6.7), and type 2 diabetes 2.0 (0.9-4.7). The association with combined hypertension and type 2 diabetes remained significant when adjusted for cardiovascular disease (CVD) risk factors and body mass index (BMI), was attenuated with adjustment for ischemic ECG; 2.4 (1.1-5.0) and lost significance with adjustment for insulin resistance; 1.3 (0.5-3.1). Conclusions: Atrial fibrillation is associated with the combined occurrence of type 2 diabetes and hypertension. Insulin resistance may be a common underlying mechanism.
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| 4. |
- Östgren, Carl Johan, et al.
(författare)
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Glycaemic control, disease duration and beta-cell function in patients with Type 2 diabetes in a Swedish community. Skaraborg Hypertension and Diabetes Project.
- 2002
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Ingår i: Diabetic Medicine. - : Wiley. - 1464-5491 .- 0742-3071. ; 19:2, s. 125-129
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Tidskriftsartikel (refereegranskat)abstract
- AimsTo examine determinants for glycaemic control in primary care patients with Type 2 diabetes. MethodsIn a community-based surveillance of primary care patients with Type 2 diabetes, 190 men and 186 women were consecutively identified and examined for cardiovascular risk factors. Insulin resistance and beta-cell function were estimated using homeostasis model assessment (HOMA). Good glycaemic control was defined as HbA1c < 6.5%. ResultsFollowing adjustment for age and gender, HbA1c>= 6.5% was associated with duration of diabetes (10.6 vs. 6.4 years, P < 0.001), lower levels of serum insulin (6.3 vs. 8.0 mU/l, P = 0.012), higher serum triglyceride levels (2.0 vs. 1.7 mmol/l, P = 0.002) and impairment of beta-cell function (HOMA index 19.5 vs. 45.8, P < 0.001). The association between HbA1c levels and duration remained with adjustment for age, gender, waist-hip ratio (WHR) and serum triglycerides (odds ratio (OR) for HbA1c>= 6.5% by 5 years diabetes duration = 1.7; 95% confidence interval (CI) 1.4-2.1) but was lost following additional adjustment for beta-cell function (OR for HbA1c>= 6.5% = 1.3; 95% CI 0.96-1.7). In a separate linear regression with beta-cell function as the dependent variable there was a significant association with HbA1c after adjustments for differences in age, gender, WHR, serum triglyceride levels and diabetes duration (P < 0.001). ConclusionsIncreasing HbA1c by time was associated with declining beta-cell function.
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| 8. |
- Östgren, Carl Johan
(författare)
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Type 2 Diabetes in a Defined Population The Skaraborg Hypertension and Diabetes Project
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To examine cardiovascular risk factors, glycaemic control and survival in patients with type 2 diabetes mellitus (T2DM) treated in primary care, patients with T2DM and a randomised age-stratified sample of men and women aged ≥40 years living in the same community were surveyed 1992-1994. ß–Cell function and insulin resistance were estimated using the Homeostasis Model Assessment (HOMA). Vital status was ascertained until year 2000. In men without hypertension and diabetes, cigarette-smoking was independently associated with impaired ß–cell function (p=0.003). Patients with both T2DM and hypertension (n=204, 51%) had higher BMI, higher serum triglycerides, higher LDL/HDL cholesterol ratio, higher fasting serum insulin, but better ß–cell function (p<0.001) and lower HbA1c (6.4% vs 6.8%, p=0.009) than patients with T2DM alone. HbA1c ≥6.5% was associated with a longer diabetes duration and impaired ß–cell function (p<0.001). In both genders together, all-cause mortality was predicted by HbA1c, dyslipidaemia, prevalent hypertension (RR = 1.72; 95% CI 1.21 - 2.44), microalbuminuria (RR = 1.87; 95% CI 1.27 – 2.76) and previous cardiovascular disease. The common Pro12Ala polymorphism in Peroxisome Proliferator-Activated Receptor-g was associated with lower diastolic blood pressure (D = 4.4; 95% CI 1.3 - 7.4) in men with T2DM. Patients with both T2DM and hypertension are characterised by an atherogenic risk factor profile related to the insulin resistance syndrome while those without hypertension are distinguished by an impaired ß–cell function. Both life-style and genetic factors contribute to the outcome in patients with T2DM.
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