The diabetes prevention program.
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Body Weight↗
Biomedical subjects
A I Adler
Publications and source records attributed to A I Adler.
Diabetes and impaired glucose tolerance in three Alaskan Eskimo populations. The Alaska-Siberia Project.
OBJECTIVE: The objectives of this study were to determine the prevalence of diabetes and impaired glucose tolerance (IGT) in three Alaskan Eskimo populations, using standardized diagnostic criteria, and to evaluate family history and obesity as risk factors. RESEARCH DESIGN AND METHODS: This cross-sectional study involved men and women > or = 25 years of age from three Eskimo ethnic groups (Siberian Yupik, Central Yupik, and Inupiat) residing in northwestern Alaska. Glucose tolerance status was defined by World Health Organization criteria and was based on a 75-g oral glucose tolerance test. Data on age, family history of diabetes, and degree of Eskimo ancestry were obtained from a personal interview. Obesity was assessed using BMI. RESULTS: A total of 454 of 899 (50.5%) eligible participants were examined for diabetic status (239 Siberian Yupik, 106 Central Yupik, and 109 Inupiat participants). The prevalence of diabetes was more than twice as high among the Siberian Yupik (9.6%) as among the Central Yupik (2.8%) and Inupiat participants (3.7%). Diabetes was more prevalent in women than men (8.8 vs. 4.2%). IGT was found in an additional 11.7% of the women and 4.7% of the men. The combined prevalence of diabetes and IGT in the population > or = 55 years of age was 30.4% (diabetes 12.0%, IGT 18.4%). Of the people identified with diabetes, 47% had not been previously diagnosed. Age-specific prevalences were similar to those found in U.S. whites in the National Health and Nutrition Examination Survey II. After adjustment for age, family history of diabetes was associated with diabetes in study participants with an odds ratio of 4.4, while obesity was associated with diabetes with an odds ratio of 2.6. CONCLUSIONS: These prevalences of diabetes are the highest yet reported among Eskimo populations. Obesity and family history of diabetes are associated with increased odds of developing diabetes. These data underscore the need to further examine risk factors and to design effective interventions.
Adult↗
Glucose tolerance and insulin-resistance syndrome among St. Lawrence Island Eskimos.
OBJECTIVES: Non-insulin-dependent diabetes mellitus (NIDDM) prevalence in Alaska Natives is rising but remains lower than the U.S. average. We conducted a screening study for diabetes mellitus and cardiovascular disease in a remote Yup'ik Eskimo community in Alaska. RESEARCH DESIGN AND METHODS: The study population included Siberian Yup'ik Eskimo residents of Gambell, Alaska, > or = age 40 years who underwent a 2 h 75 gm oral glucose tolerance test interpreted by WHO criteria. Other measurements included fasting serum insulin and lipid levels, bioimpedance body fat %, body-mass-index (BMI), waist-to-hip ratio (WHR), and blood pressure. RESULTS: Of 114 eligible subjects, 65 (57%) participated. These subjects had lower mean systolic or diastolic blood pressure, lower triglyceride, and higher mean HDL cholesterol levels compared to a similarly aged U.S. all races sample. The mean fasting insulin level of 50.9 pmol/L appeared low given the high mean BMI (27.2). Six subjects had NIDDM (9%, 95% CI 2%-16%) and eight had impaired glucose tolerance (IGT) (12%, 95% CI 4%-20%). Compared to normoglycemic subjects, diabetic subjects were more frequently female (83% vs 53%) and had higher mean systolic BP (138 mm Hg vs 117 mm Hg) than normoglycemic subjects. We used multiple regression to analyze associations between fasting insulin and either blood pressure or serum lipids, while adjusting for % body fat, WHR, age, sex, and antihypertensive medication use. Fasting insulin was significantly related to both diastolic blood pressure (p = .0430) and fasting serum triglyceride (p = .0182) but not to systolic BP, total cholesterol, or LDL and HDL subfractions. CONCLUSIONS: Although NIDDM prevalence was not high compared to non-Native U.S. residents, elements of the insulin-resistance syndrome exist in this subarctic population.
Adult↗
Diabetes complications and mortality among Alaska Natives: 8 years of observation.
OBJECTIVE: To determine the prevalence and incidence of diabetes in Alaska Natives and the incidence of cerebrovascular accidents (stroke), myocardial infarction (MI), end-stage renal disease (ESRD), lower-extremity amputations (LEA), and mortality over a 6- to 8-year period. RESEARCH DESIGN AND METHODS: The data derive from a registry of diagnosed diabetes (World Health Organization [WHO] criteria) of the Alaska Area Native Health Service (AANHS), from medical records, and from the Alaska Bureau of Vital Statistics. RESULTS: From 1986 to 1993, the prevalence of diabetes in Alaska Natives increased by 22% from 15.7 to 19.2 per 1,000 people. Of these cases, nearly all were diagnosed with type II diabetes. During the same period, 614 new cases were diagnosed. The incidence was 1.5 per 1,000 Alaska Natives per year. The incidence of confirmed MI was 8.0 per 1,000 person-years of diabetes. Aleuts had the highest rate, followed by Indians and Eskimos. The incidence of confirmed stroke was 10.6 per 1,000 person-years of diabetes. Eskimos had a significantly higher rate than Indians (P = 0.002), and women had a higher rate than men. The incidence of LEA was 5.0 per 1,000 person-years of diabetes. The incidence rate dropped significantly after instituting a foot care program. The incidence for ESRD was 3.3 per 1,000 and also showed a decline with time. The all-cause mortality rate of 43.2 per 1,000 person-years of diabetes was nearly equal between men and women. Among Alaska Natives with diabetes, cardiovascular disease (CVD) was the most common cause of death, followed by cancer and diabetes, per se. CONCLUSIONS: We conclude that diabetes is increasing in Alaska Natives, who are experiencing both the microvascular and macrovascular complications of diabetes. The incidence of LEA and ESRD show some evidence of a decrease after intervention efforts.
Age Factors↗
Risk factors for diabetic peripheral sensory neuropathy. Results of the Seattle Prospective Diabetic Foot Study.
OBJECTIVE: To identify risk factors for diabetic lower-extremity peripheral sensory neuropathy prospectively in a cohort of U.S. veterans with diabetes. RESEARCH DESIGN AND METHODS: General medicine clinic outpatients with diabetes were followed prospectively for the development of insensitivity to the 5.07 monofilament on the foot. RESULTS: Of 775 subjects, 388 (50%) had neuropathy at baseline. Of the 387 subjects without neuropathy at baseline, 288 were followed up, and of these, 58 (20%) developed neuropathy. Multivariate logistic regression modeling of prevalent neuropathy controlling for sex and race revealed independent and significant associations with age, duration of diabetes, glycohemoglobin level, height, history of lower-extremity ulceration, callus, and edema; an independent and inverse correlation was noted with ankle-arm index. Risk factors for incident neuropathy in multivariate logistic regression included age, baseline glycohemoglobin level, height, history of ulcer, and CAGE screening instrument alcohol score; current smoking and albumin level were inversely associated with risk. CONCLUSIONS: Poorer glycemic control increases the risk of neuropathy and is amenable to intervention. Height and age directly increase risk of neuropathy and may help identify patients at risk. A proportion of neuropathy in diabetic veterans is probably due to or worsened by alcohol ingestion. Neuropathy was less common in current smokers than subjects not currently smoking.
Age Factors↗
The negative association between traditional physical activities and the prevalence of glucose intolerance in Alaska Natives.
The once low prevalence of non-insulin-dependent (Type 2) diabetes (NIDDM) in Eskimos and Indians has risen approximately fourfold over the past 30 years, suggesting the presence of a non-genetic factor affecting NIDDM prevalence. At the same time, traditional physical activities required of a subsistence (self-sufficiency) lifestyle have diminished. Since physical activity has been shown to prevent NIDDM in other populations, we performed a case-control study of physical activity and glucose intolerance in 666 Yup'ik Eskimos and Athabaskan Indians > or = 40 years old in 15 villages in the Yukon Kuskokwim Delta in Alaska. Self-administered questionnaires were used to determine whether subjects participated in a number of traditional activities and/or their modern counterpart (for example, dog sledding and riding motorized vehicles). Intensity values and a score were defined for the activities. Cases included known or newly discovered impaired glucose tolerance or NIDDM. Newly discovered cases were defined by oral glucose tolerance testing of those individuals were screening blood glucose values > or = 6.7 mmol l-1 by random capillary blood glucose testing. Cases included 11 newly discovered (1 with a history of IGT) and 26 known cases of NIDDM, and 17 newly discovered and 1 known cases of IGT. The results showed that, compared to a reference group with low-level physical activity, moderate level physical activity (odds ratio, OR, 0.7, 95% confidence interval [CI] 0.4-1.3) and high level activity (OR 0.2, CI 0.1-0.6) were associated with a lower prevalence of glucose intolerance, adjusted for age, ethnicity, body mass index, and sex.
Age Distribution↗
Is diabetes mellitus a risk factor for ovarian cancer? A case-control study in Utah and Washington (United States).
Insulin resistance characterizes non-insulin dependent diabetes (NIDDM). Insulin resistance may coexist in clinical syndromes with hyperestrogenism and hyperandrogenism, suggesting that the ovary may be sensitive to effects of insulin. In addition, insulin-like growth factor-I receptors, which are capable of binding insulin, have been identified in ovarian cancer tissue and are proposed to regulate cell growth. We evaluated the association between a history of diabetes mellitus and ovarian cancer in a case-control study in seven counties in Washington and in Utah (United States) during the years 1975-87. Cases included women newly diagnosed with ovarian cancer over a five-year period who were identified through population-based cancer reporting. Controls similar to cases with regard to age and county of residence were identified via household surveys or random digit dialing. The study included 595 cases and 1,587 controls. Twenty-seven cases (4.5 percent) and 72 controls (4.5 percent) reported a history of diabetes. Logistic regression analysis of the association between diabetes and ovarian cancer controlling for age, body mass index, and race resulted in an odds ratio (OR) of 0.9 (95 percent confidence interval [CI] = 0.6-1.5). The OR was not changed with further controlling for prior oral contraceptive use or prior pregnancy. None of the 20 women with nonepithelial tumors (15 of which were stromal tumors) had a history of diabetes (upper CI = 4.0). These results, together with findings of two earlier cohort studies, do not support the hypothesis that diabetes is a risk factor for epithelial ovarian cancer.
Adult↗
Human furuncular myiasis caused by Hermetia illucens (Diptera: Stratiomyidae).
Cutaneous myiasis caused by Hermetia illucens (L.) has not been reported previously. We present a case of facultative furuncular myiasis characterized by infestation with a single larva in a woman from Seattle, WA, who had traveled to East Africa.
Adult↗
Toxic 'sock' syndrome bezoar formation and pancreatitis associated with iron deficiency and pica.
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Acute Disease↗
Lower prevalence of impaired glucose tolerance and diabetes associated with daily seal oil or salmon consumption among Alaska Natives.
OBJECTIVE: To examine the association of seal oil and salmon consumption with impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) among Alaska Natives. RESEARCH DESIGN AND METHODS: Screening was performed on 666 Yup'ik Eskimos and Athabaskan Indians > or = 40 years old in 15 villages. Self-administered questionnaires were used to obtain partial food frequency data. A case was defined as IGT or NIDDM, either newly discovered or known. Newly discovered cases (11 patients with NIDDM and 17 with IGT) were determined by random blood glucose testing followed by a 2-h 75-g oral glucose tolerance test (OGTT) for those with values > or = 6.72 mmol/l or for subjects with unconfirmed histories of glucose intolerance. Known cases included 26 patients with NIDDM and 1 with IGT. Control subjects had random blood glucoses < 6.72 or normal OGTT results. RESULTS: Compared with less-than-daily consumption, both daily seal oil (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1-0.8) and daily salmon consumption (OR 0.5, CI 0.2-1.1) were associated with a lower prevalence of glucose intolerance, controlling for age, ethnicity, body mass index, and sex. The effects were similar when limited to newly discovered cases: OR 0.3, CI 0.1-1.3 for seal oil and OR 0.4, CI 0.1-1.3 for salmon. Consumption of seal oil at least five times per week was required to reduce risk. CONCLUSIONS: Consumption of seal oil and salmon, high in omega-3 fatty acids, appears to lower the risk of glucose intolerance and is a potentially modifiable risk factor for NIDDM in Alaska Natives.
Adult↗
An outbreak of mud-wrestling-induced pustular dermatitis in college students. Dermatitis palaestrae limosae.
OBJECTIVE: To investigate an outbreak of gram-negative folliculitis in relation to a common exposure, mud wrestling, and identify risk factors for dermatitis among those who mud wrestled. DESIGN: Case-control study. SETTING: University of Washington, Seattle. PARTICIPANTS: Two college-residence groups of students. RESULTS: Cultures from affected students and from mud similar to that used for wrestling yielded Enterobacteriaceae. The odds ratio associated with mud wrestling was 79.5 (95% confidence interval, 13.9 to 895.4). Increased time spent wrestling was associated with increased risk. Skin trauma during wrestling or immersion in the mud increased the risk of infection (odds ratio, 23.1; 95% confidence interval, 1.7 to 1440.4). CONCLUSIONS: Mud wrestling is one cause of pustular follicular dermatitis. Trauma to the skin may be a necessary cofactor for the development of infection.
Adolescent↗