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Biomedical subjects

M I Harris

Publications and source records attributed to M I Harris.

At least 55 records · Page 3Linked to original sources
PubMed1993

Effect of multiple risk factors on differences between blacks and whites in the prevalence of non-insulin-dependent diabetes mellitus in the United States.

The higher prevalence of non-insulin-dependent diabetes mellitus (NIDDM) in US blacks as compared with whites may be due to a higher frequency of NIDDM risk factors in blacks, a higher inherent susceptibility to NIDDM among blacks, or the risk factors' having a greater effect in blacks. The authors evaluated 4,379 subjects from the Second National Health and Nutrition Examination Survey (1976-1980) for whom NIDDM was ascertained by medical history and oral glucose tolerance test, and for whom data on a number of risk factors were available. The prevalence of NIDDM was 60% higher in blacks than in whites (p < 0.001) and was highest in black women. Although most risk factors for NIDDM were more common in blacks, this higher frequency did not completely explain the racial disparity in the prevalence of NIDDM. After adjustment for all risk factors by logistic regression, an elevated risk of NIDDM was particularly evident at higher obesity levels in blacks as compared with whites; the odds were 70% higher for blacks at a percentage of desirable weight of 150 (95% confidence interval 1.1-2.8). The risk of NIDDM associated with obesity was greatest in black women: The odds in this group were sevenfold higher at a percentage of desirable weight of 150 versus 100 (95% confidence interval 2.6-18.8). The possibility of racial differences in metabolic adaptation to obesity highlights the importance of preventing this condition in blacks, particularly in black women.

Adult↗
PubMed1993

Attitudes and behaviors of primary care physicians regarding tight control of blood glucose in IDDM patients.

OBJECTIVE--To evaluate attitudes and practices of primary-care physicians toward tight blood glucose control in IDDM. RESEARCH DESIGN AND METHODS--A mail and telephone questionnaire survey was conducted on a systematic, stratified sample of 1429 family-practice physicians, general practitioners, internists, and pediatricians in active practice in the United States who treated patients with IDDM. Physicians were asked about methods they used for clinical and laboratory assessment of blood glucose control and about their attitudes and beliefs in treating IDDM. They were asked also what they consider to be acceptable ranges for blood glucose and HbA1 in IDDM patients. A score was developed reflecting three criteria for tight blood glucose control: fasting glucose 70-120 mg/dl (3.9-6.7 mM), 2-h postprandial glucose < 180 mg/dl (< 10 mM), and HbA1 < or = 8% (the nondiabetic value was specified as 5-7%). Physicians were accorded one point when their acceptable range agreed with an intensive treatment criterion (range for score 0-3). RESULTS--Only 31% of physicians agreed with all three criteria for tight control of blood glucose; 37% agreed with none or only one of the standards. Pediatricians were particularly low in their agreement with the HbA1 standard. Physicians who agreed with one of the three criteria often did not agree with the other two. With increasing value for the score, there was a greater proportion of physicians whose management practices (e.g., frequent measurement of HbA1, multiple insulin injections, patient SMBG, use of dietitian/educator in care of patients) are conducive toward tight control of blood glucose. However, even among physicians with a score of 3, HbA1 was ordered infrequently, three or more insulin injections/day was prescribed rarely, patient SMBG was less than fully endorsed, and both a dietitian and diabetes educator were used by a minority of physicians. CONCLUSIONS--It appears that primary-care physicians are not fully aware of recommended criteria for intensive treatment of blood glucose in IDDM patients or of the importance of multiple insulin injections, use of HbA1, and patient SMBG. Physician practice behaviors are less than optimal for intensive management of IDDM patients, even among physicians who agree with all three standards for intensive treatment of blood glucose in IDDM.

Attitude of Health Personnel↗
PubMed1993

Self-monitoring of blood glucose by adults with diabetes in the United States population.

OBJECTIVE: To evaluate self-monitoring of blood glucose, which is considered an important practice for patients with diabetes. However, little is known about the frequency or determinants of this technique. RESEARCH DESIGN AND METHODS: A detailed questionnaire on diabetes was administered to a representative sample of 2405 diabetic subjects > or = 18 yr of age in the U.S. population in the 1989 National Health Interview Survey. RESULTS: Among subjects with IDDM, 40% monitored their blood glucose at least 1 time/day. Among subjects with NIDDM treated with insulin, 26% monitored at least 1 time/day and among NIDDM subjects not treated with insulin, the percentage was 5%. When stratified by age, little difference was observed between IDDM subjects and insulin-treated NIDDM subjects in the percentage testing at least 1 time/day. By multivariate analysis, age and insulin use were the major determinants of whether diabetic subjects tested their blood glucose. Race and education were also independently related to self-monitoring of blood glucose. Blacks were 60% less likely to test their blood glucose at least 1 time/day compared with non-Hispanic whites and Mexican Americans. Those with college education were 80% more likely to test their blood glucose compared with those with lower education levels. Having had a patient education class in diabetes management and frequent physician visits for diabetes care were positively related to self-testing. Self-monitoring was not related to higher income or having health insurance. CONCLUSIONS: A large proportion of patients with diabetes do not test their blood glucose. Financial barriers associated with income and health insurance do not appear to impede the practice of self-monitoring. Because of the importance of blood glucose control in the prevention of diabetes complications and the role of self-monitoring in achieving blood glucose control, it may be prudent for physicians and their patients to make greater use of this technique. Special attention should be directed to the subgroups of patients (blacks, patients not treated with insulin, those with less education, and those with no education in diabetes) in which the frequency of self-monitoring is particularly low.

Adult↗
PubMed1992

Onset of NIDDM occurs at least 4-7 yr before clinical diagnosis.

OBJECTIVE: To investigate duration of the period between diabetes onset and its clinical diagnosis. RESEARCH DESIGN AND METHODS: Two population-based groups of white patients with non-insulin-dependent diabetes (NIDDM) in the United States and Australia were studied. Prevalence of retinopathy and duration of diabetes subsequent to clinical diagnosis were determined for all subjects. Weighted linear regression was used to examine the relationship between diabetes duration and prevalence of retinopathy. RESULTS: Prevalence of retinopathy at clinical diagnosis of diabetes was estimated to be 20.8% in the U.S. and 9.9% in Australia and increased linearly with longer duration of diabetes. By extrapolating this linear relationship to the time when retinopathy prevalence was estimated to be zero, onset of detectable retinopathy was calculated to have occurred approximately 4-7 yr before diagnosis of NIDDM. Because other data indicate that diabetes may be present for 5 yr before retinopathy becomes evident, onset of NIDDM may occur 9-12 yr before its clinical diagnosis. CONCLUSIONS: These findings suggest that undiagnosed NIDDM is not a benign condition. Clinically significant morbidity is present at diagnosis and for years before diagnosis. During this preclinical period, treatment is not being offered for diabetes or its specific complications, despite the fact that reduction in hyperglycemia, hypertension, and cardiovascular risk factors is believed to benefit patients. Imprecise dating of diabetes onset also obscures investigations of the etiology of NIDDM and studies of the nature and importance of risk factors for diabetes complications.

Australia↗
PubMed1991

Hypercholesterolemia in diabetes and glucose intolerance in the U.S. population.

The prevalence of hypercholesterolemia, according to the guidelines of the National Cholesterol Education Program, has been determined in a national survey of diabetes and glucose intolerance. Rates of elevated total cholesterol in people with diabetes in the United States are only slightly greater than in those without diabetes after adjusting for age and sex. Nevertheless, high or borderline high total cholesterol is common in diabetes and is present in 70% of adults with diagnosed diabetes and 77% with undiagnosed diabetes in the U.S. population. Of these individuals, 95% have evidence of coronary heart disease or two or more risk factors for heart disease and should therefore have their low-density lipoprotein (LDL) cholesterol measured. Based on our national data, LDL cholesterol levels warranting dietary treatment for hypercholesterolemia would be expected in 85% of these people. Although elevated LDL cholesterol is uncommon in people with diabetes who have total cholesterol of less than 200 mg/dl, other risk factors for coronary heart disease are very frequent (100% of men, 73% of women), and low total and LDL cholesterol may mask low high-density lipoprotein cholesterol. Therefore, investigation of blood lipid levels and coronary heart disease risk factors should be routine in all patients with diabetes, and treatment strategies should include management of lipid disorders and the multiple other risk factors for coronary heart disease that are highly prevalent in these patients.

Adult↗
PubMed1991

Prevalence of diabetes in Mexican Americans, Cubans, and Puerto Ricans from the Hispanic Health and Nutrition Examination Survey, 1982-1984.

The purpose of this study was to estimate the prevalence of diagnosed and undiagnosed diabetes among Mexican Americans, Cubans, and Puerto Ricans in the United States and compare these estimates to data from prior surveys for U.S. non-Hispanic whites and blacks. Data for this study are from the Hispanic Health and Nutrition Examination Survey, a multipurpose cross-sectional survey of three U.S. Hispanic populations conducted in 1982-1984. The interviewed sample of people aged 20-74 yr included 3935 Mexican Americans in the southwest, 1134 Cubans in Florida, and 1519 Puerto Ricans in the New York City area. The diabetes component consisted of interview questions on diabetes diagnosis and treatment and an oral glucose tolerance test administered to a subsample. The prevalence of diabetes was two to three times greater for Mexican Americans and Puerto Ricans than for non-Hispanic whites surveyed in 1976-1980. In Cubans, the prevalence was similar to that for non-Hispanic whites. In men and women 45-74 yr of age, the prevalence of diabetes was extremely high for both Mexican Americans (23.9%) and Puerto Ricans (26.1%) compared with Cubans (15.8%) or non-Hispanic whites (12%). The total prevalence of diabetes was not significantly different for Mexican Americans and Puerto Ricans but was significantly lower for Cubans. The relatively lower prevalence of diabetes among Cubans and the high prevalence in both Mexican Americans and Puerto Ricans may be related to socioeconomic, genetic, behavioral, or environmental factors.

Adult↗
PubMed1991

Epidemiological correlates of NIDDM in Hispanics, whites, and blacks in the U.S. population.

Characteristics, prevalence, and risk factors for non-insulin-dependent diabetes mellitus (NIDDM) among Hispanics, blacks, and whites aged 20-74 yr in the United States population were investigated with two national surveys that used a household interview to ascertain diagnosed diabetes and a 75-g 2-h oral glucose tolerance test to measure undiagnosed diabetes. The Hispanic Health and Nutrition Examination Survey of 1982-1984 studied Mexican Americans in the southwest U.S., Cuban Americans in the Miami, Florida, area, and Puerto Ricans in the New York City area. The National Health and Nutrition Examination Survey of 1976-1980 examined a national sample of U.S. residents, of whom data on blacks and whites were analyzed. People with diagnosed diabetes in the five populations were similar with respect to mean age (53-57 yr), age at diagnosis (45-48 yr), duration of diabetes (6.9-8.7 yr), and diabetes therapies (58-67% using pharmacological treatment). Mean age of people with undiagnosed diabetes (51-59 yr) was comparable to that of diagnosed cases, and mean fasting (7.1-7.8 mM) and 2-h postchallenge plasma glucose (14.1-15.5 mM) values for people with undiagnosed diabetes were similar among the five populations. However, obesity levels varied by race, sex, and whether diabetes was diagnosed or undiagnosed. Age-standardized prevalence of diabetes (sum of diagnosed and undiagnosed cases) was 6.2% in whites, 9.3% in Cubans, 10.2% in blacks, 13% in Mexican Americans, and 13.4% in Puerto Ricans. Thus, compared to whites, diabetes rates were 50-60% higher among Cubans and blacks and 110-120% higher among Mexican Americans and Puerto Ricans. Age-standardized rates of impaired glucose tolerance were similar among the five populations (10.3-13.8%). Increasing age, obesity, and family history of diabetes were associated with higher rates of diabetes but sex, physical activity, education, income, and acculturation were not risk factors or were only weakly associated with diabetes prevalence.

Adult↗
PubMed1990

Noninsulin-dependent diabetes mellitus in black and white Americans.

This report presents an overview of the prevalence, characteristics, morbidity, mortality, and risk factors for noninsulin-dependent diabetes (NIDDM) in Blacks and Whites in the United States. Data are drawn primarily from national surveys, but the report also includes the few clinical studies that have differentiated the two races. NIDDM constitutes 90-95% of all diabetes in the United States and is more prevalent in Black Americans than in Whites. Diabetes prevalence increases with age for both races and reaches 26% among Blacks aged 65-74 years compared with 18% among Whites. Rates of diabetes among persons aged 20-74 years are 30% higher in White women, 70% higher in Black men, and 100% higher in Black women, compared with White men. Approximately half of diabetes is undiagnosed in both races. White and Black diabetics are similar with regard to age, duration of diabetes, and diabetes therapies, although Blacks of both sexes are more obese than their White counterparts. Rates of vision loss, amputations, and renal disease are 1.5-4 times higher in Blacks than in Whites, although prevalence of hypertension is about equal in the two races. Blacks and Whites see the same physician specialists for their diabetes, but Whites have approximately 40% more visits to office-based physicians each year. Diabetes-specific mortality has declined significantly in the past decade and may now be lower in Black than in White diabetics. Risk factors for diabetes, including age, sex, obesity, and family history of diabetes, all operate within both race groups and probably interact with each other. The effect of gender and family history on rates of diabetes is similar in Blacks and Whites. Blacks have higher rates of diabetes at each obesity level, indicating that obesity alone cannot explain the differential in prevalence between the races. Impaired glucose tolerance (IGT), a strong risk factor for development of diabetes, increases with age in all race/sex groups except for Black women older than 54 years in whom rates of IGT, decline, possibly because of conversion of IGT to diabetes.

Adult↗
PubMed1990

Testing for blood glucose by office-based physicians in the U.S.

A national sample of 2879 physicians were surveyed to ascertain characteristics of patient visits for diabetes including whether any test had been ordered or provided or a specimen taken to assess the patient's blood glucose level. Based on survey data, an estimated 21.3 million visits were made for diabetes in 1985. Of these, 16.8 million were for continuing care of diabetes by primary-care physicians, an average of 2.7 visits/yr for the 6.1 million U.S. residents diagnosed as having diabetes. A test for blood glucose was associated with 69% of these visits, an average of 1.9 times/yr per patient with diabetes in the U.S. Rates of testing for blood glucose varied by source of payment for the visit and were higher when diabetes was the primary diagnosis and when the number of physicians practicing together was greater, such as in health maintenance organizations or group practices. Rates of testing did not differ by age, race, or sex of the patient; location of the physician's practice; whether insulin or oral agents were prescribed; or a number of other characteristics. Other studies indicate that self-monitoring of blood glucose is performed by less than 10% of diabetic patients. Hence, the physician's office remains an important location for assessment of diabetes control by measurement of blood glucose levels.

Adult↗
PubMed1990

Epidemiology of diabetes mellitus among the elderly in the United States.

Diabetes mellitus is one of the most common chronic diseases affecting the elderly in the United States. It has been diagnosed in 9.6% of people 65 years of age and older, and an additional 9.3% meet oral glucose tolerance test criteria for the disease but have not been diagnosed. Taken together, diagnosed and undiagnosed diabetes affects almost one in every five people 65 years of age and older. An additional 23% of the elderly meet diagnostic criteria for impaired glucose tolerance, a condition that conveys excess risk for macrovascular disease. Prevalence of diagnosed diabetes in the elderly is expected to increase 44% in the next 20 years, to an estimated population of 3.9 million people. Elderly people with diabetes make an average of 3.7 visits per year to physicians specifically for care of their diabetes. Over 80% of this care is delivered by general and family physicians and internists. About 30% of diabetics 65 to 74 years of age are hospitalized each year, a rate that is almost twice that of elderly people without diabetes. Cardiovascular and peripheral vascular complications are often twice as prevalent as among people without diabetes. Risk factors for macrovascular disease are also highly prevalent among the elderly, including obesity, hypertension, and hypercholesterolemia. Three fourths of deaths of diabetic patients 65 years of age and older are caused by diseases of the circulatory system, primarily ischemic heart disease and stroke. The death rate from cardiovascular disease among elderly diabetic patients is twice that of people without diabetes in the same age range.

Age Factors↗
PubMed1989

Intravenous BCNU and AZQ in patients with recurrent malignant gliomas.

Twenty-four patients with recurrent malignant glioma were treated with intravenous BCNU (80 mg/m2/day X 3 days) alternating with AZQ (8 mg/m2/day X 5 days) every 6-8 weeks. Twenty patients received two or more courses of chemotherapy, ten anaplastic astrocytomas (AA), eight glioblastomas (GBM), and two malignant oligodendrogliomas (Oligo). All had prior surgery and irradiation; one had prior chemotherapy. Median age was 37.5 years. The median Zubrod performance status (PS) was 1. Three patients (15%) achieved response status, and 7 (35%) had stable disease with median times to tumor progression (MTP) of 56 wks and 35 wks. MTP for patients with progression was 11 weeks. No GBM was responsive to chemotherapy and none of the ten patients with stable or responsive disease were older than fifty years. Dose limiting toxicity was consisted of thrombocytopenia and leukopenia. Young patients with recurrent AA and good PS appear more likely to respond to alternating BCNU/AZQ chemotherapy. The overall response rate (response plus stable) of 50% was comparable to that of BCNU alone and the hematologic toxicity was cumulative.

Adolescent↗
PubMed1989

Self-reported diabetes in Mexican Americans: HHANES 1982-84.

In the Hispanic Health and Nutrition Examination Survey (HHANES) of 3,928 Mexican Americans ages 20-74 years, the age-adjusted prevalence of self-reported diabetes was 6.8 percent among men and 7.6 percent among women. Comparable age-adjusted rates for the US population in a national survey were 2.9 percent in men and 3.8 percent in women. The prevalence of diabetes in Mexican Americans is greater in older age groups, was similar in men and women, and among women only was inversely associated with education.

Adult↗
PubMed1989

Evaluation of WHO and NDDG criteria for impaired glucose tolerance. Results from two national samples.

The considerable disagreement in the definition of impaired glucose tolerance (IGT) by National Diabetes Data Group (NDDG) and World Health Organization (WHO) criteria was explored in two independent representative adult population samples in Israel (n = 1119) and the United States (n = 1783). Five categories of nondiabetic glucose tolerance were defined according to fasting plasma glucose (FPG) values (mM) and 1- and 2-h plasma glucose values (PG1 and PG2, respectively) after oral glucose load: 1) normal by WHO and NDDG (FPG less than 6.4 mM, PG1 less than 11.1 mM, PG2 less than 7.8 mM), 2) Normal by WHO, nondiagnostic by NDDG (FPG 6.4-7.7 mM, PG1 less than 11.1 mM, PG2 less than 7.8 mM), 3) normal by WHO, nondiagnostic by NDDG (FPG less than 7.8 mM, PG1 greater than or equal to 11.1 mM, PG2 less than 7.8 mM), 4) IGT by WHO, nondiagnostic by NDDG (FPG less than 7.8 mM, PG1 less than 11.1 mM, PG2 7.8-11.0 mM), and 5) IGT by WHO and NDDG (FPG less than 7.8 mM, PG1 greater than or equal to 11.1 mM, PG2 7.8-11.0 mM). Established markers of abnormal glucose tolerance were also measured, including glycosylated hemoglobulin A1, insulin response, plasma triglycerides, serum uric acid, and rate of hypertension in Israel as well as rates of hypertension, peripheral vascular involvement, family history of diabetes, and history of cholelithiasis in the U.S. Accounting for potential confounders, levels of these markers in both national samples were similar in categories 1 and 2 and in categories 3-5.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Mortality among diabetics in a national sample.

The authors compare the mortality experience of a national sample of diabetic men and women with their nondiabetic counterparts. The study population consists of respondents from the First National Health and Nutrition Examination Survey (NHANES I), conducted in 1971-1975, who were traced in 1982-1984 through the NHANES I Epidemiologic Follow-up Study. Over the nine-year follow-up period, the age-adjusted death rates for diabetic men and women were twice the rates for nondiabetics. About 75% of the excess mortality among diabetic men and 57% among diabetic women was attributable to cardiovascular disease deaths. After adjustment for age, systolic blood pressure, serum cholesterol, body mass index, and smoking, the relative risk of death was 2.3 for diabetic men and 2.0 for diabetic women. The relative risk for diabetics was highest for ischemic heart disease mortality (2.8 for men and 2.5 for women) and lowest for noncardiovascular disease deaths (1.4 for men and 1.1 for women). When subjects who reported having had a heart attack prior to the baseline examination were excluded, the relative risks for ischemic heart disease mortality among diabetics remained substantial (2.4 for men and 2.6 for women). There was little evidence that the relative risk of death for diabetics compared with nondiabetics differed by age or sex, although 95% confidence intervals around these estimates were wide.

Adult↗
PubMed1988

Gestational diabetes may represent discovery of preexisting glucose intolerance.

A representative sample of 817 American women aged 20-44 yr who were not pregnant and had no medical history of diabetes were given 75-g 2-h oral glucose tolerance tests (OGTTs). Although these conditions are somewhat different from those recommended for pregnant women (100 g glucose, 3-h OGTT), 3.8% of the women might have been considered to have met O'Sullivan and Mahan criteria for gestational diabetes mellitus (GDM) had they been pregnant. Prevalence was 2-3% below age 35 yr, similar to that found in studies of pregnant women, and rose to 8% at age 40-44 yr. Rates of women meeting World Health Organization criteria for gestational impaired glucose tolerance (G-IGT) rose steadily from 5% at age 20-24 yr to 11% at age 40-44 yr. Risk factors for non-insulin-dependent diabetes mellitus (NIDDM) including parental history and obesity were more prevalent among women meeting these criteria than among women in the entire group; the same risk factors are also more prevalent among pregnant women with GDM. The similarity of rates in this study to rates of GDM and G-IGT, together with their association with risk factors for NIDDM, indicate that these entities are compatible with undiagnosed glucose intolerance occurring before pregnancy and discovered during the metabolic testing that generally accompanies prenatal care rather than conditions that have an etiologic relationship to pregnancy.

Adult↗
PubMed1988

Classification and diagnostic criteria for diabetes mellitus and other categories of glucose intolerance.

Diabetes mellitus is composed of a heterogeneous group of disorders characterized by high blood glucose levels. Four major types of diabetes have been defined by the National Diabetes Data Group. Insulin-dependent diabetes (IDDM), also called type I diabetes, is characterized by abrupt clinical onset, insulinopenia, proneness to ketosis even in the basal state, and dependence on exogenous insulin to sustain life. Non-insulin-dependent diabetes (NIDDM), also called type II diabetes, may remain relatively asymptomatic for years. Insulin levels may be normal, lower than normal, or elevated as a consequence of insulin resistance. Ketosis is not part of the general clinical picture except in times of metabolic stress, although the classic complications of diabetes can be expected to develop in long-duration diabetics. Gestational diabetes (GDM) refers to the recognition of abnormal glucose intolerance in pregnancy, although unrecognized abnormal tolerance may indeed have predated the pregnancy. Rates of macrosomia are higher than in non-GDM pregnancies, but fetal mortality and congenital anomalies appear to be no greater than in the general population. Other types of diabetes include a number of diverse conditions in which glucose intolerance is a feature and in which it may be etiologically related. Impaired glucose tolerance (IGT) is a class that encompasses persons whose glucose tolerance is intermediate between normal and diabetic. These individuals do not manifest the microvascular complications of diabetes, but they appear to have higher rates of macrovascular disease associated with the known cardiovascular risk factors. Two statistical risk categories have also been defined that replace the older terms prediabetes, potential diabetes, and latent diabetes. Diabetes can be diagnosed by the presence of classical signs and symptoms of diabetes and unequivocally elevated blood glucose levels; by a fasting plasma glucose greater than or equal to 140 mg/dl; or by an abnormal oral glucose tolerance test, with a venous plasma glucose value greater than or equal to 200 mg/dl at 2 hours after 75 grams oral glucose, being a hallmark criterion for diabetes. For the latter two criteria, the abnormality should be reconfirmed at a later occasion before a definitive diagnosis of diabetes is made. The oral glucose tolerance test has been standardized at a 75-gram glucose (or carbohydrate equivalent) load, given in the morning after an overnight fast. Glucose should be determined for two hours after administration of the challenge.

Blood Glucose↗