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Biomedical subjects

S E Moss

Publications and source records attributed to S E Moss.

At least 55 records · Page 3Linked to original sources
PubMed1998

The 14-year incidence of visual loss in a diabetic population.

OBJECTIVE: The purpose of the study was to estimate the 14-year incidence of visual loss in a diabetic population and to examine its relationship to potential risk factors. DESIGN: Cohort study. PARTICIPANTS: A population-based sample of younger onset diabetic persons diagnosed younger than 30 years of age and taking insulin (n = 880) were examined at baseline, 4 years, 10 years, and 14 years. INTERVENTION: Visual acuity (VA) as measured by the Early Treatment Diabetic Retinopathy Study protocol was performed. MAIN OUTCOME MEASURES: Visual impairment (VI), defined as a VA of 20/40 or worse in the better eye; blindness, defined as a VA of 20/200 or worse in the better eye; and doubling of the visual angle were measured. RESULTS: Cumulative 14-year incidences of VI, doubling of the visual angle, and blindness were 12.7%, 14.2%, and 2.4%, respectively. In univariate analyses, loss of vision as measured by doubling of the visual angle is associated with older age, longer duration of diabetes, higher glycosylated hemoglobin, higher systolic and diastolic blood pressure, presence of proteinuria, more pack-years smoked, presence of macular edema, and more severe retinopathy. In logistic regression analyses, incidence of doubling of the visual angle is associated independently with retinopathy (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03, 1.11 for each level), glycosylated hemoglobin (OR, 1.46; 95% CI, 1.28, 1.66 for each 1%), proteinuria (OR, 2.32; 95% CI, 1.39, 3.88 for presence), and age (OR, 1.45; 95% CI, 1.20, 1.75 for 10 years). In addition, a change in glycosylated hemoglobin from baseline to the 4-year examination is associated with loss of vision (OR, 1.15; 95% CI, 1.02, 1.30 for a 1% increase). CONCLUSIONS: Loss of vision continues to be significant in persons with diabetes. These results suggest that prevention of retinopathy through control of glycemia will have a beneficial effect on visual outcome.

Adolescent↗
PubMed1998

Weight change and glycemic control in a population-based sample of adults with older-onset diabetes.

BACKGROUND: Numerous clinic-based studies have observed improved glycemic control with even moderate weight reductions, for periods up to 1 year, in obese subjects with noninsulin-dependent diabetes mellitus (NIDDM). Similar benefits of weight loss have not been well documented in free-living populations, particularly in older persons with NIDDM of long duration. METHODS: Relations between weight change and glycosylated hemoglobin were evaluated in a population-based sample of persons with older-onset diabetes. Persons participating in baseline (1980-1982, n = 1370) and two follow-up examinations (1984-1986, n = 987; 1990-1992, n = 550) were included. Mean glycosylated hemoglobin levels among those losing, gaining, or remaining within 5 kg were compared in all subjects combined and stratified by insulin use, using ordinary least-squares regression to adjust for confounding variables. RESULTS: Subjects who lost weight had higher mean glycosylated hemoglobin compared to those who gained weight (baseline to second exam only). This pattern remained in those not using insulin. Weight change was not related to glycosylated hemoglobin in persons using insulin. CONCLUSIONS: Associations suggest that in older persons not using insulin, moderate weight loss over periods of 4-6 years has little beneficial impact on glycosylated hemoglobin. Weight loss may be reflecting disease processes that also result in poor glycemic control. Intentional weight loss achieved over a shorter time period and maintained through the later years in older diabetic persons remains to be evaluated.

Adult↗
PubMed1998

Self-rated health and diabetes of long duration. The Wisconsin Epidemiologic Study of Diabetic Retinopathy.

OBJECTIVE: To evaluate the self-reported quality of life in individuals with diabetes of long duration. RESEARCH DESIGN AND METHODS: An interview was administered 14 years after baseline to two cohorts of individuals with diabetes who have been followed in an epidemiological study periodically since 1980. Responses to the Medical Outcomes Study Short Form 36 as related to complications of diabetes, age, glycosylated hemoglobin level, and other characteristics were assessed. RESULTS: Physical function, physical role, general health scales, and a general question about health were related to diabetes characteristics in older- and younger-onset individuals. Symptoms of sensory neuropathy were associated with the four measures in both younger- (n = 645) and older-onset (n = 292) individuals. Other descriptive variables in the younger-onset group were the presence of nephropathy, cardiovascular disease, smoking, peak expiratory flow, physical activity, and glycosylated hemoglobin. Hypoglycemic reactions were of only borderline significance and that for only one scale (physical role). In older-onset individuals, cardiovascular disease, physical activity, and sex were descriptive of responses to the quality-of-life questions. CONCLUSIONS: Factors related to diabetes contribute to self-assessed health. some of these factors may be modifiable, which, if altered, may lead to improved quality of life.

Activities of Daily Living↗
PubMed1998

Correlates of lens thickness: the Beaver Dam Eye Study.

PURPOSE: To evaluate the relationships of lens thickness to age, to the presence of a nuclear, cortical, or posterior subcapsular cataract, and to other personal characteristics in participants in the Beaver Dam Eye Study. METHODS: Slit lamp photographs taken during a population-based prevalence study were measured for lens thickness. In addition, slit lamp photographs were graded for nuclear cataracts, and retroillumination photographs were graded for cortical and posterior subcapsular cataracts. A questionnaire was administered, and height, weight, and blood pressure were measured by protocol. RESULTS: Lens thickness increased systematically with age in men and women. In multivariate analysis, age, sex (male), cortical cataract, diabetes, nuclear cataract, and former cigarette smoking were related significantly to lens thickness. CONCLUSIONS: Age was the most significant personal characteristic associated with lens thickness among those subjects considered. In addition, other characteristics, including specific cataract types and risk factors for cataracts, also were associated with thickness. Whether lens thickness among people of the same age is associated prospectively with these characteristics requires a longitudinal follow-up.

Adult↗
PubMed1998

Disease progression and cost of insulin dependent diabetes mellitus: development and application of a simulation model.

This paper presents the development and application of a Markov model that simulates the onset and progression of insulin dependent diabetes mellitus (IDDM) and its sequelae. The model estimates direct medical costs resulting from different patterns of health states during the course of the disease. The model is user-friendly and allows for changes in the input variables to be specified, thereby providing a frame-work for sensitivity analysis. The Markov process moves a cohort of individuals through six different health states: Healthy, IDDM without chronic microvascular complications, IDDM with retinopathy alone, IDDM with neuropathy alone or with retinopathy, IDDM with nephropathy, and death. Epidemiologic data were obtained from governmental sources as well as the medical literature. Transition probabilities were estimated using data from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). Direct medical costs were estimated from actual charges from a local health maintenance organization in Wisconsin. The validity of the model was tested in several ways including a comparison with an independent cost estimate made by the Wisconsin Department of Health and Family Services. The model appears to be useful in estimating the progression and associated costs of IDDM for any large population over any period of time and in allowing changes in the inputs to evaluate their impact thus providing pertinent information to healthcare decision-makers and health planners.

Age Factors↗
PubMed1997

Is obesity related to microvascular and macrovascular complications in diabetes? The Wisconsin Epidemiologic Study of Diabetic Retinopathy.

BACKGROUND: There are few epidemiological data describing the relationship of obesity to the incidence of microvascular and macrovascular complications in patients with diabetes. METHODS: In a population-based study performed in southern Wisconsin, 1370 persons diagnosed as having diabetes when they were 30 years of age or older (mean[+/- SD] age, 66.6 +/- 11.3 years) participated in a baseline examination, 987 in a 4-year follow-up examination, and 533 in a 10-year follow-up examination. Height and weight were measured using standard protocols. Individuals were characterized as underweight, normal weight, overweight, and obese by body mass index (expressed as weight in kilograms divided by the square of the height in meters) status. Outcomes included incidence and progression of retinopathy, incidence of gross proteinuria, incidence of lower-extremity amputation, and death due to ischemic heart disease, death due to stroke, and all-cause mortality. RESULTS: The prevalence of being obese was 25.2%. After other risk factors were controlled for, being underweight was associated with higher incidence of diabetic retinopathy, death from stroke, and all-cause mortality. Body mass was not associated with progression of retinopathy, incidence of gross proteinuria, amputation of a lower extremity, or death due to ischemic heart disease. CONCLUSIONS: These data suggest that obesity in persons with older-onset diabetes is not related to the long-term incidence of microvascular and macrovascular complications.

Adult↗
PubMed1997

Annexins in the secretory pathway.

Among the multiplicity of roles suggested for proteins of the annexin family, those implicating these proteins in regulated exocytosis remain among the most convincing. Studies in this area of annexin biology have focused on annexin II, which because of its unusually low Ca(2+)-requirement for phospholipid-binding has many of the requisite properties of a membrane fusogenic Ca2+ sensor. Other annexins are also good candidates for exocytotic mediators, especially annexins I and VII, which have strong vesicle-aggregating activities. In contrast, annexin VI appears to block vesicle aggregation, perhaps acting as a negative regulator of exocytosis. In this review, we consider the evidence for and against annexins having functions in the secretory pathway.

Animals↗
PubMed1997

Incident cataract surgery: the Beaver Dam eye study.

PURPOSE: The authors describe the incidence of cataract surgery in participants of the Beaver Dam Eye Study. METHODS: Objective evidence of cataract extraction as obtained at follow-up examinations of participants of a population-based cohort is given. Participants included all adults 43 to 84 years of age who lived in the city or township of Beaver Dam, Wisconsin. RESULTS: Age-adjusted incidence is significantly greater for women, for those with lower diastolic blood pressure, for those with hypertension, widows/widowers, and for those who report that their vision is worse than it had been. Multivariate analyses disclose that the following characteristics (with their respective odds ratios) are significantly associated with incident cataract surgery: age (odds ratio [OR] for 10 years 1.40; 95% confidence interval [CI] 1.02, 1.91); cigarette smoking (> or = 35 pack years; OR 1.91; 95% CI 1.16, 3.17); nuclear cataract (OR 35.58; 95% CI 10.12, 125.17 at age 50 years); cortical cataract (OR 3.75; 95% CI 2.40, 5.88); posterior subcapsular cataract (OR 15.51; 95% CI 8.27, 29.09); impaired vision (OR 3.76; 95% CI 2.33, 6.05); intraocular pressure (> or = 14 mmHg; OR 2.56; 95% CI 1.50, 4.38); visual sensitivity to light (OR 1.94; 95% CI 1.19, 3.17); refractive error (myopic) (OR 1.99; 95% CI 1.22, 3.24); yellow color (OR 1.69; 95% CI 1.02, 2.81); and being examined by an ophthalmologist within 2 years (OR 1.54; 95% CI 1.03, 2.30). CONCLUSIONS: Many factors are associated with cataract surgery, but the prior presence of posterior subcapsular cataract is the most important lens opacity. In addition, visual function changes, which may be relatively mild, are associated with subsequent incident surgery.

Adult↗
PubMed1997

Incidence of self reported glaucoma in people with diabetes mellitus.

AIM: To determine the incidence of self reported glaucoma in a group of people with diabetes mellitus. METHODS: In an 11 county area in southern Wisconsin, a cohort of people with diabetes mellitus was identified and characterised by history, physical examination, fundus photographs, and laboratory evaluation in 1980-2 (n = 2366). The cohort was followed for 10 years with 891 younger onset and 987 older onset people participating in at least one follow up examination. RESULTS: The 10 year incidence of glaucoma was 3.7% in younger onset people, 6.9% in older onset people not using insulin, and 11.8% in older onset people using insulin. Univariate analyses revealed that in younger onset people greater body mass index, older age, longer duration of diabetes, history of cataract surgery, and increased severity of diabetic retinopathy at baseline conferred increased risk. In older onset people using insulin, older age and longer duration of diabetes, higher intraocular pressure, and history of cataract surgery at baseline were associated with increased risk of glaucoma. In multivariate analyses, only age was significantly related to increased incidence in younger onset people and age, intraocular pressure, and insulin use were significantly associated with increased risk in the older onset group. CONCLUSION: Most risk factors associated with self reported glaucoma in people with diabetes cannot currently be modified to decrease incidence. Older onset people who are at increased risk of many ocular complications of diabetes may be particularly in need of specialised ophthalmic observation.

Adult↗
PubMed1997

Risk of hypoglycemia in users of human insulin. The Wisconsin Epidemiologic study of Diabetic Retinopathy.

OBJECTIVE: To evaluate whether there has been a change in frequency of hypoglycemic reactions associated with use of insulin of animal or human type. RESEARCH DESIGN AND METHODS: Data are from a longitudinal population-based study of people with diabetes onset before 30 years of age who were receiving primary care in an 11-county area of south central Wisconsin in 1980. Interviews of study participants were conducted regarding occurrence of hypoglycemic reactions and the frequency, dose, and type of insulin used. At the 4-year follow-up, 727 of the 765 subjects were using only animal insulin and 33 were using human insulin; by the 10-year follow-up, 352 were using animal insulin and 388 were using human insulin. RESULTS: Those using animal insulin reported fewer hypoglycemic reactions than did users of human insulin (chi (1)2 = 4.66, P = 0.03). Those who changed insulin type between visits were no more likely to report more hypoglycemic reactions during the year before the visit than those who remained on the same type at the two examinations (chi (4)2 = 3.37, P = 0.50). At the 10-year exam, users of human insulin were more likely to be taking multiple doses of insulin (86.6%) than were users of animal insulin (73.9%; P < 0.0001). In multiple logistic regression, the following variables were significantly related to the frequency of hypoglycemic reactions at the 10-year visit: body mass index (lower), glycosylated hemoglobin (lower), and being female. CONCLUSIONS: In this population, level of glycemia is related to the frequency of hypoglycemic reactions. While type of insulin (human vs. animal) may be related to glycemia, it appears to have little independent effect on the frequency of reactions.

Adult↗
PubMed1997

The relation of systemic hypertension to changes in the retinal vasculature: the Beaver Dam Eye Study.

BACKGROUND PURPOSE: The objective was to investigate the relationship of systemic hypertension to the incidence of various retinal vascular lesions in the population-based Beaver Dam Eye Study. METHODS: Subjects aged 43 through 86 years who lived in Beaver Dam, Wisconsin between 1987 and 1988 were examined between 1988 and 1990 and 5 years later, 1993-1995. Blood pressure was measured using standardized protocols. Stereoscopic color fundus photographs were graded in a masked fashion using standardized protocols to determine the presence of retinopathy (blot hemorrhages, microaneurysms, hard and soft exudates, intraretinal microvascular abnormalities, and venous beading), retinal arteriolar narrowing, and arterio-venous nicking. People with diabetes or retinal vascular occlusions were excluded from the analyses. RESULTS: Among those examined, 2,151 (69.1%) were normotensive and 963 (30.9%) were hypertensive at baseline. Over the five-year period, retinopathy developed in 175 (6.0%), arteriolar narrowing in 282 (9.9%) and arterio-venous nicking in 201 (6.5%) nondiabetic subjects. After adjusting for age, hypertension was associated with the incidence of retinopathy (in men: relative risk [RR] 2.31, 95% confidence interval [CI] 1.54 to 3.48; in women: RR 1.61, 95% CI 1.07 to 2.43) and with arteriolar narrowing (in men: RR 1.82, 95% CI 1.25 to 2.66; in women: RR 1.36, 95% CI 1.05 to 1.77), but not with arterio-venous nicking (in men: RR 1.01, 95% CI 0.69 to 1.48; in women: RR 1.37, 95% CI 0.95 to 1.97). The five-year incidence of retinopathy and of arteriolar narrowing was higher in those subjects whose blood pressure was elevated despite use of antihypertensive medications compared with those subjects whose blood pressure was controlled with antihypertensive medications or those who were normotensive. CONCLUSIONS: These data show a relation of hypertension to an increased incidence of retinopathy and arteriolar narrowing. Furthermore, these data suggest that pharmacologic control of blood pressure is related to a lower incidence of these anatomic retinal lesions relative to uncontrolled blood pressure.

Adult↗
PubMed1996

The Ca2+-dependent lipid binding domain of P120GAP mediates protein-protein interactions with Ca2+-dependent membrane-binding proteins. Evidence for a direct interaction between annexin VI and P120GAP.

The CaLB domain is a 43-amino acid sequence motif found in a number of functionally diverse signaling proteins including three Ras-specific GTPase activating proteins (GAPs). In the Ras GTPase activating protein, P120(GAP), this domain has the ability to confer membrane association in response to intracellular Ca2+ elevation. Here we have isolated three proteins, p55, p70, and p120, which interact with the P120(GAP) CaLB domain in vitro. We identify p70 as the Ca2+-dependent phospholipid-binding protein annexin VI. Using co-immunoprecipitation studies, we have shown that the interaction between P120(GAP) and annexin VI is also detectable in rat fibroblasts, suggesting that this interaction may have a physiological role in vivo. Thus, the CaLB domain in P120(GAP) appears to have the ability to direct specific protein-protein interactions with Ca2+-dependent membrane-associated proteins. In addition, annexin VI is known to have tumor suppressor activity. Therefore, it is possible that the interaction of annexin VI with P120(GAP) may be important in the subsequent modulation of p21(ras) activity.

Animals↗
PubMed1996

Identification by differential display of annexin-VI, a gene differentially expressed during melanoma progression.

To identify genes involved in the melanocyte to malignant melanoma conversion, we have applied differential display to the comparison of syngeneic murine B16F10 (metastatic melanoma) and Melan-a-immortalized melanocyte cell lines. Approximately 7000 bands were analyzed, revealing approximately 80 to be differentially displayed. Reverse Northern blotting and subsequent Northern blotting confirmed the reproducible differential expression of four transcripts. Three B16F10-specific bands encode novel genes or partially sequenced cDNAs of unknown function. One Melan-a-specific band was found to be identical to the 3' end region of the mouse Annexin VI mRNA and shown to have a reduced message expression in B16F10 relative to Melan-a. Differential expression was confirmed at the protein level with Western blotting using a rabbit polyclonal antiserum. Immunohistochemistry of human melanoma specimens with this antiserum revealed a decrease or loss of Annexin VI expression as melanomas progressed from a benign to a more malignant phenotype. Our results provide further evidence for a potential role of Annexin VI in tumor suppression.

Animals↗
PubMed1996

The incidence of hypertension in insulin-dependent diabetes.

BACKGROUND: There are few epidemiologic data describing the long-term incidence of hypertension in people with diabetes. METHODS: In a population-based study performed in southern Wisconsin, 765 individuals diagnosed as having diabetes when they were younger than 30 years and taking insulin participated in baseline, 4-year, and 10-year examinations. Blood pressure was measured by standardized protocols,and hypertension was defined as a mean systolic blood pressure of 160 mm Hg or more ( > or = 140 mm Hg in those younger than 25 years) and/or mean diastolic blood pressure of 95 mm Hg or more ( > or = 90 mm Hg in those younger than 25 years) and/or history of hypertension with the use of antihypertensive medication. RESULTS: The prevalence of hypertension at baseline was 17.3%. The 10-year incidence of hypertension was 25.9%. The incidence of hypertension was greater with older age, longer duration of diabetes, higher glycosylated hemoglobin level, proteinuria, more severe retinopathy, and male gender. After other risk factors were controlled for, the 10-year incidence of hypertension was significantly related to higher glycosylated hemoglobin level (odds ratio, 1.23 per percentage increase; 95% confidence interval, 1.13 to 1.34) presence of gross proteinuria (odds ratio, 3.64; 95% confidence interval, 2.26 to 5.85), longer duration of diabetes (odds ratio, 1.03 per year of diabetes; 95% confidence interval, 1.01 to 1.04), and being male (odds ratio, 1.93; 95% confidence interval, 1.34 to 2.77). CONCLUSION: These data suggest that control of hyperglycemia and prevention of gross proteinuria may lead to a reduction in the long-term incidence of hypertension.

Adult↗
PubMed1996

Relation of glycemic control to diabetic microvascular complications in diabetes mellitus.

OBJECTIVE: To describe the relation between glycated hemoglobin and the incidence or progression, or both, of diabetic microvascular complications in persons with insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). DESIGN: Population-based on cohort study. SETTING: An 11-county area in southern Wisconsin. PATIENTS: All persons with IDDM diagnosed before age 30 and taking insulin (n = 996) and a probability sample (based on duration of disease) of persons diagnosed with diabetes at age 30 or older who were either taking insulin (n = 674) or not taking insulin (n = 696) and who participated in a baseline examination from 1980 to 1982. Survivors of the cohort were re-examined again in 1984 to 1986 and 1990 to 1992. MEASUREMENTS: The incidence and progression of diabetic retinopathy was determined by masked grading of stereoscopic color fundus photographs using the modified Early Treatment Diabetic Retinopathy Study severity scale. Gross proteinuria was determined using a dipstick. Ten-year incidence of renal dialysis or transplantation or loss of tactile sensation or of temperature sensitivity was based on self-reported history. RESULTS: The glycated hemoglobin level at baseline was strongly related to the incidence or progression, or both, of diabetic retinopathy, the incidence of gross proteinuria, and the incidence of loss of tactile sensation or temperature sensitivity in persons with either IDDM or NIDDM. CONCLUSIONS: These prospective epidemiologic data suggest that glycemic control is similarly related to the incidence and progression of diabetic microvascular complications in both IDDM and NIDDM. However, further evidence from clinical trials in persons with NIDDM is necessary to assess the risks and benefits of such treatment in preventing these complications.

Age of Onset↗
PubMed1996

Change in visual acuity associated with cataract surgery. The Beaver Dam Eye Study.

PURPOSE: Cataract is the most common age-related eye disease in most countries worldwide. However, unlike many age-related eye diseases, therapy, in the form of cataract surgery, is successful in restoring at least some function in the vast majority of patients. The purpose of this investigation is to evaluate the change in vision related to specific kinds of cataract and cataract surgery in a population-based study in Beaver Dam, Wisconsin. METHODS: The data are derived from the Beaver Dam Eye Study, a population-based incidence study of age-related eye disease. Participants were seen for their baseline evaluation (n = 4926) between March 1, 1988, and September 14, 1990, and for a follow-up examination (n = 3684) an average of 4.8 years later. All examinations, interviews, lens photography, and grading were performed using standard protocols. The age range was 43 to 84 years at the census preceding the baseline examination. RESULTS: For those with no cataract at baseline and without cataract surgery at follow-up, there was an average decline of 0.5 letters (on a logMAR scale) in the right eye by the follow-up examination. In persons with any cataract at baseline and without cataract surgery at follow-up, there was a decrease of four letters. When cataract surgery was done in the interval, it was associated with a significant (P < 0.0001) nine-letter (2-line) improvement in visual acuity. CONCLUSION: Cataract surgery in this population was associated with a significant improvement in visual acuity. It is appropriate to evaluate visual acuity, cataract, and visual needs in planning for eye care in aging populations.

Adult↗
PubMed1996

Cigarette smoking and ten-year progression of diabetic retinopathy.

PURPOSE: To examine the association between cigarette smoking and the incidence and progression of diabetic retinopathy. METHODS: A population-based cohort study of 708 adult younger-onset persons with diabetes, 485 older-onset persons taking insulin, and 502 older-onset persons with diabetes not taking insulin who participated in baseline, 4-year, and 10-year examinations. Incidence and progression of retinopathy and progression to proliferative retinopathy were measured as determined by fundus photography. RESULTS: Neither smoking status nor pack-years smoked showed significant associations with increased risk of retinopathy. CONCLUSIONS: Cigarette smoking is not a risk factor for the long-term incidence of retinopathy. However, the failure to find an association between smoking and diabetic retinopathy does not imply that persons with diabetes who smoke should not stop as cigarette smoking is a risk factor for other complications and associated conditions of diabetes, particularly cardiovascular disease.

Adolescent↗