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Cancer patients with diabetes experience a poorer prognosis, yet the population burden of this multimorbidity remains unknown. This study aimed to estimate the latest incidence and prevalence of cancer with diabetes mellitus in Japan. We used projection of cancer incidence and latest survival data from population‐based cancer registries. The incidence of cancer associated with diabetes was estimated separately for patients with pre‐existing diabetes and those without diabetes, and used to estimate the 5‐year cancer prevalence for those with and without diabetes. The prevalence of pre‐existing diabetes in cancer patients at any cancer site was estimated to be 20.7% (647,160 men and women). Among cancer sites, diabetes prevalence was high in patients with liver and pancreatic cancers in both sexes. In conclusion, our study shows a large burden of diabetes in cancer patients in Japan, which warrants further attention by health practitioners and policy‐makers., This study aimed to estimate the latest incidence and prevalence of cancer with diabetes mellitus in Japan. The prevalence of pre‐existing diabetes in cancer patients at any cancer site was estimated to be 20.7% (647,160 men and women). Our study shows a large burden of diabetes in cancer patients in Japan, which warrants further attention by health practitioners and policy‐makers.

INTRODUCTION AND OBJECTIVES Little is known about changes in cardiovascular risk factors (CVRF) profile over time in patients presenting with acute myocardial infarction (AMI). METHODS We assessed changes in age and CVRF profile in consecutive AMI patients enrolled in the Swiss nationwide AMIS Plus registry between January 1, 1997 and December 31, 2018. RESULTS A total of 57,995 AMI patients were included in the analysis. Mean age at presentation was 71.5±11.3 years for women and 63.9±12.8 years for men and did not change over time. Overall, the mean (standard deviation) number of CVRF increased from 1.76 (1.07) in 1997/98 to 2.26 (1.10) in 2017/18 in men (P$_{trend}$

Aims To determine the long-term risk of diabetes in a cohort of children treated with recombinant human growth hormone in Israel, using data from the Israeli National Diabetes Register. Methods Between 1988 and 2009, 2513 children were approved for growth hormone treatment. They were assigned to one of two groups. The first group included children treated for isolated growth hormone deficiency and who were small for gestational age and the second included those treated for multiple pituitary hormone deficiency, chronic renal failure, Turner syndrome or Prader-Willi syndrome. The cohort was cross-linked with the Israeli National Diabetes Register for 2014 (mean follow-up duration 12.1±5.3 years), and prevalent cases of diabetes were identified. Standardized prevalence ratios for diabetes were calculated for people aged 10-29 years. Results In 2014, a total of 23 individuals were identified with diabetes (four with pre-existing diabetes, seven developed diabetes before age 17 years and 12 developed it at a later age). In the isolated growth hormone deficiency and small-for-gestational-age group there was no difference in the prevalence of diabetes compared with the general population (standardized prevalence ratio 2.05, 95% CI 0.94-3.89). In the group that included people with multiple pituitary hormone deficiency, chronic renal failure, Turner syndrome and Prader-Willi syndrome there was a significantly higher diabetes prevalence (standardized prevalence ratio 11.94, 95% CI 6.53-20.00) compared with the general population. Conclusions No difference in diabetes prevalence was found in the isolated growth hormone deficiency and small-for-gestational-age group, compared with the general population. Children treated with growth hormone with pre-existing risk factors had an increased prevalence of diabetes. It is advisable to monitor blood glucose levels closely during and after growth hormone treatment, especially in such children.

AIM The prevalence of diabetes has been increasing over the past few decades. The objective of this study is to assess the time trends in diabetes between 1994 and 2017 in Jordan. METHODS Surveys were conducted in 1994, 2004, 2009 and 2017 by the same investigators using generally similar methods. Fasting blood glucose was measured in all surveys. Variables were obtained using structured questionnaires designed specifically for the surveys. Crude and age-specific diabetes prevalence rates were derived for each sex, together with overall, crude and age-standardized prevalence rates. RESULTS The prevalence of diabetes in men aged ≥ 25 years increased from 14.2% in 1994 to 18.3% in 2004, 26.8% in 2009 and 32.4% in 2017. The corresponding prevalence rates in women were 12.3%, 16.9%, 18.8%, and 18.1%, respectively. The overall age-standardized prevalence rate increased from 13.0% in 1994 to 17.1% in 2004, 22.2% in 2009 and 23.7% in 2017. Known diabetes in the 2017 survey accounted for 82.6% of people with diabetes. A HbA1c of

We conducted three single-day point type 2 diabetes prevalence surveys of all inpatient clinical records in November 2013, 2014 and 2016. The prevalence of diabetes was 19.7-25.3%. The majority (63.4-76%) had type 2 diabetes. Twenty-one percent (n = 21) in 2013, 12% (n = 9) in 2014 and 22.6% (n = 21) in 2016 were diagnosed with diabetes during hospital admission; 41.8% (n = 41) in 2013, 46.7% (n = 35) in 2014 and 51.6% (n = 48) in 2016 required insulin. The high prevalence of diabetes among inpatients mandates active detection and specialist management of diabetes during the admission.

OBJECTIVE The aim of this study was to assess weight trends and diabetes prevalence among US veterans. METHODS Information from the Veterans Affairs Informatics and Computing Infrastructure Corporate Data Warehouse was used to construct data sets that included demographic data, diabetes status, and weight observations for males and females. Secular and longitudinal trends in mean weight were analyzed. RESULTS A total of 4,527,865 patients born from 1915 to 1984 with weight data during 2000 to 2014 were included; 36.8% had diabetes. Mean weight at baseline was higher in men and women with diabetes (97 kg and 88 kg, respectively) than in men and women without diabetes (86 kg and 76 kg, respectively). Mean weight increased from 2000 to 2014 (P

Objectives Diabetes mellitus and periodontitis are complex chronic diseases with an established bidirectional relationship. This systematic review evaluated in subjects with professionally diagnosed periodontitis the prevalence and odds of having diabetes. Methods The MEDLINE-PubMed, CENTRAL and EMBASE databases were searched. Prevalence of diabetes mellitus among subjects with periodontitis were extracted or if possible calculated. Results From the 803 titles and abstracts that came out of the search, 29papers met the initial criteria. Prevalence of diabetes was 9.4% among subjects with periodontitis and 12.8%among subjects without periodontitis. Based on sub-analysis, for subjects with periodontitis, the prevalence of diabetes was 6.5%when diabetes was self-reported, compared to 17.3%when diabetes was clinically assessed. The highest prevalence of diabetes among subjects with periodontitis was observed in studies originating from Asian countries(17.2%,n=16647) and the lowest in studies describing populations from Europe(4.3%(n=7858). The overall odds ratio for diabetes patients to be among subjects with periodontitis as compared to those without periodontitis was 2.59(95%CI[2.12;3.15]). A substantial variability in the definitions of periodontitis, combination of self-reported and clinically assessed diabetes, lack of confounding for diabetes control in included studies introduces estimation bias. Conclusions The overall prevalence and odds of having diabetes is higher within periodontitis populations compared to people without periodontitis. Self-reported diabetes underestimates the prevalence when compared to this condition assessed clinically. Geographical differences were observed: the highest diabetes prevalence among subjects with periodontitis was observed in studies conducted in Asia and the lowest in studies originating from Europe. This article is protected by copyright. All rights reserved.

Objective To investigate differences in community characteristics associated with diabetes prevalence between the Diabetes Belt and the rest of the contiguous United States (U.S.) Methods County-level adult diabetes prevalence estimates (i.e., percent of people [≥20 years] with diagnosed diabetes 2009) were used from the Centers for Disease Control and Prevention, in addition to data from the U.S. Census Bureau, U.S. Department of Agriculture, and U.S. Department of Health and Human Services, to carry out a spatial regime analysis to identify county-level factors correlated with diabetes prevalence in the Diabetes Belt versus the remainder of the U.S. Results Counties outside of the Diabetes Belt demonstrated stronger positive associations between diabetes prevalence and persistent poverty and greater percentages of unemployed labor forces. For counties in the Diabetes Belt, diabetes prevalence showed a stronger positive association with natural amenities (e.g., temperate climate and topographic features) and a stronger negative association with fitness/recreation facility density. Conclusions Community-level correlates of diabetes prevalence differed between the Diabetes Belt and elsewhere in the U.S. Economic hardship was shown to be more relevant outside the Diabetes Belt, while recreational context effects were more pronounced among counties within the region. Prevention and treatment targets are geographically unique, and public health efforts should acknowledge these differences in crafting policy.

Comparison of the prevalence of type 2 diabetes mellitus (T2DM) in adults aged 25-64 years in selected Pacific Island countries using whole blood and plasma glucose cut-off points. Unit records of STEPwise approach to Surveillance (STEPS) surveys obtained from Fiji, Samoa, and Tonga Ministries of Health; T2DM prevalence recalculated using whole blood and plasma cut-off points. Shaded bars indicate T2DM prevalence based on correct glucose cut-off points for the glucose meter used (fasting blood glucose [FBG] ≥6.1 mmol/L for early surveys1,3,5 ; fasting plasma glucose [FPG] ≥7.0 mmol/L for later surveys),2,4,6 whereas open bars show T2DM prevalence based on incorrect glucose cut-off points (FPG ≥6.1 mmol/L for later surveys).2,4,6 Highlights Incorrect glucose cut-off points were applied to the Fiji 2011, Samoa 2013, and Tonga 2012 STEPS surveys. This doubled the actual T2DM prevalences compared to using the correct glucose cut-off points. The errors occurred due to modern glucose meters producing measurements in plasma-equivalent concentrations from whole blood samples. The incorrect whole blood glucose cut-off (≥6.1mmol/L) was applied instead of the correct plasma glucose cut-off (≥7.0mmol/L). This error likely affects other Pacific states, and may have global ramifications.

Background: Recent decades have seen a constant upward projection in the prevalence of diabetes. Attempts to estimate diabetes prevalence rates based on relatively small population samples quite often result in underestimation. The aim of the present study was to investigate whether the Dutch diabetes prevalence estimate of 930 000 for 2013, based on a relatively small sample, still holds true when a larger population is studied using actual prevalence data. Methods: Data were collected from 92 primary care groups, including the total number of people with and without diabetes in 2013. Patients with diabetes were identified using the International Classification of Primary Care codes T90.02 (diabetes mellitus type 2; T2DM), T90.01 (diabetes mellitus type 1) and T90 (diabetes mellitus). Prevalence data were compared with previous estimates made in 2009. Diabetes prevalence was estimated using linear extrapolation. Results: Complete data were available from 67 (73%) care groups, which together provided care for 7 922 403 subjects; 431 396 patients were coded as having diabetes, of whom 406 183 were coded as having T2DM. Based on these results, the extrapolated Dutch diabetes prevalence was 914 387 (5.45%). Conclusions The results show that the previous estimate (reported in 2009), which was based on data collected in 2007, resulted in a

Background There is a growing interest in using the 2010 U.S. Census data for age adjustment after the Census data are officially released. This report discusses the rationale, procedures, demonstrations, and caveats of age adjustment using the 2010 U.S. Census data. Methods Empirical data from the Behavioral Risk Factor Surveillance System and the 2010 U.S. Census age composition were used in demonstrations of computing the age-adjusted prevalence of diagnosed diabetes by race/ethnicity, across various geographic regions, and over time. Results The use of the 2010 U.S. Census data yielded higher age-adjusted prevalence of diagnosed diabetes than using the 2000 projected US population data. The differences persisted across geographic regions, among racial/ethnic groups, and over time. Sixteen age compositions were generated to facilitate the use of the 2010 Census data in age adjustment. The SAS survey procedures and SUDAAN software programs yielded similar age-adjusted prevalence estimates of diagnosed diabetes. Conclusions Using the 2010 U.S. Census data tends to yield a higher age-adjusted measure than using the 2000 projected U.S. population data. Consistent use of a standard population and age composition is recommended once they are chosen for age adjustment.

Measures of human body mass confound 1) well-established population differences in body form and 2) exposure to obesogenic environments, posing challenges for using body mass index (BMI) in cross-population studies of body form, energy reserves, and obesity-linked disease risk. We propose a method for decomposing population BMI by estimating basal BMI (bBMI) among young adults living in extremely poor, rural households where excess body mass accumulation is uncommon. We test this method with nationally representative, cross-sectional Demographic and Health Surveys (DHS) collected from 69,916 rural women (20–24 years) in 47 low-income countries. Predicting BMI by household wealth, we estimate country-level bBMI as the average BMI of young women (20–24 years) living in rural households with total assets

Most Swedish studies show stable diabetes prevalence despite increasing obesity, but glucose levels may shift upwards below the diagnostic threshold for diabetes. Our aim was to explore trends in glucose distribution in northern Sweden; whether these trends were uniformly distributed throughout the spectrum of glucose concentrations; and to relate trends to traditional risk factors and the obesity-related adipokine leptin.The project consisted of four cross-sectional surveys between 1990 and 2009, with 7069 participants aged 25-64 years. The overall participation rate was 74.4%. Trend analyses of glucose concentrations along the entire distribution and linear regression in relation to survey years and risk markers were used.Fasting and post-load glucose increased in women (both P0.001) and post-load glucose in men (P = 0.004). The increase was seen in most deciles of glucose concentrations. The prevalence of impaired glucose tolerance doubled in women to 14.5% and tripled in men to 10.1% (both P = 0.004). The prevalence of impaired fasting glucose rose in women from 4.5 to 7.7% (P0.001). The prevalence of diabetes was unchanged-6.4% in 2009. In men, leptin, together with traditional risk factors, explained 7.8 and 10.8% of the variance in fasting (P = 0.008) and post-load (P0.001) glucose, respectively.Increasing fasting and post-load glucose concentrations were seen in most deciles of the glucose distribution, indicating a shift in the entire population. Leptin was significantly associated with fasting and post-load glucose in men.

Aim The prevalence of diabetes mellitus among Malaysians aged ≥ 30 years of age has increased by more than twofold over a 20-year period. This study aimed to determine the current status and to evaluate the diagnostic usefulness of the HbA1c cut-off point of 48 mmol/mol (6.5%). Methods Using a two-stage stratified sampling design, participants aged ≥ 18 years were recruited from five zones selected to represent Malaysia. An oral glucose tolerance test was performed on all those not known to have diabetes. Results A total of 4341 subjects were recruited. By World Health Organization criteria, the prevalence of diabetes mellitus was 22.9%; of that percentage, 10.8% was known diabetes and 12.1% was newly diagnosed diabetes. Diabetes was most prevalent amongst Indians (37.9%) and Malays (23.8%). Prevalence of new diabetes mellitus was only 5.5% (95% CI 4.9–6.3) when based on the HbA1c diagnostic criteria of 48 mmol/mol (6.5%) and, although the cut-off point was highly specific (98.1%), it was less sensitive (36.7%) compared with 45 mmol/mol (6.3%), which showed the optimal sum of sensitivity (42.5%) and specificity (97.4%) in identifying new diabetes mellitus. Conclusion This study recorded an overall diabetes prevalence of 22.6%, almost a twofold increase from 11.6% reported in 2006. This was likely attributable to the higher prevalence of new diabetes (12.1%) diagnosed following an oral glucose tolerance test. An HbA1c of 45 mmol/mol (6.3%) was found to be a better predictive cut-off point for detecting new diabetes in our multi-ethnic population.

Diabet. Med. 29, e308–e311 (2012) Abstract As diabetes prevalence shifts from affluent to lower-income groups in India, focus on depression in diabetes will become essential. This paper describes four perspectives through which depression and diabetes should be understood in the Indian context. We consider (1) how rapid socio-economic and demographic changes contribute to increased co-occurring diabetes and depression; (2) how social, cultural and economic factors in the Indian context contribute to depression and therefore play an important role in diabetes care; (3) biological and behavioural pathways between depression and diabetes; and (4) the role of health systems in depression, diabetes and their overlap. We conclude with recommendations for future research and policy on this topic in India.

Geoff Hackett identifies gender differences in the provision of care for patients with diabetes and suggests ways in which these may be overcome. Copyright © 2011 Wiley Interface Ltd

Summary Objective To examine how socioeconomic differences are related to the prevalence, awareness and treatment of diabetes in rural Yunnan province, a relatively undeveloped province in southwest China. Methods A cross-sectional survey was conducted from 2008 to 2010; 10 007 consenting individuals aged ≥18 years were selected to participate in the study using a stratified, multistage sampling technique. Information about participants’ demographic characteristics, smoking habits, drinking habits, awareness and treatment of diabetes, and family history of diabetes were obtained using a standard questionnaire. Height, weight, waist circumference, hip circumference, fasting blood sugar level and blood pressure were also measured for each individual. Data were analysed using multivariate logistic regression. Results The age-standardised presence of diabetes was 6.8% in the study population. In diabetic subjects, 28.7% were aware that they had diabetes, and 22.6% had received treatment. After controlling for age, sex, smoking behaviour, drinking behaviour, hypertension, being overweight, central obesity and family history of diabetes, individual educational level was negatively associated with the prevalence of diabetes and positively associated with the awareness and treatment of diabetes. The awareness and treatment of diabetes showed a negative relationship with ethnic minority status and a positive relationship with individual household income. Conclusions There are low levels of awareness and treatment among individuals living with diabetes in rural southwest China. Strategies that can enhance public awareness of diabetes and increase access to affordable medications are urgently needed, especially for poor, less educated individuals who belong to ethnic minorities. Objetivo: Examinar como las diferencias socioeconomicas estan relacionadas con la prevalencia de diabetes, la conciencia de la enfermedad y su tratamiento en la provincia rural de Yunnan, un area relativamente subdesarrollada del sudoeste de China. Metodos: Estudio croseccional realizado entre el 2008 y el 2010. Se seleccionaron 10,007 individuos ≥18 anos que dieron su consentimiento para participar en el estudio que se realizo utilizando una tecnica de muestreo estratificada y multiestadio. Se recogio informacion sobre las caracteristicas demograficas de los participantes, los habitos de fumar y de beber, concientizacion sobre la diabetes y su tratamiento, e historia de diabetes en la familia mediante un cuestionario estandar. En cada individuo se midio la talla, el peso, la circunferencia de la cintura, los niveles de azucar en sangre en ayunas y la presion sanguinea. Los datos se analizaron mediante una regresion logistica multivariada. Resultados: La presencia de diabetes en la poblacion de estudio y estandarizada por edad era del 6.8%. Entre los sujetos diabeticos, un 28.7% eran conscientes de que tenian diabetes y un 22.6% habia recibido tratamiento. Despues de controlar para edad, sexo, comportamiento de fumar y beber, hipertension, sobrepeso, obesidad central e historia familiar de diabetes, el nivel educativo individual estaba negativamente asociado con la prevalencia de diabetes, y positivamente asociado con el ser consciente sobre la diabetes y su tratamiento. La conciencia sobre la diabetes y su tratamiento tenian una relacion negativa con el estatus de minoria etnica y una relacion positiva con el ingreso individual del hogar. Conclusiones: Los niveles de concientizacion y tratamiento son bajos entre los individuos que viven con diabetes en zonas rurales del sudoeste de China. Se requiere urgentemente de estrategias que mejoren la conciencia publica sobre la diabetes y aumenten el acceso a medicamentos asequibles, especialmente entre los individuos mas pobres, menos educados y que pertenecen a minorias etnicas.

We assessed temporal trends in diabetes prevalence and key diabetes risk factors (obesity, physical activity, smoking) over 5 years in a nationally representative sample.

A Danish data source was examined to determine age and sex specific rates of diabetes and glaucoma in a large cataract extracted population. Comparisons with population rates were done. An excess prevalence of diabetes in the cataract population below 70 years was found. For cataract extracted males and females below the age of 40 years, the diabetes prevalence was 15 to 25 times the prevalence in a general population. This prevalence excess decreases with age to normal levels at 75 years of age. Furthermore, we found higher relative frequencies of diabetes among cataract extracted females than among males. Mean age at time of surgery was significantly lower for the diabetic cataract patients. Also for primary glaucoma, an excess prevalence was found in the cataract population. For cataract extracted males and females aged 40 to 49 years the glaucoma frequency was 4-5 times the frequency in a general population. This excess relative frequency decreases with age. The glaucomatous cataract patients have a higher mean age at the time of cataract surgery. A large number of factors seems to contribute to the excess frequencies of diabetes and glaucoma found in the cataract extracted population.

SUMMARY Aims To determine glycaemia and insulinaemia in elderly subjects aged 70–75 years, living across Europe, who participated in the EURONUT-SENECA (Survey in Europe on Nutrition and the Elderly, a Concerted Action) study. Methods Fasting plasma glucose (FPG) and fasting insulin concentrations were measured in 1830 subjects aged 70–75 years living in 15 traditional towns in 11 European countries. For the diagnosis of diabetes, the recommendations of the 1997 report of the American Diabetes Association ‘Expert Committee on the diagnosis and classification of diabetes mellitus’ were used. Results A total of 31.6% of the study subjects had either diabetes (17.5%) or impaired fasting plasma glucose (FPG) (14.1%). Fifty-one per cent of the subjects with diabetes were unaware of the disease. No difference in diabetes prevalence was found for sex, but male subjects were more likely to have impaired FPG than female subjects (16.8 vs. 11.5%, P = 0.001). Hyperinsulinaemia (fasting insulin levels in the highest quartile) was associated with increased FPG, body mass index, and waist-to-hip ratio. Conclusions It was found that a substantial number of elderly Europeans have impaired glucose homeostasis, with diabetes and impaired FPG being present in almost a third of European subjects aged 70–75 years.

PURPOSE Non-insulin-dependent diabetes may become a public health problem in the next decade, given the increasing life expectancy of populations and because the baby-boom generation will reach the age at risk. Moreover a modification of the diagnostic criteria may increase the number of diabetic patients. We studied the evolution of diabetes prevalence. METHODS A non-specific household survey, performed every 10 years was used. Patients who bought an oral antidiabetic drug during these studies were classified as diabetics. RESULTS In 1980-81 and 1991-92 the crude diabetes prevalences were not significantly different even if there was a trend to increase (1.27% and 1.41%, respectively). When the 1980-81 prevalence was standardized to the age distribution of the 1991-92 sample, the trend disappeared (prevalence 1980-81:1.35%). CONCLUSION There was no increase in an individual's risk of diabetes. However the crude prevalence tended to increase because of the changing age structure of the population. On-going studies are needed to follow the prevalence of diabetes during the next decade.

Background The aim of the present study was to compare specific causes of death in Type 2 diabetic patients attending and not attending the diabetes center. Methods The study was carried out within the framework of the Verona Diabetes Study, a population-based survey of known diabetes prevalence with a 10-year mortality follow-up. On 31 December 1986, 7148 Type 2 diabetic patients were identified in Verona, north-east Italy. Among them 4047 regularly attended the diabetes center, while 3101 did not attend the diabetes center. On 31 December 1996, life status was determined and the underlying cause of death was coded according to the ICD-9. During the follow-up, 2896 subjects died. Difference in mortality from specific causes between attenders and non-attenders were evaluated by a Cox model, controlling for sex, age, diabetes treatment and place of residence (downtown vs suburbs). Results Mortality was lower in subjects who attended the diabetes center (38.6% vs 43.0%, p

The objective of this review was to revise the existing information regarding type 2 diabetes (T2D) prevalence in the Argentine population during the past 30 years and to see whether the available data and methodology of the studies conducted allow analysis of time trends. The PubMED and LILACS databases were searched using the search terms "diabetes prevalence" and "Argentina". A total of 301 studies were identified and 19 of them remained in the review after applying the inclusion and exclusion criteria. The studies reviewed covered a time period of 30 years (1979-2012). The studies conducted in Argentina during the last 30 years assessing the prevalence of T2D are very heterogeneous. The majority of the studies were conducted in the province of Buenos Aires. As the assessment of T2D varied between the studies in respect of diagnostic criteria and diagnostic tests for T2D, meaningful comparisons are difficult to make, not to mention an analysis of time trends. All in all, the T2D prevalence seems to be at least 10% in the Argentina population. However, the latest large population surveys conducted in Argentina is promising and may offer the most reliable estimates of the T2D prevalence even though the diagnosis of T2D was based on participant self-report. This article is protected by copyright. All rights reserved.

Socio-economic status is an important predictor of mortality and morbidity in the diabetic and non-diabetic population. Improving the representation of people from deprived areas in vocal pressure groups may foster practical ideas which would improve health outcome. The general public may be represented through a variety of local and national organizations. The British Diabetic Association (BDA) represents people with diabetes mellitus, their relatives, and their health care professionals. Assuming a uniform diabetes prevalence of 1.5 %, there would be 75 484 diabetic people in Scotland, of which only 5649 (7.5 %) are currently members of the BDA. Using area based codes of socio-economic status, it was calculated that the odds ratios of BDA membership in the most affluent category (1) to the most deprived category (7) were 1.00, 0.81, 0.68, 0.57, 0.45, 0.43 and 0.21, respectively (p

The aim of the study was to investigate the influence of outpatient care, overall hospital bed provision and the prevalence of diabetes on the hospital use by adult diabetic patients. Population based data were collected in Finland from a 3-year period. Hospital admissions, inpatient days, and mean length of stay due to diabetes were derived from the Hospital Discharge Register. Estimates of diabetes prevalence were derived from the Central Drug Register. Primary outpatient site, annual number of physician visits, and age at onset among diabetic patients were assessed by questionnaire. The unit of analysis was hospital district (n = 21) and all analyses refer to the 15–64 years age group. Linear regression models were used to explain discharge rates and inpatient days in the district. Large variations between hospital districts were observed in diabetes prevalence, discharge rates due to diabetes, and mean length of stay among diabetic patients. Prevalence of diabetes and overall supply of hospital beds in the district were not related to hospital use. Univariate analyses showed that the larger the proportion of diabetic patients primarily using a private practitioner, the lower the hospital use. In districts where early onset of diabetes was more common, the average number of inpatient days was significantly lower than in other districts. In stepwise regression analyses, early onset of diabetes was the only variable that entered the models. In the full model, 24.6 % of the variance in inpatient days and 16.1 % of the variance in discharge rates were explained. In conclusion, factors related to health care structure, provision of hospital beds or morbidity explain little of the regional variation in hospital use. The observed variations in hospital use probably depend mainly on local treatment policies and differences in clinical decision-making.

In order to assess whether differences in the extent of antidiabetic drug utilization may be an indicator of variations in diabetes prevalence (Type 1 plus Type 2, including non-pharmacologically treated diabetics), intercommunity variations of antidiabetic drug utilization (insulin plus oral agents) in Sweden were examined through sales expressed in defined daily doses per 1000 inhabitants per day and compared with intercommunity prevalence variations. There were large (two-fold) and long-lasting (>10 years) between-county differences in antidiabetic drug sales. Low-sales counties were found both in the doctor-dense south and the doctor-sparse north of Sweden, which argues against the assumption that the sales variation simply was due to different access to medical care. Recent diabetes prevalence figures have been obtained for eight municipalities in different parts of Sweden. In these, antidiabetic drug sales and diabetes prevalence (including non-pharmacologically treated diabetics) showed a close correlation (r = 0.87; p < 0.01), supporting the assumption that variations in antidiabetic drug utilization may indicate variations in diabetes prevalence, at least in countries that, like Sweden, have uniform health care systems. The findings also suggest that, in Sweden, there is little intercommunity variation in the proportion of non-pharmacologically treated diabetics. On the other hand, it is likely that there are many undetected diabetics in areas where no diabetes screening has been performed. Hence, although differences in antidiabetic drug sales may help to indicate where to look for differences in diabetes prevalence, drug sales data are no substitutes for prevalence studies.

It is accepted that the prevalence of known diabetes mellitus has increased in some countries, although the available data are incomplete and sometimes anecdotal. In 1974 a sample of the urban population (n = 21410) in a suburb of Athens (Greece) was evaluated for the prevalence of known diabetes mellitus. The study was repeated 17 years later in the same area under the same conditions and methodology on 12 836 randomly selected inhabitants (both sexes, all ages). Visiting nurses contacted the inhabitants at home and filled in a questionnaire. The results show a clear increase in diabetes prevalence of the population as a whole (standardized rates: 1974:2.4 % (95 % confidence intervals 2.2-2.6 %) 1990: 3.1 (2.8-3.4 %)). Standardization was done on the basis of data obtained from the same census. The changes were statistically significant in the 50–59, 60–69, and 70–79 age groups (1974: 5.87, 10.98, and 11.41 %; 1990: 7.70, 13.68, and 19.52 %, respectively). Thus, the prevalence of known diabetes mellitus has considerably increased during the last 17 years in a sample of urban Greek population.

The World Health Organization and the National Diabetes Data Group each recommend a diagnostic cut-off point for diabetes of 7.8 mmol l−1 for fasting plasma glucose concentrations as part of the diagnostic criteria for epidemiological studies. However, this cut-off has been shown to be insensitive compared with a screening test based on 2-h plasma glucose levels. In thirteen Pacific populations, from four ethnic groups (Asian Indian, Melanesian, Micronesian, and Polynesian), we have examined whether a different cut-off point for fasting plasma glucose would be more accurate for obtaining an estimate of the prevalence of diabetes when compared with 2-h levels. A fasting plasma glucose diagnostic cut-off of 7.0 mmol l−1 gave an estimate of prevalence not significantly different from that based on the 2-h plasma glucose in 12 of the 13 populations (mean difference 0.27, range −1.51 to +2.44,%). On the other hand, when a cut-off of 7.8 mmol l−1 for fasting plasma glucose was used, the resulting prevalence over-estimated the 2-h glucose prevalence in all populations (mean difference 1.91, range 0.14–5.80,%). Thus for Pacific populations, a fasting plasma glucose cut-off of 7.0 mmol l−1 provides estimates of prevalence that are equivalent to those based on 2-h plasma glucose levels. In epidemiological studies designed to estimate diabetes prevalence, we recommend use of a fasting plasma glucose cut-off of 7.0 mmol l−1 in preference to a detection level of 7.8 mmol l−1, if glucose loading is not possible. The low sensitivity associated with the 7.0 mmol l−1 cut-off however, precludes its use as a definitive screening test for diabetes, particularly in the clinical setting.

Our aim was to examine the sensitivity of the fasting plasma glucose test for diabetes detection using the revised criteria of the American Diabetes Association. The study was a retrospective review of results of glucose tolerance tests performed on suspicion of Type 2 diabetes mellitus and was carried out in the Chemical Pathology Department of a university hospital, Bristol, UK. A total of 599 patients had been referred for glucose tolerance testing on the suspicion of Type 2 diabetes mellitus. Diabetes mellitus was defined by either 2 hour venous plasma glucose ≥11.1 mmol/L, or by elevated fasting venous plasma glucose using both 1985 WHO (7.8 mmol/L) and the lower 1997 ADA (7.0 mmol/L) thresholds. Two hundred and twelve of the 599 subjects had 2 hour plasma glucose≥11.1 mmol/L and, of these, 128 (60%) had FPG≥7.8 mmol/L, a further 31 (15%)had FPG 7.0 to 7.7 mmol/L, and 53 (25%) still had FPG