Type 2 Diabetes Mellitus in Augsburg - an Epidemiological Overview

C. Meisinger; A. Döring; M. Heier; B. Thorand; H. Löwel; for the MONICA/KORA Study Group

doi:10.1055/s-2005-858251

Gesundheitswesen 2005; 67: 103-109
DOI: 10.1055/s-2005-858251

Übersicht

Type 2 Diabetes Mellitus in Augsburg - an Epidemiological Overview

Typ-2-Diabetes in Augsburg - ein epidemiologischer ÜberblickC. Meisinger1, ² , A. Döring² , M. Heier² , B. Thorand² , H. Löwel1, ² , for the MONICA/KORA Study Group

¹Augsburg Central Hospital, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
²GSF National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany

The MONICA/KORA study group consists of: KORA: H.-E. Wichmann (speaker), H. Löwel, C. Meisinger, T. Illig, R. Holle, J. John and co-workers who are responsible for the design and conduct of the KORA studies; MONICA: U. Keil (principal investigator), A. Döring, B. Filipiak, H. W. Hense, H. Löwel, J. Stieber and co-workers who were responsible for the design and conduct of the MONICA studies.

Abstract

Zusammenfassung

Der vorliegende Artikel gibt eine Übersicht über die Diabetesprävalenz sowie die antidiabetische Therapie über einen Zeitraum von 17 Jahren. Die Risikofaktoren für die Krankheitsentstehung und die Auswirkungen des Diabetes auf die kardiovaskuläre Morbidität werden diskutiert. Außerdem werden Veränderungen im Lebensstil und Risikofaktorprofil bei Diabetikern aufgezeigt. Die Ergebnisse beruhen auf Daten der MONICA/KORA-Augsburg-Surveys S1-S4, die zwischen 1984/85 und 1999/2001 in der Studienregion Augsburg, Süddeutschland, durchgeführt wurden, und des HI-Registers. Im Gegensatz zu den meisten Studien aus anderen Ländern war in der 25- bis 74-jährigen Augsburger Bevölkerung in den letzten Jahren keine Zunahme der Prävalenz des bekannten Diabetes zu verzeichnen. Adipositas und körperliche Inaktivität stellen die beiden Hauptrisikofaktoren für die Entstehung eines Typ-2-Diabetes dar. Weitere modifizierbare Risikofaktoren wie Rauchen und Hypertonie wurden in der Augsburger Bevölkerung mit der Entstehung eines Typ-2-Diabetes in Verbindung gebracht. In Übereinstimmung mit den Empfehlungen einer intensivierten Blutzuckereinstellung hat sich während der Studienperiode die Diabetesbehandlung kontinuierlich verbessert. Dagegen lässt der als ungünstig zu bezeichnende Gesundheitszustand von Diabetikern in der Augsburger Bevölkerung vermuten, dass die Empfehlungen zur Primärprävention von kardiovaskulären Erkrankungen bei Diabetikern bis zum Jahr 1999/2001 nicht ausreichend in die Praxis umgesetzt wurden. Zudem unterstreichen die Daten aus dem MONICA/KORA-Augsburg-Herzinfarktregister die Notwendigkeit, vor allem bei Personen mit Diabetes mellitus intensiviert präventive Maßnahmen, die nachweislich das kardiovaskuläre Risiko vermindern, zu ergreifen. Die Daten der MONICA/KORA-Augsburg-Studien zeigen, dass der Diabetesprävention zukünftig ein hoher „public health”-Stellenwert zukommen sollte.

Abstract

This article provides an overview of the prevalence of type 2 diabetes and the antidiabetic treatment over a 17 year study period. The causes of the disease and the impact of diabetes on cardiovascular disease (CVD) morbidity are discussed. Furthermore, changes in lifestyle and risk factor profile in persons with diabetes are reported. We present data from the MONICA/KORA surveys S1-S4 conducted between1984/85 and 1999/2001 in the region of Augsburg, Southern Germany and the Augsburg Myocardial Infarction Registry. Contrary to most studies from other countries, in the 25 to 74 year old Augsburg population the prevalence of known diabetes did not increase over the last years. Obesity and decreased physical activity are the two main lifestyle related risk factors for type 2 diabetes. Recently, further modifiable risk factors such as smoking and hypertension have been associated with the development of type 2 diabetes in the Augsburg population. Consistent with recommendations to intensify glucose control in diabetic persons the diabetes treatment continuously improved during the study period. However, health status of persons with diabetes is far from optimal in the Augsburg population suggesting that recommendations for primary prevention of CVD in diabetic persons were not sufficiently put into practice until 1999/2001. Furthermore, data from the MONICA/KORA Augsburg Myocardial infarction registry underline the challenge that in particular men and women with diabetes should receive intensive preventive interventions proven to reduce CVD risk. In conclusion, data from the MONICA/KORA Augsburg studies suggest that it should become an important public health priority to prevent diabetes mellitus.

Schlüsselwörter

Diabetes mellitus - Epidemiologie - Trends - Prävalenz - Risikofaktoren

Key words

Diabetes mellitus - epidemiology - trends - prevalence - risk factors

Full Text

References

1 Resnick H E, Shorr R I, Kuller L. et al . Prevalence and clinical implications of American Diabetes Association-defined diabetes and other categories of glucose dysregulation in older adults. J Clin Epidemiol. 2001; 54 869-876
2 Klein R. Hyperglycemia and microvascular and macrovascular disease in diabetes. Diabetes Care. 1995; 18 258-268
3 Feskens E J, Kromhout D. Glucose tolerance and the risk of cardiovascular disease: the Zutphen Study. J Clin Epidemiol. 1992; 45 1327-1334
4 Haffner S M, Lehto S, Ronnemaa T. et al . Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998; 339 229-234
5 Newman A B, Siscovick D S, Manolio T A. et al . Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Circulation. 1993; 88 837-845
6 Fabris F, Zanocchi M, Bo M. et al . Carotid plaque, aging, and risk factors. Stroke. 1994; 25 1133-1140
7 Gu K, Cowie C C, Harris M I. Diabetes and decline in heart disease mortality in U.S. adults. JAMA. 1999; 281 1291-1297
8 Illig T, Bongardt F, Schöpfer A. et al . Kooperative Gesundheitsforschung im Raum Augsburg/Cooperative Research in the Region of Augsburg. Significant association of the interleukin-6 gene polymorphisms C-174G and A-598G with type 2 diabetes. J Clin Endocrinol Metab. 2004; 89 5053-5058
9 King H, Aubert R E, Herman W H. Global burden of diabetes 1995 - 2025. Prevalence, numerical estimates, and projections. Diabetes Care. 1998; 21 1414-1431
10 Keil U, Liese A D, Hense H W. et al . Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984 - 1992. Eur Heart J. 1998; 19 1197-1207
11 Hense H W, Filipiak B, Döring A. et al . Ten-year trends of cardiovascular risk factors in the MONICA Augsburg Region in Southern Germany. Results from the 1984/85, 1989/90, and 1994/95 surveys. CVD Prevention. 1998; 1 318-327
12 Holle R, Happich M, Löwel H. et al . KORA - A research platform for population based health research. Gesundheitswesen. 2005; 67 S1 S19-S25
13 Löwel H, Meisinger C, Heier M. et al . The population-based Acute Myocardial Infarction (AMI) Registry of the MONICA/KORA study region of Augsburg. Gesundheitswesen. 2005; 67 S1 S31-S37
14 Diamond J. The double puzzle of diabetes. Nature. 2003; 423 599-602
15 Katsilambros N, Aliferis K, Darviri C. et al . Evidence for an increase in the prevalence of known diabetes in a sample of an urban population in Greece. Diabet Med. 1993; 10 87-90
16 Neil H A, Gatling W, Mather H M. et al . The Oxford Community Diabetes Study: evidence for an increase in the prevalence of known diabetes in Great Britain. Diabet Med. 1987; 4 539-543
17 Laakso M, Reunanen A, Klaukka T. et al . Changes in the prevalence and incidence of diabetes mellitus in Finnish adults, 1970 - 1987. Am J Epidemiol. 1991; 133 850-857
18 Meisinger C, Heier M, Doering A. et al . Prevalence of known diabetes and antidiabetic therapy between 1984/85 and 1999/2001 in Southern Germany. Diabetes Care. 2004; 27 2985-2987
19 Thefeld W. Prävalenz des Diabetes mellitus in der erwachsenen Bevölkerung Deutschlands. Gesundheitswesen. 1999; 61 85-S89
20 Rathmann W, Haastert B, Icks A. et al . High prevalence of undiagnosed diabetes mellitus in Southern Germany: Target populations for efficient screening. The KORA survey 2000. Diabetologia. 2003; 46 182-189
21 Rathmann W, Haastert B, Icks A. et al . The diabetes epidemic in the elderly population in Western Europe: data from population-based studies. Gesundheitswesen. 2005; 67 S1 S110-S114
22 Tuomilehto J, Lindström J, Eriksson J G. et al . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344 1343-1350
23 Knowler W C, Barrett-Connor E, Fowler S E. et al . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346 393-403
24 Haffner S M, Stern M P, Hazuda H P. et al . Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before onset of clinical diabetes?. JAMA. 1990; 263 2893-2898
25 Meisinger C, Thorand B, Schneider A. et al . Sex differences in risk factors for incident type 2 diabetes mellitus. The MONICA Augsburg Cohort Study. Arch Intern Med. 2002; 162 82-89
26 Pearson T A, Blair S N, Daniels S R. et al . AHA Guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Circulation. 2002; 106 388-391
27 De Backer G, Ambrosioni E, Borch-Johnsen K. et al . European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2003; 24 1601-1610
28 UK Prospective Diabetes Study Group . Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998; 352 837-853
29 Riddle M. Combining sulfonylureas and other oral agents. Am J Med. 2000; 108 15-22
30 Löwel H, Koenig W, Engel S. et al . The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment? Results of a population-based myocardial infarction register follow-up study. Diabetologia. 2000; 43 218-226
31 Löwel H, Stieber J, Koenig W. et al . The diabetes-related risk of acute myocardial infarction in a southern German population: Results of the MONICA-Augsburg-studies 1985 - 1994. Diab Stoffw. 1999; 8 11-21
32 Winer N, Sowers J R. Epidemiology of diabetes. J Clin Pharmacol. 2004; 44 397-405
33 Hansson L, Zanchetti A, Carruthers S G. et al . Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998; 351 1755-1762

Dr. Christa Meisinger, MPH

Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry

Stenglinstraße 2

86156 Augsburg

Germany

Email: christa.meisinger@gsf.de