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Epidemiology of diabetes in a well defined population in Sweden: the Skaraborg Diabetes Registry

Berger, Bo LU (2006)
Abstract
Time trends in prevalence, incidence and mortality was followed in 15000 diabetic patients in 1991?2005. Clinical findings, C-peptide protocols, and islet antibodies were compared in their ability to distinguish type 1 from type 2 diabetes, and factors associated with the prognosis of diabetes were explored.



The incidence and the age at onset remained stable but the prevalence of diabetes increased due partly to improved survival, partly to changed criteria for diagnosis. At onset of diabetes, 30% of the remaining expected lifetime disappeared and young patients, especially women, had an increased mortality risk. The survival was closely correlated to HbA1c and systolic bloodpressure, but not to diastolic blood pressure... (More)
Time trends in prevalence, incidence and mortality was followed in 15000 diabetic patients in 1991?2005. Clinical findings, C-peptide protocols, and islet antibodies were compared in their ability to distinguish type 1 from type 2 diabetes, and factors associated with the prognosis of diabetes were explored.



The incidence and the age at onset remained stable but the prevalence of diabetes increased due partly to improved survival, partly to changed criteria for diagnosis. At onset of diabetes, 30% of the remaining expected lifetime disappeared and young patients, especially women, had an increased mortality risk. The survival was closely correlated to HbA1c and systolic bloodpressure, but not to diastolic blood pressure or body-mass.



Random C-peptide was better than fasting or glucagon-stimulated C-peptide in distinguishing type 1 from type 2 diabetes, and is recommended for determination of beta-cell function and need for insulin treatment.



The three islet autoantibodies (ICA, GADA, and IA-2A) had equal power to diagnose autoimmune diabetes in children. In adults, one single islet autoantibody was not enough for detecting autoimmune destruction of the beta-cell. The value of analyzing IA-2A in adults was low.



The conflicting clinical findings underline that nature has developed a spectrum of clinical and laboratory findings associated with hyperglycemia and not two separate diseases. Hence, the present classification ought to be modified or discarded. A description of the patients in terms of genetic susceptibility, autoimmune markers, beta-cell function, and insulin sensitivity would be more appropriate for identifying homogenous groups of patients for studies of epidemiology, therapeutic alternatives, and prognosis. (Less)
Abstract (Swedish)
Popular Abstract in Swedish

Tidstrender i prevalens, incidens och mortalitet följdes för 15000 diabetespatienter under 1991-2005. Kliniska fynd, C-peptidanalyser och öcellsantikroppar jämfördes med avseende på förmågan att särskilja typ 1 från typ 2 diabetes och faktorer som påverkade prognosen undersöktes.



Incidens och ålder vid insjuknandet förhöll sig oförändrade över tid, men prevalensen ökade succesivt delvis på grund av förbättrad överlevnad och delvis på grund av ändrade diagnoskriterier.



Unga diabetespatienter, speciellt kvinnor, hade kraftigt ökad dödlighet. Vid diabetesdebuten förlorade patienterna i medeltal 30% av sin förväntade återstående levnadstid. Överlevnaden var... (More)
Popular Abstract in Swedish

Tidstrender i prevalens, incidens och mortalitet följdes för 15000 diabetespatienter under 1991-2005. Kliniska fynd, C-peptidanalyser och öcellsantikroppar jämfördes med avseende på förmågan att särskilja typ 1 från typ 2 diabetes och faktorer som påverkade prognosen undersöktes.



Incidens och ålder vid insjuknandet förhöll sig oförändrade över tid, men prevalensen ökade succesivt delvis på grund av förbättrad överlevnad och delvis på grund av ändrade diagnoskriterier.



Unga diabetespatienter, speciellt kvinnor, hade kraftigt ökad dödlighet. Vid diabetesdebuten förlorade patienterna i medeltal 30% av sin förväntade återstående levnadstid. Överlevnaden var starkt korrelerad till HbA1c och systoliskt blodtryck, men inte till diastoliskt blodtryck eller kroppsvikt.



Slump-C-peptid var bättre än faste-C peptid och glukagonstimulerad C-peptid när det gällde att särskilja typ 1 från typ 2 diabetes och rekommenderas för bestämning av betacellsfunktion och insulinbehov.



De tre öcellsantikropparna(ICA, GADA och IA-2A)hade alla god förmåga att diagnosticera autoimmun diabetes hos barn. Bland vuxna var en enskild öcellsantikropp inte tillräckligt för att diagnosticera autoimmun destruktion av betacellerna. Värdet av att analysera IA-2A hos vuxna var lågt.



De motsägelsefulla kliniska fynden understryker att naturen inte har utvecklat två distinkta diabetessjukdomar, utan ett spectrum av kliniska fynd och laboratoriefynd som i olika hög grad är associerade till hyperglykemi. Därför bör den befintliga klassifikationen av diabetes modifieras eller utrangeras.



En beskrivning av diabetespatienterna utifrån genetisk risk, autoimmuna markörer, betacellsfunktion och insulinkänslighet skulle medföra en mer adekvat identifiering av homogena patientgrupper vilket skulle effektivisera framtida forskning avseende epidemiologi, behandling och prognos. (Less)
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author
supervisor
opponent
  • Docent Eliasson, Mats, Umeå Universitet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Immunology, diabetologi, Endokrinologi, diabetology, secreting systems, Endocrinology, Medicin (människa och djur), Medicine (human and vertebrates), IA-2A, GADA, ICA, islet antibodies, C-peptide, mortality, prevalence, serology, transplantation, Immunologi, serologi, Public health, incidence, epidemiology, epidemiologi, sekretion, Folkhälsa
publisher
Faculty of Medicine, Lund University
defense location
Konferenssalen Medelhavet plan I Wallenberglaboratoriet Universitetssjukhuset MAS Malmö
defense date
2006-10-27 13:00:00
ISBN
91-85559-18-0
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Diabetes Epidemiology and Neuropathy (013241560)
id
7cf0fecb-c7c7-4407-83c0-01058e5b90fd (old id 547300)
date added to LUP
2016-04-01 15:18:47
date last changed
2018-11-21 20:33:48
@phdthesis{7cf0fecb-c7c7-4407-83c0-01058e5b90fd,
  abstract     = {Time trends in prevalence, incidence and mortality was followed in 15000 diabetic patients in 1991?2005. Clinical findings, C-peptide protocols, and islet antibodies were compared in their ability to distinguish type 1 from type 2 diabetes, and factors associated with the prognosis of diabetes were explored.<br/><br>
<br/><br>
The incidence and the age at onset remained stable but the prevalence of diabetes increased due partly to improved survival, partly to changed criteria for diagnosis. At onset of diabetes, 30% of the remaining expected lifetime disappeared and young patients, especially women, had an increased mortality risk. The survival was closely correlated to HbA1c and systolic bloodpressure, but not to diastolic blood pressure or body-mass.<br/><br>
<br/><br>
Random C-peptide was better than fasting or glucagon-stimulated C-peptide in distinguishing type 1 from type 2 diabetes, and is recommended for determination of beta-cell function and need for insulin treatment.<br/><br>
<br/><br>
The three islet autoantibodies (ICA, GADA, and IA-2A) had equal power to diagnose autoimmune diabetes in children. In adults, one single islet autoantibody was not enough for detecting autoimmune destruction of the beta-cell. The value of analyzing IA-2A in adults was low.<br/><br>
<br/><br>
The conflicting clinical findings underline that nature has developed a spectrum of clinical and laboratory findings associated with hyperglycemia and not two separate diseases. Hence, the present classification ought to be modified or discarded. A description of the patients in terms of genetic susceptibility, autoimmune markers, beta-cell function, and insulin sensitivity would be more appropriate for identifying homogenous groups of patients for studies of epidemiology, therapeutic alternatives, and prognosis.},
  author       = {Berger, Bo},
  isbn         = {91-85559-18-0},
  language     = {eng},
  publisher    = {Faculty of Medicine, Lund University},
  school       = {Lund University},
  title        = {Epidemiology of diabetes in a well defined population in Sweden: the Skaraborg Diabetes Registry},
  url          = {https://lup.lub.lu.se/search/ws/files/4364852/547302.pdf},
  year         = {2006},
}