Abstract
To examine the contribution of cardiovascular risk factors to the development of non-insulin dependent diabetes mellitus, a prospective follow-up study was performed of a cohort, initially examined in a population survey on cardiovascular risk factors. The survey was conducted from 1975 to 1978 in the Netherlands among 5700 men and women aged 20 to 65. In 1988 a questionnaire on the prevalence of chronic diseases, including diabetes mellitus, was sent to all living participants of the initial survey. The general practitioners of the persons who indicated to have diabetes mellitus were asked to confirm the diagnosis. Diabetes mellitus was defined as current use of oral hypoglycemic drugs or insulin. After exclusion of the prevalent cases at the initial survey, 65 incident confirmed cases remained. All others responding to the questionnaire served as controls.
The incidence of diabetes mellitus was associated with body mass index, use of diuretics, systolic and diastolic blood pressure. After adjustment for age and body mass index systolic and diastolic blood pressure were still associated with the incidence of non-insulin dependent diabetes mellitus in men; relative risks 1.28 (95% confidence interval 1.06–1.54) and 1.40 (95% CI 1.06–1.85) per 10 mmHg respectively. For women, only the relative risk associated with the use of diuretics remained statistically significant (2.26, 95% CI 1.04–4.90). This probably reflects the risk of (treated) hypertension: adjusted for blood pressure, the relative risk lost statistical significance.
These findings suggest that elevated blood pressure is a risk for the development of non-insulin dependent diabetes mellitus (NIDDM). This supports the view that NIDDM and hypertension may have a similar origin.
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References
Anonymous (1989): Guidelines for the management of mild hypertension memorandum from a WHO/ISH meeting - J. Hypertension 7: 689–693.
Barrett-ConnorE. (1989): Epidemiology, obesity, and non-insulin-dependent diabetes mellitus -Epidemiol. Rev. 11: 172–181.
ButlerW.J., OstranderL.D., CarmanW.J. and LamphiearD.E. (1982): Diabetes mellitus in Tecumseh, Michigan. Prevalence, incidence, and associated conditions - Am. J. Epidemiol. 116: 971–980.
CopelandK.T., CheckowayH., McMichaelA.J. and HolbrookR.H. (1977): Bias due to misclassification in the estimation of relative risk - Am. J. Epidemiol. 105: 488–495.
DeFronzoR.A. and FerraniniE. (1991): Insuline resistance: a multifaced syndrome responsible for NIDDM, hypertension dyslipidemia, and atherosclerotic cardiovascular disease - Diabetes Care 14: 173–194.
FerrariP. and WeidmanP. (1990): Insulin, insulin sensitivity and hypertension - J. Hypertension 8:491–500.
FeskensE.J.M. and KromhoutD. (1989): Cardiovascular risk factors and the 25-year incidence of diabetes mellitus in middle-aged men. The Zutphen Study - Am. J. Epidemiol. 130: 1101–1108.
FeskensE.J.M. and KromhoutD. (1989): Effects of body fat and its development over a ten-year period on glucose tolerance in euglycaemic men: The Zutphen Study - Int. J. Epidemiol. 18: 368–373.
GrobbeeD.E., RimmE.B., GiovannucciE, ColditzG., StampferM. and WillettW. (1990): Coffee, caffeine, and cardiovascular disease in men - N. Eng. J. Med. 323: 1026–1032.
HaffnerS.M., SternM.P., HazudaH.P., MitchellB.D. and PattersonJ.K. (1990): Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start thicking before the onset of clinical diabetes? - JAMA 263: 2893–2898.
HarrisM.I., HaddenW.C., KnowlerW.C. and BennettP.H. (1987): Prevalence of diabetes and impaired glucose tolerance and plasma glucose levels in U.S. population aged 20–74 years - Diabetes 36: 523–534.
JarrettR.J. (1989): Epidemiology and public health aspects of non-insulin-dependent diabetes mellitus -Epiderniol. Rev. 11: 151–171.
McPhillipsJ.B., Barrett-ConnorE. and WingardD.L. (1990): Cardiovascular disease risk factors prior to the diagnosis of impaired glucose tolerance and non-insulin dependent diabetes mellitus in a community of older adults - Am. J. Epidemiol. 131: 443–453.
MurphyM.B., LewisP.J., KohnerE., SchumerB. and DolleryC.T. (1982): Glucose intolerance in hypertensive patients treated with diuretics. A fourteen-year follow-up - Lancet ii: 1293–1295.
ReavenG.M. (1988): Role of insulin resistance in human disease. Banting lecture - Diabetes 37: 1595–1607.
SkarforsE.T., LithellH.O., SelinusI. and AbergH. (1989): Do anti-hypertensive drugs precipitate diabetes in predisposed men? - Br. Med. J. 298:1147–1152.
SmithU. (1990): Insulin resistance. A major hazard for cardiovascular disease? (editorial) - J. Intern. Med. 227: 219–220.
SwislockiA. (1990): Insulin resistance and hypertension - Am. J. Med. Sci. 300: 104–115.
ToumilehtoJ., Toumilehto-WolfE., VirtalaE. and LaPorteR. (1990): Coffee consumption as trigger for insulin dependent diabetes mellitus in childhood -Br. Med. J. 300: 642–643.
ValkenburgH.A., HofmanA., KleinF. and GroustraF.N. (1980): An epidemiologic study of cardiovascular risk indicators (EPOZ). I. Blood pressure, serum cholesterol Quetelet index and smoking habits in an open population aged 5 years and over (abstract in English) - Ned. Tijdschr Geneesk 124: 183–189.
WilsonP.W.F., KannelW.B. and AndersonK.M. (1985): Lipids, glucose intolerance and vascular disease: The Framingham Heart Study - Monogr Atheroscler. 13: 1–11.
World Health Organization (1985): Technical report series 727. Diabetes Mellitus, Geneva.
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Stolk, R., Van Splunder, I., Schouten, J. et al. High blood pressure and the incidence of non-insulin dependent diabetes mellitus: Findings in A 11.5 year follow-up study in the Netherlands. Eur J Epidemiol 9, 134–139 (1993). https://doi.org/10.1007/BF00158782
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DOI: https://doi.org/10.1007/BF00158782