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Articles by J. Chalmers
Total Records ( 3 ) for J. Chalmers
  C. C. Lee , R. P. Stolk , A. I. Adler , A. Patel , J. Chalmers , B. Neal , N. Poulter , S. Harrap , M. Woodward , M. Marre , D. E. Grobbee and J. W. Beulens
  Aims  We investigated the association between alcohol consumption and diabetic retinopathy and deterioration of visual acuity in individuals with Type 2 diabetes.

Methods  We conducted a cohort analysis of 1239 participants with Type 2 diabetes aged 55-81 years enrolled in the AdRem study, a sub-study of the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial. Current and past consumption of wine, spirits and beer was measured by self-report. Moderate and heavy alcohol consumption was defined as 1-14 and > 14 drinks/week, respectively. Diabetic retinopathy, measured by mydriatic stereoscopic seven-field retinal photography, was defined by a 2-step progression in the Early Treatment of Diabetic Retinopathy Study (ETDRS) score or the presence of any retinal vascular lesions. Deterioration of visual acuity was defined by a decrease of two lines in best vision in either eye, measured corrected, or through a pinhole using a Snellen chart.

Results  In a mean follow-up of 5.5 years, we identified 182 participants with a 2-step progression in the ETDRS score, 640 participants with the presence of any retinal vascular lesions and 693 participants with a deterioration of visual acuity. Current moderate consumption of alcohol, compared with no current consumption, was not associated with presence or progression of diabetic retinopathy; however, it was associated with higher risk of deterioration of visual acuity (multivariable-adjusted OR 1.83; 95% CI 1.34-2.48; P < 0.001).

Conclusions  Alcohol consumption is associated with increased risk of deterioration of visual acuity, but not with retinopathy in individuals with Type 2 diabetes.

  M. J. Zaman , A. Patel , J. Chalmers , M. Woodward , P. Clarke , Q. Li and S. Zoungas
 

Aims

The ADVANCE trial recruited participants from 20 countries worldwide. We analyse here regional variations and causes of hospitalization for people with Type 2 diabetes from Asia, Established Market Economies and Eastern Europe.

Methods

A cohort analysis examining the effects of region on causes of first hospitalization, and the association of participant characteristics on all-cause first hospitalization across regions, using multivariable (adjusted for clinical, physiological, behavioural and socio-demographic factors) Cox models.

Results

Of 11 140 individuals (6407 men), all-cause hospitalization rates were highest in Established Market Economies, followed by Eastern Europe then Asia. Eastern Europe had rates of hospitalization for diabetic causes four times greater than Established Market Economies [multivariable-adjusted hazard ratio 4.02 (95% CI 2.86-5.63)]. There were no significant regional variations in hospitalization rates for cardiovascular disease (P = 0.534), but much lower rates for musculoskeletal and non-specific causes in Eastern Europe [multivariable-adjusted hazard ratio 0.44 (95% CI 0.32-0.60) and 0.19 (95% CI 0.12-0.29)] and Asia [hazard ratio 0.21 (95% CI 0.16-0.29) and 0.09 (95% CI 0.06-0.14)] compared with Established Market Economies. In all regions, participants hospitalized for any cause were more likely to be older, male, hypertensive, smokers, have higher glycated haemoglobin and a history of macrovascular or macrovascular disease.

Conclusions

Across three markedly different regions of the world, regional rates and causes of hospitalization varied widely in patients with Type 2 diabetes. Adjustment for a range of patient characteristics did not explain these regional differences in hospitalization, which appear to be attributable to health system factors.

  C. M Fischbacher , R Bhopal , M Steiner , A. D Morris and J. Chalmers
  Background

There are doubts whether diabetes care is equitable across UK ethnic groups. We examined processes and outcomes in South Asians with diabetes and reviewed the UK literature.

Methods

We used name search methods to identify South Asians in a regional diabetes database. We compared prevalence rates, processes and outcomes of care between November 2003 and December 2004. We used standard literature search techniques.

Results

The prevalence of diabetes in South Asians was 3–4 times higher than non-South Asians. South Asians were 1.11 times (95% confidence interval 1.06, 1.16) more likely to have a structured review. South Asian women were 1.10 times more likely to have a record of body mass index (95% CI 1.04, 1.16). HbA1c levels were 1.03 times higher (95% CI 1.00, 1.06) among South Asians, retinopathy 1.36 times more common (95% CI 1.03, 1.78) and hypertension 0.71 times as common (95% CI 0.58, 0.87).

Conclusions

We found evidence of equity in many aspects of diabetes care for South Asians in Tayside. The finding of higher HbA1c and more retinopathy among South Asians needs explanation and a service response. These findings from a region with a small non-White population largely support the recent findings from other parts of the UK.

 
 
 
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