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Articles by J. E. Shaw
Total Records ( 7 ) for J. E. Shaw
  R. A. Sicree , P. Z. Zimmet , D. W. Dunstan , A. J. Cameron , T. A. Welborn and J. E. Shaw
  Aim  To determine the extent of gender-related differences in the prevalence of glucose intolerance for the Australian population and whether body size may explain such differences.

Methods  Cross-sectional data were collected from a national cohort of 11 247 Australians aged ≥ 25 years. Glucose tolerance status was assessed according to both fasting plasma glucose (FPG) and 2-h plasma glucose (2hPG) levels following a 75-g oral glucose tolerance test (OGTT). Anthropometric and glycated haemoglobin measurements were also made.

Results  Undiagnosed diabetes and non-diabetic glucose abnormalities were more prevalent among men than women when based only on the FPG results (diabetes: men 2.2%, women 1.6%, P = 0.02; impaired fasting glycaemia: men 12.3%, women 6.6%, P < 0.001). In contrast 16.0% of women and 13.0% of men had a 2hPG abnormality (either diabetes or impaired glucose tolerance, P = 0.14). Women had a mean FPG 0.3 mmol/l lower than men (P < 0.001), but 2hPG 0.3 mmol/l higher (P = 0.002) and FPG-2hPG increment 0.5 mmol/l greater (P < 0.001). The gender difference in mean 2hPG and FPG-2hPG increment disappeared following adjustment for height. For both genders, those in the shortest height quartile had 2hPG levels 0.5 mmol/l higher than the tallest quartile, but height showed almost no relationship with the FPG.

Conclusions  Men and women had different glycaemic profiles; women had higher mean 2hPG levels, despite lower fasting levels. It appeared that the higher 2hPG levels for women related to lesser height and may be a consequence of using a fixed glucose load in the OGTT, irrespective of body size.

  A. J. Cameron , P. Z. Zimmet , J. E. Shaw and K. G. M. M. Alberti
  Aims  The value of clinical definitions of the metabolic syndrome has been questioned, with confusion surrounding their intended use and purpose. Our aim was to construct a mission statement that outlines the value of the metabolic syndrome in clinical and public health settings.

Methods  Case studies have been used to demonstrate three key points.

Results  We argue here for recognition of obesity as being a crucial element within the metabolic syndrome but perhaps even more important before its development. We also contend that the concept does indeed have a role as a risk prediction tool, and that it could provide a useful metric for the scale and progress of the looming global epidemic of diabetes and cardiovascular disease.

Conclusions  Through appreciation of its purpose, and recognition of both its limitations and those attributes that make it unique and valuable, we believe we have demonstrated here that the metabolic syndrome deserves its place in the global toolbox of diabetes and CVD prevention.

  L. Chen , D. J. Magliano , B. Balkau , R. Wolfe , L. Brown , A. M. Tonkin , P. Z. Zimmet and J. E. Shaw
  Aims  To evaluate how to most efficiently screen populations to detect people at high risk of incident Type 2 diabetes and those with prevalent, but undiagnosed, Type 2 diabetes.

Methods  Data from 5814 adults in the Australian Diabetes, Obesity and Lifestyle study were used to examine four different types of screening strategies. The strategies incorporated various combinations of cut-points of fasting plasma glucose, the non-invasive Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK1) and a modified version of the tool incorporating fasting plasma glucose (AUSDRISK2). Sensitivity, specificity, positive predictive value, screening costs per case of incident or prevalent undiagnosed diabetes identified and intervention costs per case of diabetes prevented or reverted were compared.

Results  Of the four strategies that maximized sensitivity and specificity, use of the non-invasive AUSDRISK1, followed by AUSDRISK2 in those found to be at increased risk on AUSDRISK1, had the highest sensitivity (80.3%; 95% confidence interval 76.6-84.1%), specificity (78.1%; 95% confidence interval 76.9-79.2%) and positive predictive value (22.3%; 95% confidence interval 20.2-24.4%) for identifying people with either prevalent undiagnosed diabetes or future incident diabetes. It required the fewest people (24.1%; 95% confidence interval 23.0-25.2%) to enter lifestyle modification programmes, and also had the lowest intervention costs and combined costs of running screening and intervention programmes per case of diabetes prevented or reverted.

Conclusions  Using a self-assessed diabetes risk score as an initial screening step, followed by a second risk score incorporating fasting plasma glucose, would maximize efficiency of identifying people with undiagnosed Type 2 diabetes and those at high risk of future diabetes.

  S. Soulimane , D. Simon , J. E. Shaw , P. Z. Zimmet , S. Vol , D. Vistisen , D. J. Magliano , K. Borch-Johnsen and B. Balkau
  Aim  We examined the ability of fasting plasma glucose and HbA1c to predict 5-year incident diabetes for an Australian cohort and a Danish cohort and 6-year incident diabetes for a French cohort, as defined by the corresponding criteria.

Methods  We studied 6025 men and women from AusDiab (Australian), 4703 from Inter99 (Danish) and 3784 from DESIR (French), not treated for diabetes and with fasting plasma glucose < 7.0 mmol/l and HbA1c < 48 mmol/mol (6.5%) at inclusion. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l and/or treatment for diabetes or as HbA1c ≥ 48 mmol/mol (6.5%) and/or treatment for diabetes.

Results  For AusDiab, incident fasting plasma glucose-defined diabetes was more frequent than HbA1c-defined diabetes (PMcNemar < 0.0001), the reverse applied to Inter99 (PMcNemar < 0.007) and for DESIR there was no difference (PMcNema = 0.17). Less than one third of the incident cases were detected by both criteria. Logistic regression models showed that baseline fasting plasma glucose and baseline HbA1c predicted incident diabetes defined by the corresponding criteria. The standardized odds ratios (95% confidence interval) for HbA1c were a little higher than for fasting plasma glucose, but not significantly so. They were respectively, 5.0 (4.1-6.1) and 4.1 (3.5-4.9) for AusDiab, 5.0 (3.6-6.8) and 4.8 (3.6-6.3) for Inter99, 4.8 (3.6-6.5) and 4.6 (3.6-5.9) for DESIR.

Conclusions  Fasting plasma glucose and HbA1c are good predictors of incident diabetes defined by the corresponding criteria. Despite Diabetes Control and Complications Trial-alignment of the three HbA1c assays, there was a large difference in the HbA1c distributions between these studies, conducted some 10 years ago. Thus, it is difficult to compare absolute values of diabetes prevalence and incidence based on HbA1c measurements from that time.

  A. L. S. Hansen , K. Wijndaele , N. Owen , D. J. Magliano , A. A. Thorp , J. E. Shaw and D. W. Dunstan
  Background  Television viewing time is associated cross-sectionally with abnormal glucose tolerance and diabetes risk; however, the impact of changes in television viewing time on glycaemic measures is less understood. We examined relationships of 5-year change in television viewing time with 5-year change in glucose homeostasis markers.

Methods  Participants in the Australian Diabetes, Obesity and Lifestyle study with data available at the 1999-2000 baseline and the 2004-2005 follow-up were included (4870; 45% men). Television viewing time (h/week) was assessed by questionnaire. Fasting plasma glucose, serum insulin and 2-h plasma glucose were obtained from an oral glucose tolerance test. Beta-cell function and insulin resistance were ascertained using the homeostasis model assessment 2-calculator. Associations of change in television viewing time with changes in glucose homeostasis markers were examined using linear regression models [β-coefficients (95% CI)]. Adjustments included baseline measures of age, television viewing time and glycaemic marker, and baseline and 5-year change in diet quality, energy intake, physical activity and waist circumference.

Results  For every 5-h per week increase in television viewing time from baseline to 5-year follow-up, changes in glucose homeostasis markers were observed: among women there was a significant increase in fasting plasma glucose [0.01 (0.00-0.02) mmol/l] insulin resistance [0.03 (0.01-0.05)] and insulin secretion [1.07 (0.02-2.12) %]; insulin levels increased [men: 1.20 (0.30-2.09); women: 1.06 (0.32-1.80) pmol/l]; in men, 2-h plasma glucose levels increased [0.06 (0.01-0.1) mmol/l].

Conclusion  Five-year increases in television viewing time were associated adversely with changes in glucose homeostasis markers. These findings add to earlier cross-sectional evidence that television viewing time can be associated with biomarkers of diabetes risk.

  L. M. Ruta , D. J. Magliano , R. LeMesurier , H. R. Taylor , P. Z. Zimmet and J. E. Shaw
 

Background

As the global prevalence of diabetes increases, so will the numbers of people with diabetic retinopathy. Our review aimed to provide a comprehensive picture of available studies of diabetic retinopathy and how prevalence varies around the developed and developing world.

Methods

A detailed literature search using PubMed was undertaken. The following search term was used: ‘diabetic retinopathy AND prevalence’. The titles and abstracts of all publications identified by the search were reviewed and 492 studies were retrieved. Inclusion and exclusion criteria were applied.

Results

A total of 72 articles from 33 countries were included. There were only 26 population-based studies using fundus photography (12 in developing countries), of which only 16 (eight in developing countries) were published since 2000. Prevalence estimates varied from as low as 10% to as high as 61% in persons with known diabetes and from 1.5 to 31% in newly diagnosed diabetes. Across all the studies, the median (interquartile range) prevalence of any diabetic retinopathy in known diabetes was 27.9% (22-37%) and 10.5% (6-16%) in newly diagnosed diabetes. Prevalence of diabetic retinopathy was higher in developing countries.

Conclusion

Significant gaps exist in that reliable population-based data from developing nations and indigenous populations in particular are lacking. Major differences in study characteristics and methodologies make comparisons very difficult. More research is required and study methodologies must be better standardized. This will provide important information for prevention and treatment strategies.

  N. M. Grantham , D. J. Magliano , S. K. Tanamas , S. Soderberg , M. P. Schlaich and J. E. Shaw
 

Aims

A very limited number of prospective studies have reported conflicting data on the relation between heart rate and diabetes risk. Our aim therefore was to determine in a large, national, population-based cohort if heart rate predicts the development of diabetes.

Methods

The Australian Diabetes Obesity and Lifestyle study followed up 6537 people over 5 years. Baseline measurements included questionnaires, anthropometrics and blood and urine collection. Heart rate was recorded in beats per min (Dinamap). An oral glucose tolerance test was performed at baseline and follow-up, and diabetes was defined using World Health Organization criteria.

Results

A total of 5817 participants were eligible for analysis, 221 of whom developed diabetes. Compared with participants with a heart rate < 60 b min-1, those with a heart rate ≥ 80 b min-1 were more likely to develop diabetes (odds ratio 1.89, 95% CI 1.07-3.35) over 5 years, independent of traditional risk factors. This relationship was highly significant, particularly in non-obese men (odds ratio 5.61, 95% CI 1.75-17.98), but not in their obese counterparts or in women.

Conclusions

Resting heart rate is associated with an increased risk of diabetes over a 5-year period, particularly among non-obese men. This suggests that sympathetic overactivity may be a contributing factor to the development of diabetes, and that resting heart rate may be useful in predicting risk of Type 2 diabetes in non-obese men.

 
 
 
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