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Articles by J. Tuomilehto
Total Records ( 7 ) for J. Tuomilehto
  P. Pajunen , M. Peltonen , J. G. Eriksson , P. Ilanne-Parikka , S. Aunola , S. Keinanen-Kiukaanniemi , M. Uusitupa , J. Tuomilehto and J. Lindstrom
  Aims: We analysed the Finnish Diabetes Prevention Study data in order to evaluate how the new HbA1c-based criterion compares with the oral glucose tolerance test in diagnosing Type 2 diabetes among high-risk individuals during a prospective average follow-up of 4 years. Methods: In the Diabetes Prevention Study, 172 men and 350 women who were overweight and had impaired glucose tolerance at baseline were randomized into an intensive lifestyle intervention or a control group. The oral glucose tolerance test and HbA1c measurements were performed annually until the diagnosis of diabetes using the World Health Organization 1985 criteria. Results: The sensitivity of the HbA1c≥ 6.5% (≥ 48 mmol/mol) as a diagnostic criterion for Type 2 diabetes was 35% (95% CI 24%, 47%) in women and 47% (95% CI 31%, 64%) in men compared with diagnosis based on two consecutive oral glucose tolerance tests. The corresponding sensitivities for HbA1c≥ 6.0% (≥ 42 mmol/mol) were 67% (95% CI 55%, 77%) and 68% (95% CI 51%, 82%). The participants with HbA1c≥ 6.5% (≥ 48 mmol/mol) and diabetes based on the oral glucose tolerance test were more obese and had higher fasting glucose and 2-h glucose concentrations than those who had a diabetic oral glucose tolerance test but HbA1c < 6.5% (< 48 mmol/mol). There were no differences in the predictive performance of baseline fasting glucose, oral glucose tolerance test and HbA1c. Conclusions: Of those with diabetes diagnosis based on two oral glucose tolerance tests during the Diabetes Prevention Study follow-up, 60% would have remained undiagnosed if diagnosis had been based on HbA1c≥ 6.5% (≥ 48 mmol/mol) criterion.
  F. Ning , Z. C. Pang , Y. H. Dong , W. G. Gao , H. R. Nan , S. J. Wang , L. Zhang , J. Ren , J. Tuomilehto , N. Hammar , K. Malmberg , S. W. Andersson and Q. Qiao
  Objective  To investigate the major risk factors and their association with the dramatic increase in the prevalence of diabetes from 2001-2002 to 2006 in Qingdao, China.

Methods  Population-based cross-sectional studies on diabetes were performed in 4598 men and 7026 women aged 35-74 years. The 2006 World Health Organization diagnostic criteria for diabetes were used.

Results  The crude prevalence of diabetes was 11.3% in both men and women in urban areas and 5.3% and 8.9% in rural areas in 2001-2002. This increased to 19.2% and 16.1% in urban areas and 14.2% and 13.8% in rural areas in 2006 for men and women, respectively. The increase in diabetes prevalence from 2001-2002 to 2006 was paralleled by an increased body mass index in rural areas but not in urban areas. The major risk factors associated with diabetes were age, family history of diabetes, obesity, hypertension and high triglycerides. The multivariate adjusted odds ratio and 95% confidence interval for diabetes corresponding to a one standard deviation increase in waist circumference was 1.81 (1.47, 2.23) in urban men, 1.64 (1.26, 2.13) in rural men, 1.98 (1.66, 2.37) in urban women and 2.02 (1.63, 2.51) in rural women. Low socio-economic classes had a higher risk for diabetes in urban areas but a lower risk in rural areas, both associated with increased waist circumference.

Conclusion  Established risk factors are of great importance for the prevalence of diabetes in the urban and rural Chinese populations and changes in these factors could explain the recent dramatic increase in diabetes prevalence, particularly in rural areas. Considering the high prevalence of obesity and physical inactivity, intervention is urgently required in China.

  W. G. Gao , Y. H. Dong , Z. C. Pang , H. R. Nan , S. J. Wang , J. Ren , L. Zhang , J. Tuomilehto and Q. Qiao
  Aims  A diabetes risk score for screening undiagnosed diabetes was constructed and validated in Chinese adults.

Methods  Two consecutive population-based diabetes surveys among Chinese adults aged 20-74 years were conducted in 2002 (n = 1986) and 2006 (n = 4336). Demographic and anthropometric measures were collected following similar procedures. Standard 2-h 75-g oral glucose tolerance tests (OGTTs) were performed to diagnose diabetes in both surveys. Fasting capillary plasma glucose (FCG) and glycated haemoglobin (HbA1c) were also measured together with the OGTTs on the same day of the 2006 survey. Beta coefficients estimated using logistic regression analysis derived from data of the 2002 survey were used to develop the risk assessment algorithm. The performance of the algorithm was validated in the study population of the 2006 survey.

Results  Of all the variables tested, waist circumference, age and family history of diabetes were significant predictors of diabetes and were used to construct the risk assessment score. The score, ranging from 3 to 32, performed well when applied to the study population of the 2006 survey. The area under the receiver operating characteristic curve was 67.3% (95% CI, 64.9-69.7%) for the score, while it was 76.3% (73.5-79.0%) for FCG alone and 67.8% (64.9-70.8%) for HbA1c alone. At a cut-off point of 14, the sensitivity and specificity of the risk score were 84.2% (81.0-87.5%) and 39.8% (38.2-41.3%).

Conclusions  The risk score based on age, waist circumference and family history of diabetes is efficient as a layperson-oriented diabetes screening tool for health promotion and for population-based screening programmes.

  F. Zhang , L. Dong , C. P. Zhang , B. Li , J. Wen , W. Gao , S. Sun , F. Lv , H. Tian , J. Tuomilehto , L. Qi , C. L. Zhang , Z. Yu , X. Yang and G. Hu
  Aims  To investigate the trend in the prevalence of gestational diabetes mellitus during 1999-2008 in women living in urban Tianjin, China.

Methods  A universal screening for gestational diabetes mellitus has become an integral part of the antenatal care in Tianjin, China from 1998. A total of 105 473 pregnant women living in the six urban districts of Tianjin, China, participated in the gestational diabetes mellitus screening programme between December 1998 and December 2008. The screening test consisted of a 50-g 1-h glucose test. Women who had a glucose reading ≥ 7.8 mmol/l at the initial screening were invited to undergo the standard 2-h oral glucose tolerance test with a 75-g glucose load. Gestational diabetes mellitus was confirmed using the World Health Organization's diagnostic criteria.

Results  The adjusted prevalence of gestational diabetes mellitus increased by 2.8 times during 1999-2008, from 2.4 to 6.8% (P < 0.0001 for linear trend). In 2008, the age-specific prevalence of gestational diabetes mellitus was the highest among women aged 30-34 years (11.3%) and lowest among women aged 25 and under (1.2%). In women aged 35 years and more, the prevalence was 5.3%.

Conclusions  The prevalence of gestational diabetes mellitus has markedly been increasing in a universally screened urban Chinese female population and has become an important public health problem in China.

  T. Laitinen , J. Lindstrom , J. Eriksson , P. Ilanne-Parikka , S. Aunola , S. Keinanen-Kiukaanniemi , J. Tuomilehto and M. Uusitupa
  Aims  The aim of this study was to investigate the prevalence of cardiovascular autonomic neuropathy in persons with previously diagnosed impaired glucose tolerance and to characterize associations between components of metabolic syndrome and cardiovascular autonomic neuropathy in the Finnish Diabetes Prevention Study cohort.

Methods  Two hundred and sixty-eight individuals with impaired glucose tolerance at baseline in the Finnish Diabetes Prevention Study, but not diagnosed with diabetes during follow-up, were studied for cardiovascular autonomic neuropathy. At the second annual follow-up visit after the end of lifestyle intervention, we performed deep-breathing and active orthostatic tests to detect possible parasympathetic and sympathetic dysfunction. To describe metabolic characteristics, anthropometric measurements, an oral glucose tolerance test and assessments for HbA1c, serum lipids and blood pressure were carried out.

Results  Prevalence of parasympathetic dysfunction was 25% and prevalence of sympathetic dysfunction was 6%, with no difference between the former intervention and control group participants or between men and women. Subjects with parasympathetic dysfunction were older, more obese (weight, waist circumference, body mass index) and had higher triglyceride concentration compared with those with normal parasympathetic function (P < 0.01 for all). Parasympathetic dysfunction was not significantly associated with other characteristics of metabolic syndrome; for example, high cholesterol, glucose and insulin levels or HbA1c. Correlations between the Expiration/Inspiration (E/I) ratio (the longest heart beat duration in expiration divided by the shortest heart beat duration in inspiration) and measures reflecting obesity were statistically significant in the pooled population and in men but not in women.

Conclusions  Cardiovascular autonomic neuropathy is common in persons with impaired glucose tolerance. Obesity, especially among men, seems to play an important role in the early pathogenesis of cardiovascular autonomic neuropathy.

  B. Costa , F. Barrio , J.-J. Cabre , J.-L. Pinol , F.-X. Cos , C. Sole , B. Bolibar , C. Castell , J. Lindstrom , N. Barengo and J. Tuomilehto
  Aim  To investigate changes in the prevalence of diabetes and pre-diabetes by shifting from 2-h plasma glucose and/or fasting plasma glucose diagnostic criteria to the proposed new HbA1c-based criteria when applied to a Mediterranean population detected to have a high risk of Type 2 diabetes.

Methods  Individuals without diabetes aged 45-75 years (n = 2287) were screened using the Finnish Diabetes Risk Score questionnaire, a 2-h oral glucose tolerance test plus HbA1c test. Prevalence and degree of diagnostic overlap between three sets of criteria (2-h plasma glucose, fasting plasma glucose and HbA1c) and three diagnostic categories (normal, pre-diabetes and diabetes) were calculated.

Results  Defining diabetes by a single HbA1c measurement resulted in a dramatic decrease in prevalence (1.3%), particularly in comparison with diabetes defined by 2-h plasma glucose (8.6%), but was also significant with regard to fasting plasma glucose (2.8%). A total of 201 screened subjects (8.8%) were classified as having diabetes and 1023 (44.7%) as having pre-diabetes based on at least one of these criteria; among these, the presence of all three criteria simultaneously classified only 21 and 110 individuals respectively, about ten percent of each group. The single overlap index between subjects diagnosed as having diabetes by 2-h plasma glucose/fasting plasma glucose vs. HbA1c was 13.9/28%. Similarly, the single overlap index regarding pre-diabetes was 19.2/27.1%.

Conclusions  A shift from the glucose-based diagnosis to the HbA1c-based diagnosis for diabetes will reduce diabetes prevalence with a low overall or single degree of overlap between diagnostic categories in this high-risk Spanish population.

  N. Rautio , J. Jokelainen , H. Oksa , T. Saaristo , M. Peltonen , H. Puolijoki , J. Tuomilehto , M. Vanhala , L. Moilanen , M. Uusitupa and S. Keinanen-Kiukaanniemi
  Aims  To investigate whether a positive family history of diabetes is associated with the effectiveness of lifestyle counselling on cardio-metabolic risk factors and glucose tolerance status in a 1-year follow-up in a cohort of Finnish men and women at high risk for Type 2 diabetes.

Methods  Altogether, 10 149 individuals who had high risk of Type 2 diabetes participated in the implementation programme of the national diabetes prevention programme at baseline. One-year follow-up data were available for 2798 individuals without diabetes. Family history of diabetes was based on self-report. Lifestyle interventions were individual or groups sessions on lifestyle changes. The effectiveness of lifestyle intervention was measured as changes in cardiovascular risk factors, glucose tolerance status and incidence of Type 2 diabetes.

Results  Family history was associated with the effectiveness of lifestyle intervention in men, but not in women. During the 1-year follow-up, body weight, BMI, systolic blood pressure, total cholesterol, LDL cholesterol and score for 10-year risk for fatal cardiovascular disease (SCORE) decreased and glucose tolerance status improved more in men without a family history of diabetes than in men with a family history of diabetes. Of the participating men and women, 10% and 5% developed Type 2 diabetes, respectively. Family history was not related to the incidence of Type 2 diabetes in either gender.

Conclusions  Men without a family history of diabetes were more successful in responding to lifestyle counselling with regard to cardio-metabolic measurements and glucose tolerance than those with a family history of diabetes. Similar results were not seen in women. In keeping with findings from earlier studies, the prevention of Type 2 diabetes is not influenced by a family history of diabetes.

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