Impact of the population at risk of diabetes on projections of diabetes burden in the United States: an epidemic on the way

AIMS/HYPOTHESIS: The aim of this study was to make projections of the future diabetes burden for the adult US population based in part on the prevalence of individuals at high risk of developing diabetes. MATERIALS AND METHODS: Models were created from data in the nationally representative National Health and Nutrition Examination Survey (NHANES) II mortality survey (1976–1992), the NHANES III (1988–1994) and the NHANES 1999–2002. Population models for adults (>20 years of age) from NHANES III data were fitted to known diabetes prevalence in the NHANES 1999–2002 before making future projections. We used a multivariable diabetes risk score to estimate the likelihood of diabetes incidence in 10 years. Estimates of future diabetes (diagnosed and undiagnosed) prevalence in 2011, 2021, and 2031 were made under several assumptions. RESULTS: Based on the multivariable diabetes risk score, the number of adults at high risk of diabetes was 38.4 million in 1991 and 49.9 million in 2001. The total diabetes burden is anticipated to be 11.5% (25.4 million) in 2011, 13.5% (32.6 million) in 2021, and 14.5% (37.7 million) in 2031. Among individuals aged 30 to 39 years old who are not currently targeted for screening according to age, the prevalence of diabetes is expected to rise from 3.7% in 2001 to 5.2% in 2031. By 2031, 20.2% of adult Hispanic individuals are expected to have diabetes. CONCLUSIONS/INTERPRETATION: The prevalence of diabetes is projected to rise to substantially greater levels than previously estimated. Diabetes prevalence within the Hispanic community is projected to be potentially overwhelming. ELECTRONIC SUPPLEMENTARY MATERIAL: Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00125-006-0528-5 and is accessible to authorized users

Association of genomic domains in BRCA1 and BRCA2 with prostate cancer risk and aggressiveness

Pathogenic sequence variants (PSV) in BRCA1 or BRCA2 (BRCA1/2) are associated with increased risk and severity of prostate cancer. Weevaluated whether PSVs inBRCA1/2 were associated with risk of overall prostate cancer or high grade (Gleason 8+) prostate cancer using an international sample of 65 BRCA1 and 171 BRCA2 male PSV carriers with prostate cancer, and 3,388 BRCA1 and 2,880 BRCA2 male PSV carriers without prostate cancer. PSVs in the 30 region of BRCA2 (c.7914+) were significantly associated with elevated risk of prostate cancer compared with reference bin c.1001c.7913 [HR = 1.78; 95% confidence interval (CI), 1.25-2.52; P = 0.001], as well as elevated risk of Gleason 8+ prostate cancer (HR = 3.11; 95% CI, 1.63-5.95; P = 0.001). c.756-c.1000 was also associated with elevated prostate cancer risk (HR = 2.83; 95% CI, 1.71-4.68; P = 0.00004) and elevated risk of Gleason 8+prostate cancer (HR = 4.95; 95% CI, 2.12-11.54; P = 0.0002). No genotype-phenotype associations were detected for PSVs in BRCA1. These results demonstrate that specific BRCA2 PSVs may be associated with elevated risk of developing aggressive prostate cancer. Significance: Aggressive prostate cancer risk in BRCA2 mutation carriers may vary according to the specific BRCA2 mutation inherited by the at-risk individual.Peer reviewe

Genome-wide association and transcriptome studies identify target genes and risk loci for breast cancer

Genome-wide association studies (GWAS) have identified more than 170 breast cancer susceptibility loci. Here we hypothesize that some risk-associated variants might act in non-breast tissues, specifically adipose tissue and immune cells from blood and spleen. Using expression quantitative trait loci (eQTL) reported in these tissues, we identify 26 previously unreported, likely target genes of overall breast cancer risk variants, and 17 for estrogen receptor (ER)-negative breast cancer, several with a known immune function. We determine the directional effect of gene expression on disease risk measured based on single and multiple eQTL. In addition, using a gene-based test of association that considers eQTL from multiple tissues, we identify seven (and four) regions with variants associated with overall (and ER-negative) breast cancer risk, which were not reported in previous GWAS. Further investigation of the function of the implicated genes in breast and immune cells may provide insights into the etiology of breast cancer.Peer reviewe

The effect of suprapubic catheterization versus transurethral catheterization after abdominal surgery on urinary tract infection: a randomized controlled trial.

BACKGROUND/AIM: Transurethral catheterization is generally associated with a higher incidence of urinary tract infections than suprapubic catheterization; however, suprapubic catheterization is associated with other disadvantages such as higher costs and a more difficult technique, and at the moment there is no consensus about the use of both catheter systems. Therefore, a prospective randomized study was performed to investigate the effects of suprapubic catheterization and transurethral catheterization in patients undergoing surgery on the incidence of urinary tract infections and patient satisfaction. METHODS: Patients who underwent an elective laparotomy were randomized and received a suprapubic or transurethral catheter. The primary end point was urinary tract infection. Other parameters of urinary tract infection, as well as duration of catheterization, hospital stay, and number of recatheterizations and of relaparotomies were monitored. Treatment 'per protocol' was also analyzed after exclusion of patients receiving another catheter than randomized for. Patients were asked for their satisfaction with the catheters and complaints during and after catheterization. RESULTS: 165 patients were eligible, of whom 19 patients had to be excluded. 75 patients were allocated to receive the suprapubic catheter and 71 the transurethral catheter. There was no difference in the incidence of a urinary tract infection between the suprapubic group (n = 9/75; 12%) and the transurethral group (n = 8/71; 11%). Most patients (6/9) who developed a urinary tract infection in the suprapubic group, however, underwent recatheterization because of postoperative complications/sepsis and relaparotomy. The incidence of urinary tract infections in patients who received a suprapubic catheter and not a transurethral catheter was 3/59 (5%). The patients did not differ with respect to satisfaction and complaints. Being a men, recatheterization and duration of catheterization are risk factors. CONCLUSIONS: The incidence of a urinary tract infection between a suprapubic catheter and a transurethral catheter in patients undergoing major surgery was not different. A potential advantage of the suprapubic catheter (reduction of urinary tract infections) is probably partly negated, because transurethral catheters were used if recatheterization was indicated during the postoperative stay or due to complications

Impact of the ageing population on burden of disease. Projections of chronic disease prevalence for 2005-2025

Due to ageing and growth of the population, the number of persons with a chronic disease will increase in the next twenty years, with the largest increase expected in the number of persons with diabetes and osteoporosis. In the next twenty years, 300,000 additional cases of diabetes are expected, with a further 100,000 cases of diabetes expected if the increase in the prevalence of obesity continues at the present rate. 350,000 additional cases of osteoporosis are expected in the next twenty years. In the past decades, smoking has declined in men, while it has increased in women, resulting in future patterns of smoking-related diseases (COPD and lung cancer) that are different for men and women: a smaller increase in men, and a larger increase in women than expected on the basis of demographic changes alone. These are some of the results drawn from projections of the chronic disease burden for 2005 up to 2025. Projections - for cardiovascular diseases (myocardial infarction, stroke and heart failure), diabetes mellitus, cancer (lung, colon, breast), asthma, COPD and osteoporosis - were made for anticipating future health-care needs and costs. Different methods employed here were: simple demographic projections, using present age-specific prevalence combined with future population numbers; projections using the Chronic Diseases Model, in which trends in diseases observed in the past are taken into account, and projections using the Chronic Diseases Model in which also future trends in obesity and smoking are taken into account.Door de groei en vergrijzing van de Nederlandse bevolking zal het aantal chronisch zieken de komende twintig jaar sterk toenemen. Vooral het aantal diabeten en mensen met botontkalking (osteoporose) zal stijgen. Naar schatting is het aantal diabeten over twintig jaar met 300.000 toegenomen. Als de huidige toename van het aantal mensen met overgewicht doorzet, zal het aantal diabeten in die periode met 100.000 patienten extra toenemen. Ook wordt een sterke toename verwacht van het aantal mensen met osteoporose met ongeveer 350.000 personen. De stijging van aan roken gerelateerde ziekten (COPD en longkanker) zal naar verwachting bij vrouwen groter zijn dan op grond van de demografische toename wordt verwacht, en kleiner bij mannen. Dat komt doordat vrouwen de afgelopen decennia meer zijn gaan roken en mannen juist minder. Dit zijn enkele prognoses voor het aantal chronisch zieken tussen 2005 en 2025. Deze prognoses geven meer inzicht in de mate waarin het aantal zieken zal stijgen. Die kennis is van belang om te kunnen anticiperen op de toekomstige vraag naar zorg, en de daarmee gepaard gaande kosten. De prognoses zijn op drie manieren berekend, afhankelijk van de beschikbare informatie. Ten eerste is alleen uitgegaan van de veranderende omvang van de bevolking en de vergrijzing. Vervolgens zijn berekeningen met het Chronische Ziekten Model (CZM), een wiskundig simulatiemodel, uitgevoerd. In deze berekeningen zijn, behalve gegevens over groei en vergrijzing, trends in het aantal patienten met de onderzochte ziekten verdisconteerd. Ten slotte is, ook met het CZM, berekend wat de invloed is van toekomstige ontwikkelingen van overgewicht en roken. De in dit rapport besproken ziekten zijn: hart- en vaatziekten (hartinfarct, beroerte, hartfalen), diabetes, kanker (long-, borst-, en dikke darmkanker), astma, COPD en osteoporose