Epidemiology of type 2 diabetes and cardiovascular disease statistics,type 1 diabetes control and management,pw tld - Downloads 2016

In 2011, 26 million people or 8.3% of the population in the United States had the disease, with nearly 2 million people over the age of 20 newly diagnosed in 2010 alone. Call Diabetes Partnership of Cleveland at 216-591-0800 and ask to speak with a dietitian, attend a Diabetes Education Class, learn about what your numbers mean to reduce your risk for complications.
The burden and public health impact of macrovascular disease in patients with diabetes mellitus is increasing with the increasing prevalence of diabetes. Mortality rates in diabetes mellitus are approximately twice as high compared to individuals without diabetes. Diabetic patients without a previous myocardial infarction have about the same risk rate of major cardiovascular events as non-diabetic patients with a previous myocardial infarction (figure 1)[1]. Several epidemiologic studies have shown an increased cardiovascular risk in the earliest stages of the disease. Gender differences in diabetes mellitus have been observed with increasing evidence showing that the disease affects women and men differently, in particular for CHD and stroke risk.
Apart from the under-representation of women in studies and possible disparities in treatment, explanations for a more adverse cardiovascular risk profile in women could be altered estrogen-related protective mechanisms, altered insulin action, low-grade inflammation, and changes in coagulation and fibrinolysis. Overlapping in type 1 and type 2 diabetes, important predictors of cardiovascular morbidity and mortality include diabetes duration, glycemic control, hypertension, age, smoking, dyslipidemia, microalbuminuria and a history of CHD. Microalbuminuria is a strong and independent risk factor for future cardiovascular morbidity and mortality in both people with and people without diabetes. Two decades ago, the DCCT and The United Kingdom Prospective Diabetes Study [UKPDS] were the pioneering studies demonstrating that intensive blood glucose control results in a remarkable reduction of diabetes-related complications.
Similar findings were documented for type 2 diabetes in the UKPDS: a clinically relevant post-trial risk reduction of 15% emerged over time for myocardial infarction, whereas differences during the interventional phase of the trial were not significant. The Framingham Heart Study investigated age- and sex-adjusted incidence rates of cardiovascular disease among subjects with and without diabetes in two different time periods. However, while improvements in diabetes care, including self-management and intensifying medical treatment, result in improved cardiovascular morbidity and mortality rates, this is offset by the increasing incidence of diabetes mellitus; the societal burden of diabetes-related cardiovascular complications still remains high.
Han transcurrido mas de 5 anos desde la publicacion de esta Guia de Practica Clinica y esta pendiente su actualizacion. Consiste en la determinación de la glucemia en plasma venoso a las dos horas de una ingesta de 75 g de glucosa en los adultos. El estadio de intolerancia a la glucosa (TAG) solamente puede ser diagnosticado por glucemia a las dos horas del TTOG.
Science, Technology and Medicine open access publisher.Publish, read and share novel research. Anemia of Chronic Kidney Disease — A Modifiable Risk Factor in a Growing High Cardiovascular Risk PopulationNadine Montemarano1, Jennifer Guttman1 and Samy I. Based on reference 3 Beutler et al.Multiple risk factors increase the risk of developing anemia. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification Andrew S.
National Kidney Foundation: KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Prevalence of and Risk Factors for Peripheral Arterial Disease in the United States : Results From the National Health and Nutrition Examination Survey, 1999 -2000. Writing Group Members for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Zoccali C, Bode-Boger S, Mallamaci F, Benedetto F, Tripepi G, Malatino L, Cataliotti A, Bellanuova I, Fermo I, Frolich J, Boger R.
366 million people have diabetes worldwide and this number has nearly doubled in the last 30 years. It has been proven beyond doubt that the highest rates of diabetes-related morbidity and mortality are attributable to one of the three major macrovascular complications: coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD). The increased risk of cardiovascular disease in diabetes is the most important explanation for these high mortality rates.
Already in subjects with pre-diabetes, such as an impaired fasting glucose (IFG), an increased risk is found.
In type 2 diabetes a greater excess coronary risk (relative risk up to 50%) has been found in women compared to men [6][7].
These latter factors could, individually or combined, result in more pronounced endothelial dysfunction in an early stage of the disease. Furthermore, there is an independent and continuous association between the degree of albuminuria in combination with a reduced eGFR and the risk for cardiovascular outcomes in patients with type 2 diabetes (figure 4). In line with the known increased risk for those with type 2 diabetes, this study showed an almost three fold higher incidence of cardiovascular disease in the diabetic group compared to the non-diabetic group in both time periods. Las recomendaciones que contiene han de ser consideradas con precaucion teniendo en cuenta que esta pendiente evaluar su vigencia. Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Among multiple factors, individuals with CVD, DM and CKD, HTN(HTN) and of African American race are at significantly high risk than the general population [4,5,6].
The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Prevalence and associations of anemia of CKD: Kidney Early Evaluation Program (KEEP) and National Health Nutrition Examination Survey(NHANES)1999-2004.
Cardiovascular disease associated with anemia in diabetic patients with chronic kidney disease. Hematologic differences between African-Americans and whites: the roles of iron deficiency and alpha-thalassemia on hemoglobin levels and mean corpuscular volume. Bethesda, MD, The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2006. The intensity of hemodialysis and the response to erythropoietin in patients with end-stage renal dis- ease. Abnormal membrane fluidity and acetylcholinesterase activity in erythrocytes from insulin-dependent diabetic patients.
Membrane lipid alteration and Na-pumping activity in erythrocytes from IDDM and NIDDM subjects. Changes in fluidity and composition of erythrocyte membranes and in composition of plasma lipids in type I diabetes. In vitro effects of high glucose concentrations on membrane protein oxidation, G- actin and deformability of human erythrocytes.
Transferrinuria in type 2 diabetic patients with early nephropathy and tubulointerstitial injury. Left ventricular mass index increase in early renal disease: impact of decline in haemoglobin. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Ethnic Disparities in Cardiovascular Risk Factors and Coronary Disease Prevalence among Individuals with Chronic Kidney Disease: Findings from the Third National Health and Nutrition Examination Survey. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence.
Biomarkers of inflammation and thrombosis as predictors of near-term mortality in patients with peripheral arterial disease: a cohort study. Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: A pooled analysis of community-based studies.
Target level for hemoglobin correction in patients with diabetes and CKD: primary results of the Anemia Correction in Diabetes (ACORD) Study. TREAT Investigators: A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease.
Predictors of fatal and nonfatal cardiovascular events in patients with type 2 diabetes mellitus, chronic kidney disease, and anemia: an analysis of the Trial to Reduce cardiovascular Events with Aranesp (darbepoetin-alfa) Therapy (TREAT). USRDS 2011 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States. Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: A prospective study. Reducing the burden of cardiovascular calcification in patients with chronic kidney disease. New insights into the pathophysiology of diabetic nephropathy: from hemodynamics to molecular pathology. Case for intrarenal hypertension in initiation and progression of diabetic and other glomerulopathies. For those over age 65 in the USA, nearly 27% are suffering diabetes’ ill effects which include high rates of cardiovascular disease, neuropathy, kidney damage, blindness, high blood pressure, and amputation. The increased cardiovascular risk in those with impaired glucose tolerance (IGT) is in fact independent of the subsequent development of diabetes (figure 2) Figure 2. Furthermore, a greater risk of stroke in diabetic women has been found with a relative risk increase of 27%[8]. Still, a substantial proportion of the higher cardiovascular risk in women with diabetes remains unclear. Cumulative incidence of the first of any adverse cardiovascular outcomes in patients with type 1 diabetes initially treated with intensive or conventional therapy.. But in the later period the incidence rate for cardiovascular disease in the diabetic patients decreased markedly by almost 50% compared to the earlier period.
Definition, Diagnosis and classification of diabetes mellitus and its complications: Report of a WHO Consultation.
Isolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men.
Use of HbA1c in predicting progression to diabetes in French men and women: data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR).
Consensus Statement on the Worldwide Standardization of the Hemoglobin A1C Measurement: The American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine, and the International Diabetes Federation.
IntroductionDiabetes Mellitus (DM) has become a modern day epidemic, affecting millions of people around the globe. The facts speak to an urban triumph that has led to greater national prosperity and higher standards of living for tens of millions of Americans. Relative risk of cardiovascular events in those without and with diabetes, with and without a history of previous myocardial infarction (MI).
Cumulative hazards for CVD based on the 2-hour glucose results following an Oral Glucose Tolerance Test.[2].
En los estados no basales (posprandiales), ambas determinaciones son prácticamente iguales.
It has grown parallel to the rising epidemic of obesity, leading to increased cardiovascular disease (CVD) morbidity and mortality. Postulated mechanisms of anemia in CKD, CVD and DMCKD, CVD and DM are intricately interconnected with one another.
Josh Stephens Blog Visualizing Hyperdensity The most dense neighborhood in Manhattan is surprisingly low-key. Furthermore, the combination of diabetes and a prior myocardial infarction is associated with a steep increase in CHD mortality risk. Combined effects of albuminuria and renal function (expressed as eGFR) at baseline on the risk for cardiovascular death.To reduce cardiovascular risk it is important to target the potentially modifiable risk factors in diabetes. The incidence of cardiovascular disease in participants without diabetes was 35% lower in the later period [12]. Currently, DM is the most common cause of chronic kidney disease (CKD) and subsequent end stage renal disease (ESRD) requiring renal replacement therapy.
Therefore, assessment and reduction of microalbuminuria play an important role in diabetes management.
Although statistics indicate a leveling off in the incidence of ESRD among diabetics, these statistics do not hold true for some of the most vulnerable populations such as minority populations.CVD is the primary cause of death in people with DM who also possess traditional risk factors such as hypertension (HTN), obesity (particularly central obesity), dyslipidemia (decreased HDL, and elevated triglycerides), increased age, sedentary lifestyle and smoking.

According to the Center for Disease Control (CDC), more than 35% of people aged 20 years or older with DM have CKD and more than 20% of people aged 20 years or older with HTN have CKD [9]. View all jobsPost a Job Research thousands of planners, designers, architects, developers, and other professionals and academics who are working with the built environment. This decline reduced the absolute difference between individuals with and without diabetes [13].
Nontraditional risk factors for CVD include increased inflammation, stimulation of the renin-angiotensin-aldosterone system (RAAS), increased fibrinogen, increased platelet activator inhibitor factor -1 (PAI-1) among others. Regardless of the level of estimated glomerular filtration rate (e-GFR), anemia is both more frequent and more severe in diabetics compared to non-diabetic patients [10]. Post a job Insider's Guide to Careers in Urban Planning Check out our behind the scenes look at 25 careers in Urban Planning.
Furthermore, a large reduction in the incidence of cardiovascular disease, particularly acute myocardial infarction has been observed as well. Diabetic kidney disease (DKD) is a well established cause of CVD and currently, it is considered a cardiovascular equivalent. Diabetes types 1 and 2, are the leading cause of CKD in the western world, accounting for approximately 30-40% of cases.
Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence.
Of note, the rate reduction of acute myocardial infarction, stroke, amputation, and end-stage renal disease among the patients with diabetes surpassed the rate reduction in the patients without diabetes [14].
Although it is difficult to compare such findings, the same trends were observed in other countries.
The exact cause of increased CVD risk in CKD is likely multifactorial but is largely unknown.
A number of mechanisms contribute to the development of anemia in diabetics with CKD such as decreased red blood cell (RBC) life span, iron deficiency, nutritional folate deficiency, occult blood loss, systemic inflammation and what appears to be the most dominant causal factor, erythropoietin deficiency [11].
Anemia has been shown to increase cardiovascular risk in this vulnerable population and prior studies have demonstrated that treatment of anemia reduces this risk and improves quality of life [5]. Renal anemia is associated with a reduction in the number of RBCs and with an increase in oxidative stress to RBCs [23]. On the other hand, recent trials have shown an increased risk of CVD in those with higher hemoglobin values being treated with ESA [56].
It is unclear whether the ESA in large doses confers this harm or whether the correction of anemia to high hemoglobin levels is responsible.
While this phenomenon has been recognized for over 50 years, the mechanism is not completely understood [12]. These uncertainties explain why many clinicians prefer transfusion therapy over the use of ESA. Some studies show that the decrease in RBC half life is partially caused by the uremic environment present in CKD patients. Several questions remain unanswered including the mechanisms by which anemia confers increased cardiovascular risk in CKD and dialysis patients. Another important issue surrounded by controversy is the degree to which anemia should be corrected with erythropoietic stimulating agents (ESA).
Studies have also shown that the RBCs in diabetics have multiple metabolic and functional abnormalities [17,18].
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In this chapter, we discuss the relationship between DM and CKD and the associated CVD risk factors, highlighting the pathophysiologic mechanisms that link anemia and CVD. View top schools Planetizen Guide to Graduate Urban Planning Programs The Guide is the only comprehensive ranking and listing of graduate urban planning programs available. We also explore the therapeutic rationale behind the current guidelines provided by the National Kidney Foundation for the management of anemia.
These guidelines are constantly updated as new randomized controlled trials continuue to emerge. According to Manodori et al, as a result of these changes, RBC life span in diabetic patients is decreased compared to nondiabetic patients with similar degrees of renal impairment [22].
Transferrin is a protein that captures iron that has been absorbed from the GI tract and that has been released from macrophages and delivers it to maturing RBCs.
Newer research differentiates anemia cutoffs based on both race and age in addition to sex. Table 1 lists proposed lower limits of normal for hemoglobin concentration based on Scripps-Kaiser data for the 5th percentiles and the NHANES data published in 2006 [2]. As uremia leads to platelet dysfunction, CKD patients are at increased risk for bleeding and iron loss [24]. Hemodialysis patients are at particular risk because of the chance for blood loss during dialysis [25].
Diabetics with nephropathy are at an added risk for iron loss by urinary excretion as their proteinuria progresses [26]. Systemic Inflammation is one of the leading features of diabetics with CKD that appears to contribute to anemia.
Fanis Grammenos warns planners and urban designers that the answer is not so simple, and misusing the statistics will weaken effective debate.
This inflammatory response is secondary to a variety of factors including elevated levels of inflammatory cytokines, volume overload and oxidative stress. Increased level of cytokines impair bone marrow function and significantly alter iron metabolism.
One example is the association that was recently made between car travel and the lower average healthy life expectancy (DFLE) (by 1.5 years) of US citizens versus their OECD counterparts. Erythropoietin (EPO) is a glycoprotein growth factor that is produced by the peritubular interstitial fibroblasts of the renal cortex and outer medulla [27].
The release of EPO is regulated by a complex feedback mechanism at the level of the kidney.
Inadvertently, even with all their mathematical rigour, stats often conceal as much as they reveal (a fact unintentionally made unintelligible in the "study limitations" sections).To expand the horizon of the health-travel conversation, I explore additional statistics that I believe need to be assimilated into it. These may reveal the multiplicity of factors and their interactions and raise questions about misapplied correlations and improbable causalities.
This article does not aim to deny the merit of proposing policies to increase active travel (a worthwhile goal) but seeks to limit the license to use statistics incautiously to prove their value. In this group, EPO deficiency is regarded as functional as it stems from a failure to increase EPO levels in response to a falling hemoglobin level, even though the absolute value of EPO may be within normal limits. EPO deficiency appears to contribute largely to the development of anemia in patients with diabetic nephropathy and CKD [28, 29]. For a century dominated by motorized transport, which in its early decades caused a virtual slaughter on city streets and, without catalytic converters until the late 70s (combined with a very inefficient fleet), produced a very noxious, toxic environment, this upward trend is counter-intuitive. Multiple explanations have been postulated to account for the EPO deficiency in this patient population including microvascular damage, chronic hypoxia, oxidative stress, and autonomic neuropathy.
Such a trend raises the question of the exact role automobiles plays in the loss of life-years.The first fifty years of auto-mobility, however bad they might have been, are not typical of a general lifestyle that relies predominantly on cars for transport and they could be sidestepped as unrepresentative. Damage to the tubulointerstitial cells has been observed in the early stages of diabetic nephropathy resulting in impairment of the signaling cascade that triggers transcription and release of EPO [29]. The true motorization of daily life took hold from the 50s on, the Interstate Highway era, with the expansion of cities into vast first and second tier suburbs.A comparison of VMTs and longevity for the 2nd half of the 20th century also shows a fairly good correlation.
Unregulated activation of the Renin-Angiotensin-Aldosterone System (RAAS) in diabetics may also contribute to impaired erythropoietin release.
In these 50 years, the per capita VMTs in the US rose from about 3,000 miles in 1950 to about 9,000 miles in 2000, an astonishing 300% percent increase.
Similarly, experimental models have illustrated that autonomic dysfunction, as seen in diabetics who tend to develop splanchnic nerve dysfunction, have impaired production of EPO [30].
Many of the same risk factors that contribute to DM, CKD and CVD, both independently and synergistically. We don't know in what ways auto-mobility could mediate a life-span increase, except by the mundane and likely insignificant fact of speedier access to hospitals for accident victims and heart or stroke patients.
Another speculative connection, supported by research, is the opportunity it provides for frequent visits to the countryside, a confirmed de-stressor.
Some of the traditional risk factors include obesity, hypertension, dyslipidemia and smoking.
Cottages, for example, a cherished possession of about 10% of households, would be entirely inaccessible on weekends or other occasions without auto-mobility. Among the non traditional risk factors are anemia, chronic systemic inflammation, oxidative stress, hyperparathyroidism, hyperhomocysteinemia, endothelial dysfunction and prothrombin states [34].
Diabetic kidney disease, also known as diabetic nephropathy, is one of the major complications of type 2 diabetes. Abundant research has shown a correlation between proximity to nature and better population health, but we don't know whether cottage owners or frequent hikers fair better than others. Consequently, lacking the list and the data on the mediating mechanisms, the question of a potential positive influence of auto-mobility and its magnitude remains unanswered for now.
The increased intracellular glucose leads to increased production of glucose intermediaries cycling through multiple metabolic pathways. And, based on the simple countervailing evidence, neither can we assert that this dramatic three-fold increase in VMTs had a calamitous effect on health or longevity.Zooming in on mechanismsOn the negative influence side, we can at least speculate on the possible mechanisms (Chart 1). This leads to the production of advanced glycation products (AGEs), activation of protein kinase C (PKC), increased expression of transforming growth factor-beta (TGF-beta), GTP-binding proteins, and the formation of reactive oxygen species (ROS) [64]. Eight health problems are associated with inadequate physical activity, of which driving is one. Of these eight, heart and cerebrovascular diseases have decreased dramatically in the US (down by roughly two thirds since 1950), though they still remain as principal causes.
In addition to these metabolic events, there is also a hemodynamic component to diabetic kidney disease. Cancers, of which there are many types and have many, and unknown, potential causes (including a chemical overload in foods, drinks and air), have remained practically unchanged. Hyperglycemia impairs glomerular circulation, mainly dilation of the afferent arteriole, which subsequently leads to increased glomerular capillary pressure [67, 68]. The culmination of these hyperglycemia induced metabolic and hemodynamic derangements sets off a cascade of aberrant cell growth, angiogenesis, extracellular matrix abnormalities, hyalinization of arterioles, proteinuria, and hyperfiltration, ultimately resulting in diabetic kidney injury [64]. Respiratory diseases have increased and air pollution could be a partial cause for the increase. Type 2 diabetes is the most common cause of CKD among the US adult population and both DM and CKD can cause anemia. The decreased oxygen carrying capacity associated with anemia may aggravate myocardial hypoxia, increase cardiac output, cause volume overload, increase heart rate, stimulate the RAAS, and can lead to left ventricular hypertrophy (LVH). The damage caused as a result produces myocyte loss, progressive fibrosis, coronary heart disease (CHD) and heart failure [32,33]. Or, if it did, speculate that other countervailing factors mask the effect?Until we fully understand the mechanisms of the onset of these diseases and the precise attribution to factors that trigger their emergence, the jury on how auto-mobility modifies lifespan, whether negatively or positively and to what net extent, is still out.Of the mechanisms, we know that obesity, an early sign of possible negative health outcomes, can have several triggers acting singly or in concert.
Type 2 diabetes increases the risk of CHD events by at least by two- to three fold compared with non-diabetics [31].
Driving has been shown to correlate with the odds of obesity increase as have lack of exercise, education, stress, and food amount and type. EpidemiologyGiven the constant influx of immigrants to the western world, addressing the medical issues facing minorities holds critical relevance. Note that the fifties, the highway era, also saw the widespread adoption of television soon to become the key media for communication, politics, advertizing and free entertainment, inducing more passivity at home.
Approximately one third of American population currently identifies as minority, including Hispanics, African Americans, Asians, and Native Americans [35].
The same era also saw an exponential growth of fast food chains that paid little attention to dietary rules.

Between 2010 and 2050, this population is expected to grow geometrically, most markedly in the Asian and Hispanic American populations, which are both anticipated to double during this period [36]. These covariances in cultural traits also imply a respective increase in the probable triggers of obesity aside from and in addition to driving. The exact contribution of each remains undetermined.On the job scene, during these fifty years, the service sector overtook the production sector in employment. Ethnic differences in CKDESRD is much more common among ethnic minorities with rates per million as high as 925 among blacks, 501 among Hispanics, and 465 among Native Americans compared with 276 among NHWs.
ESRD as caused by HTN, the second leading cause, is also much more common in minorities with a nearly 11 times greater prevalence among blacks than whites [48]. On top of that, in patients with ESRD, the prevalence of HTN is greater in both Hispanic and NHBs compared with NHWs. Increased odds also correlate well with lower education levels and rise dramatically with stress-induced overeating.
Levels of C-reactive protein (CRP) and white blood cells are highest among blacks in this population, suggesting a role for inflammation in disease progression [49]. Elevated levels of CRP are associated with the development of Type 2 diabetes [50], an increased risk for coronary events [51] and symptomatic PAD [52] and may help to explain the increased prevalence of CKD in the black population.CKD puts patients at greater risk for MI, stroke and death, with approximately 6 million Americans suffering from both CVD and CKD. According to NHANES, the prevalence of CVD is 63 percent in those with CKD stages 3–5, compared with 5.8 percent in those without kidney disease [48]. Curiously, just after the war, the same normal-weight Japanese had one of the lowest life expectancies in the world a fact that excludes genetic influences and makes the negative impact of increased auto-mobility, which occurred mostly after the war, a moot point.If obesity can be shown to correlate well with life expectancy, deciphering the relative magnitude of impact of each of its triggers can help rationalise and prioritize policy responses. The risk for these cardiovascular endpoints is even higher among African Americans with CKD.
Focusing exclusively or predominantly on driving may sidestep great opportunities for speedy, effective action. However, if Chart 2 were taken at face value, only a tenuous correlation, if any, between obesity and life expectancy can be construed. Other factors may be at work that require a closer look.The curious case of DenmarkThe logic goes that if we walk and bike more and use public transport we should expect to live, on average, longer and healthier lives. Ethnic differences in diabetic CKDDM is significantly more prevalent among Non Hispanic Blacks (NHB) than among non-Hispanic whites (NHW). As it happens, we can test this hypothesis with a real life example, an OECD member, Denmark. Of fifteen EU nations ( Chart 2), Denmark had the second lowest car ownership rates in 2004 (354 per 1000), had the highest walking share of trips, the second highest bicycling rate (18% in 2003) the fourth lowest obesity rate at 11.4% (2008) and a below average fatal accident rate (at 7 victims per 100k pp in 2005). Because of the increased risk of Type 2 diabetes among blacks and among other ethnic minorities [38], the number of Americans with DM is expected to triple from 20 million [37] to more than 60 million over the next forty years [39].
Among those aged 30–39, the rate of ESRD in diabetics has risen by 69 percent between 2000 and 2010 whereas it has dropped by one percent in age matched whites. Similarly, Native Americans in this age group have seen an increase of ESRD by 30.1 percent during this period. This contrasts with rates of ESRD in diabetics older than sixty where ESRD has dropped more dramatically among ethnic minorities than among whites. Similarly, the UK showing more than twice Denmark's obesity rate has a higher life expectancy by a whole year. Data from two other industrialized countries that are highly motorized add more complexity to the puzzle of presumed correlations.
Ethnic differences in CKD as one of diabetic CVD complicationsDM is also linked with a greatly increased risk of CVD.
The rise in prevalence of both coronary heart disease (CHD) and peripheral arterial disease (PAD) ranges between double and quadruple the risk of the general population [40].
The risk of PAD increases by 28 percent with each one percent increase in glycosylated hemoglobin, a marker for blood glucose levels [41].Furthermore, NHBs are at significantly greater risk of both PAD and CVD than NHWs [39]. Based on the third National Health and Nutrition Examination Survey (NHANES III), 5 million US adults above age 40 have PAD.
Source: OECD report 2009 (Belgium- data missing)Chart 3 shows no correlation between rates of obesity and incidence of diabetes.
UK with the highest rate of obesity shows the lowest incidence of diabetes and conversely the least obese nation, Italy, at less than half the UK rate shows almost double the incidence of diabetes.
According to the NAACP, NHB males have a 30 percent greater chance of dying from heart disease than NHW males [44].The development and the worsening of CKD as a complication of diabetic CVD is the result of a number of interacting pathways. Denmark and the Netherlands, the nations with the highest levels of active transport do not vary significantly from the average incidence (6.0), contrary to what might be expected. These include enhanced levels of oxidative stress, inflammation, endothelial dysfunction, and RAAS activation [48]. Clearly, other, unknown mediating factors between obesity and diabetes and, consequently, between driving and diabetes are at work. In addition, hypertriglyceridemia, associated with CVD, promotes lipid accumulation in renal cells and consequent dysfunction [49]. Furthermore, vascular calcification in CVD is commonplace among the renal vessels, fostering CKD progression [63]. The spikes and troughs of variations in obesity are not mirrored in the corresponding disease incidence.The Denmark example would be disquieting, if we took the longevity indicator at face value.
It would mean that, if the US were to achieve Denmark's levels of active transportation, a task that might take several generations of policy implementation, it may arrive at square one of the longevity track. Thus, ethnic minorities are more likely to develop these conditions both independently and as part of cardiorenal syndrome. Clearly, longevity seems a poor indicator of the effectiveness of active transport in improving health. Part of the racial discrepancy in CKD, diabetic CKD and the associated complications may be explained by an increase in metabolic risk factors among minorities. Based on a three-year, cross-sectional sample of 15,826 patients with Type 2 diabetes, both Hispanics and NHBs were found to have higher body mass index, HbA1c, and LDL values in comparison with NHWs. Moreover, ethnic minorities are both less physically active and have worse dietary behaviors compared to NHWs [46]. In the same period, US car ownership rose by 190%, a similar range, though starting at a higher point.
Minorities are also less likely to have health insurance coverage or to have a regular doctor [44]. Between 1952 and 2005, Netherlands saw their Bike Kilometres Travelled (BKTs) drop by almost half (but still leading Europe).
As a result of the lower levels of glycemic control and the higher prevalence of both vascular disease and metabolic risk factors, rates of mortality from DM are persistently higher among NHBs than among NHWs [47]. The difference in the prevalence of cardiovascular disease in those with DM and CKD among different ethnicities is striking. Netherlands and Denmark saw their obesity rate double since 1988 and the same is true for Sweden (yet another leader in walking and biking). These trends are both surprising and disquieting: when people who have experienced the benefits of an active lifestyle abandon it in increasing numbers, the prospects dim for everyone.Is the rise in obesity in these leading countries caused by increased auto-mobility?
As health disparities continue to grow, a closer investigation into the root of these ethnic differences will help clinicians to create a more targeted approach.3. Therapeutic rationale Anemia is a risk factor for cardiovascular morbidity and mortality that is reversible [54].
Are these nations heading in the NA direction while NA is attempting to emulate their highest achievements? A perplexing question worth investigating in detail.Getting to the fine grain differencesIf we can't explain these incongruities, there are other potential correlations that beg for our attention, interpretation and, possibly, choice of interventions.
There are currently two Food and Drug Administration (FDA) approved ESAs in the United States, Epoetin alfa (Epogen, Procrit) and Darbepoetin alfa (Aranesp). According to the Kidney Foundation Guidelines, all patients with CKD should be screened at least annually for anemia with a set of labs that include a complete blood count (CBC), a hemoglobin concentration (MCHC), iron studies, folate and Vitamin B12. A Canadian Study found a difference in life expectancy between the highest and lowest income quintiles of 6 years for men and 3 years for women. Patients found to be iron deficient need to be started on iron supplementation, especially hemodialysis patients who may lose up to 3-5g of iron per year. However, lower income could also imply higher unemployment rates, therefore increased average sedentary life and also increased stress. Note that the lower incomes and higher obesity rates occur in the southern states where African-Americans form a significant proportion of the population; though still a minority (one region where they form a majority is the District of Columbia, the outlier in chart 5).
There has been a constant gap in unemployment between whites and blacks that fluctuated between 5 and 10 percent in the last 30 years. During this three year study complete correction of anemia did not affect the likelihood of a first cardiac death.
The US CDC reports that obesity has tripled among children between the ages of 6 and 11 in the last 30 years and has gone from 5% to 18.1% among children of 12 to 19 years of age.
These young people, who are not drivers, will soon merge into the adult population seeking an explanation for their handicap.
The Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) trial in 2009 is randomized, double blind placebo controlled trial that was conducted to evaluate whether increasing the hemoglobin level with the use of darbepoetin would lower the rate of death, cardiovascular events or end stage renal disease in patients with type 2 diabetes and CKD. We also saw the many faces of obesity and the influence of income, education, job type, sedentary lifestyle, diet and stress could have in triggering it. Darbepoetin did not reduce the primary endpoints of death, cardiovascular events or ESRD in patients with DM and CKD. In addition, we saw obesity being just one of many potential contributors to life threatening ailments.Each study that looks at specific obesity-generating triggers recommends policies to combat them. Few attempts have been made at these questions.Given these intriguing disparities and unsolved puzzles, the question of meaningful correlations between auto-mobility and health remains wide open to finer-grain investigations. Their findings brought to light several important ways to improve CVD risk stratification [57].
A 2012 update to the National Kidney Foundation clinical practice guidelines for DM and CKD was recently published to address new evidence that has emerged since the release of the 2007 guidelines. He focused on housing affordability, building adaptability, municipal regulations, sustainable development and, recently, on street network patterns.
He holds a degree in Architecture from the U of Waterloo.Few of many sourcesCRS Report for Congress Life Expectancy in the United States Updated August 16, 2006Laura B.
If the anemia is addressed in its early stages, the risk of complications can be significantly reduced, especially those related to cardiovascular morbidity and mortality among the diabetic population.
In addition, appropriate and timely treatment can improve the quality of life for these patients. It is important that physicians screen patients who are at risk for developing anemia as per accepted guidelines. This is especially important given that based on data collected from 1998-2008, NHANES found that the prevalence of DKD has steadily been increasing. The latest United States Renal Data System (USRDS) reported a 30 percent increase in the incidence of ESRD in diabetics in the United States between 1992 and 2008 [59, 60]. These figures indicate that anemia as caused by CKD in diabetics is an ongoing and ever-increasing problem in which all of the risk factors involved need to be addressed as part of regular preventative health measures. Crouter,2008 Walking, Cycling, and Obesity Rates in Europe, North America, and Australia, Human Kinetics.Cynthia L. The risk of developing CVD is significantly increased in diabetics with CKD compared with non-diabetics with CKD.

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