1、Epidemiology of Insulin Resistance, Diabetes Mellitus, and Coronary Heart DiseaseSteven Haffner, MDAdapted from World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Geneva: World Health Organization:1999:52.Criteria for the Diagnosis of Diab
2、etes Mellitus and HyperglycemiaPlasma Glucose Concentration7.0 (126)6.1 (110) to 11.1 (200)7.8 (140) to20 years) by Year and Region2000 2025Hospitalization Costs for Chronic Complications of Diabetes in the USAmerican Diabetes Association. Economic Consequences of Diabetes Mellitusin the US in 1997.
3、 Alexandria, VA: American Diabetes Association, 1998:1-14. Total costs 12 billion US $ CVD accounts for 64% of total costsOthersOphthalmic diseaseCardiovasculardiseaseRenal diseaseNeurologicdiseasePeripheralvasculardisease024681012141618Annual CHD Deathsper1000PersonsKannel WB, McGee DL. JAMA 1979;2
4、41:2035-2038.Framingham Study: DM and CHD Mortality20-Year Follow-up178174Men WomenDMNon-DM01020304050Ischemicheartdisease%of DeathsGeiss LS et al. In: Diabetes in America. 2nd ed. 1995; chap 11.Mortality in People with DiabetesCauses of DeathOtherheartdiseaseDiabetes Cancer Stroke Infection Other05
5、101520253035Mortality per 1000 person-years*Age-adjustedAdapted from Gu K et al. Diabetes Care 1998;21:1138-1145.Mortality Due to Heart Disease in Men and Women with or without Diabetes (US)29.919.2Men WomenDiabetesNo DiabetesAll heart disease Ischemic heart diseaseMen Women11.56.323.07.111.03.6Nond
6、iabetesDiabetes05101520*Defined in 1971-1975, followed up through 1982-1984.*Defined in 1982-1984, followed up through 1992-1993.Gu K et al. JAMA 1999;281:1291-1297.Trends in Mortality Rates for Ischemic Heart Disease in NHANES Subjects with and without Diabetes*17.06.8-16.6% +10.7%Men, cohort 1*Men
7、, cohort 2*Women, cohort 1*Women, cohort 2*-43.8% -20.4%14.27.6 7.44.22.4 1.9(P=0.46) (P=0.76) (P0.001) (P=0.12)Rateper1000 person-yearsWOMENMENSurvival Post-MI in Diabetic and Nondiabetic Men and Women: Minnesota Heart SurveyAdapted from Sprafka JM et al. Diabetes Care 1991;14:537-543.1008060400Sur
8、vival (%)Months Post-MINo diabetesn=228n=1628Months Post-MISurvival (%)0 20 40 60Diabetes100806040080 0 20 40 60 80DiabetesNo diabetesn=156n=568WOMENMEN0102030405060Cardiovascular Mortality in People with Diabetes%of Deaths (Crude Rate)Adapted from Miettinen H et al. Diabetes Care. 1998;21:69-75.Diabetes No Diabetes28.6 22.110.9 11.9Diabetes No Diabetes15.49.622.79.09.14.2 11.12.828 d 1 yHospitalization 28 dOut of Hospital
