Low Prevalence of Long-Term Complications in Non–Insulin-Dependent Diabetes Mellitus in France: A Multicenter Study

doi:10.1016/S1056-8727(97)98005-3

Journal of Diabetes and its Complications

Volume 12, Issue 2, March–April 1998, Pages 88-95

https://doi.org/10.1016/S1056-8727(97)98005-3 Get rights and content

Abstract

The aim of this study was to assess the prevalence of long-term complications in a large sample of French NIDDM patients. Therefore, 427 NIDDM patients 35–74 years old were recruited in ten centers. Standardized clinical criteria and central reading for retinal and electrocardiographic changes were used to assess the presence of complications. The prevalence rates of complications were 29.7% and 3.3% for background and proliferative retinopathy; 21.8%, 6.1%, and 2.8% for microalbuminuria, proteinuria, and renal insufficiency; 19.9 and 11.7% for asymptomatic and symptomatic pheripheral neuropathy; 8.2% for orthostatic hypotension; 10.1% and 8.4% for angina pectoris and myocardial infarction; and 13.1% and 6.3% for mild and moderate to severe peripheral vascular disease, respectively. In conclusion, prevalence rates in this study were lower than in most studies from other countries.

Introduction

The risk (and costs) linked with diabetes mellitus lies essentially in its long-term complications (retinopathy, nephropathy, neuropathy, and cardiovascular diseases). Non–insulindependent diabetic (NIDDM) patients have been shown to experience an important excess of cardiovascular mortality.[1]Moreover, NIDDM patients represent an important proportion of the cases of endstage renal disease² and blindness,3, 4and they experience lower-limb amputation up to ten times more often than nondiabetic subjects,[5]because of the joint effects of neuropathy and peripheral vascular disease. Thus, NIDDM is an important issue in Public Health.

The CODIAB study is the first study in France assessing the prevalence rates of complications in a multicenter sample of NIDDM patients, with standardization of the diagnosis of complications.

Section snippets

Study Sample

Seven departments of internal medicine in regional hospitals, one University center in Paris and two private diabetologists participated in the study. Between April 1989 and May 1992, 540 diabetic outpatients, consulting regularly in the centers, were recruited. Inclusion criteria for NIDDM patients were (1) age 35–74 years, (2) duration of diabetes greater than 1 year, and (3) treatment with diet and/or oral antidiabetic drugs and/or secondarily with insulin (at least 2 years after the

Results

The characteristics of the CODIAB sample are shown in Table 2; it included 200 women and 227 men, i.e., 53% of men. As could be awaited for type II diabetic patients, they had been diagnosed in middle age (mean age at diagnosis, 46 years), were treated mostly by oral antidiabetic agents and were overweight: 56% of men and 77% of women were obese (BMI greater than 27 kg/m² in men and 25 kg/m² in women). Finally, glycemic control was not satisfactory: 54% of the patients had a fasting blood

Prevalence of Complications

The prevalence rates of the different complications in our study were among the lowest found in the literature. It is necessary to examine whether methodological flaws might have produced an underestimation of the prevalences. First of all, the analysis of the characteristics of our patients shows that this can hardly be due to our sampling methods. As no diabetes registry exists in France, our concern was to constitute a sample of diabetic patients as representative as possible. The

Conclusion

In conclusion, our study suggests that the French population may be protected against the most severe forms of NIDDM; insulin therapy is less frequently required than in the United States and in Northern Europe, and correspondingly, prevalence of retinopathy and nephropathy are lower. Cardiovascular diseases may also be less prevalent, like in the general French population.

Acknowledgements

This study was financially supported by ZENECA PHARMA-France. This study was supported by the Société de Secours des Amis de la Science.

References (44)

R Nomiyama et al.
One-day survey of albuminuria in diabetic outpatients in Fukuoka prefecture, Japan
J Diabet Complications
(1991)
O Torffvit et al.
Albuminuria and associated medical risk factorsa cross-sectional study in 451 type II (non-insulin-dependent) diabetic patients. Part 2
J Diabet Complications
(1991)
DK Gupta et al.
The prevalence of microalbuminuria in diabetesa study from North India
Diabetes Res Clin Pract
(1991)
RJ Jarrett
Epidemiology of macrovascular disease and hypertension in diabetes mellitus,
C Catalano et al.
Epidemiology of end-stage renal disease in patients with diabetes mellitusfrom the dark ages to the middle ages
Nephrol Dial Transplant
(1992)
IM Ghafour et al.
Common causes of blindness and visual handicap in the west of Scotland
Br J Ophthalmol
(1983)
A Nicolosi et al.
Prevalence and causes of visual impairment in Italy
Int J Epidemiol
(1994)
OI Siitonen et al.
Lower-extremity amputation in diabetic and nondiabetic patients. A population-based study in eastern Finland
Diabetes Care
(1993)
C Delcourt et al.
Visual impairment in type 2 diabetic patientsA multicenter study in France
Acta Ophthalmol Scand
(1995)
Proceedings of a consensus development conference on standardized measures in diabetic neuropathy. Diabetes Care...

PG Wiles et al.

Vibration perception thresholdinfluence of age, height, sex, and smoking, and calculation of accurate centile values

Diabetic Med

(1991)

R Klein et al.

The Wisconsin Epidemiologic Study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years

Arch Ophthalmol

(1984)

MW Knuiman et al.

Prevalence of diabetic complications in relation to risk factors

Diabetes

(1986)

SM Haffner et al.

Diabetic retinopathy in Mexican Americans and non-Hispanic whites

Diabetes

(1988)

RF Hamman et al.

Prevalence and risk factors of diabetic retinopathy in non-hispanic whites and hispanics with NIDDM, San Luis Valley Diabetes Study

Diabetes

(1989)

QZ Liu et al.

Glycated haemoglobin, plasma glucose and diabetic retinopathyCross-sectional and prospective analyses

Diabetologia

(1993)

PJ Dyck et al.

The prevalence by staged severity of various type of diabetic neuropathy, retinopathy and nephropathy in a population-based cohortThe Rochester Diabetic Neuropathy Study

Neurology

(1993)

KM West et al.

A detailed study of risk factors for retinopathy and nephropathy in diabetes

Diabetes

(1980)

A Schmitz et al.

MicroalbuminuriaA major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients

Diabetic Med

(1988)

MA Gall et al.

Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (non-insulin-dependent) diabetic patients

Diabetologia

(1991)

S Verhoeven et al.

Impact of late complications in type 2 diabetes in a Dutch population

Diabetic Med

(1991)

O Descamps et al.

Etude de la microalbuminurie dans une population de 653 patients diabétiques de type 1 et 2

Diabete Metab

(1991)

Cited by (54)

Prevalence of peripheral neuropathy in patients with diabetes: A systematic review and meta-analysis
2020, Primary Care Diabetes
We aimed to determine pooled prevalence of diabetic peripheral neuropathy (DPN) in patients with diabetes and to explore the impacts of research variables on prevalence estimates.
A systematic search was performed in PubMed, EMBASE, The Cochrane Library and Scopus from onset up to July 2018 to identify articles investigating the prevalence of DPN. Random-effects models were used to calculate the pooled prevalence of DPN. The heterogeneity of the study was estimated with the I² statistic. The publication bias was described by Egger’s test and funnel plot.
A total of 29 studies with a total of 50,112 participants were included in this meta-analysis. The results showed that the pooled prevalence of DPN was 30% (95% confidence interval, CI 25–34%). The pooled prevalence of DPN among patients with type 2 diabetes mellitus was higher than patients with type 1 diabetes mellitus (31.5%, 95% CI 24.4–38.6% vs 17.5%, 95% CI 4.8–30.2%). The pooled prevalence of DPN of studies involving a mixed type of diabetes mellitus was 24.8% (95% CI 13.1–36.5%, I² = 99.1%).
Medical staff should strengthen the evaluation and diagnosis of DPN. Moreover, they need to teach diabetic patients how to prevent this complication.
Molecular mechanism of diabetic neuropathy and its pharmacotherapeutic targets
2018, European Journal of Pharmacology
Citation Excerpt :
Nicolucci and co-workers reported about 12–50% of diabetic patients develop some degree of diabetic neuropathy in US (Nicolucci et al., 1996). Considering the impact of age on nerve function, age is regarded as a potential risk factor of diabetic neuropathy (Papanas and Zeigler, 2015); however, Delcourt et al. reported there is no correlation between diabetic neuropathy and age (Delcourt et al., 1998). In a study at a Bulgarian hospital, diabetic women were found to have higher macrovascular risk than diabetic men (Kamenov et al., 2010).
Diabetic neuropathy is regarded as one of the most debilitating outcomes of diabetes mellitus and may cause pain, decreased motility, and even amputation. Diabetic neuropathy includes multiple forms, ranging from discomfort to death. Prognosis of diabetic neuropathy is an uphill task as it remains silent for several years after the onset of diabetes. Hyperglycemia, apart from inducing oxidative stress in neurons, also leads to activation of multiple biochemical pathways which constitute the major source of damage and are potential therapeutic targets in diabetic neuropathy. A vast array of molecular pathways, including polyol pathway, hexosamine pathway, PKCs signaling, oxidative stress, AGEs pathway, PARP pathway, MAPK pathway, NF-κB signaling, hedgehog pathways, TNF-α signaling, cyclooxygenase pathway, interleukins, lipoxygenase pathway, nerve growth factor, Wnt pathway, autophagy, and GSK3 signaling may be accounted for the pathogenesis and progression of diabetic neuropathy. Although symptomatic treatment is available for diabetic neuropathy, few treatment options are available to eliminate the root cause. The immense physical, psychological, and economic burden of diabetic neuropathy highlights the need for cost effective and targeted therapies. The main aim of this review is to highlight the putative role of various mechanisms and pathways involved in the development of diabetic neuropathy and to impart an in-depth insight on new therapeutic approaches aimed at delaying or reversing various modalities of diabetic neuropathy.
Diabetes in Europe: An update
2014, Diabetes Research and Clinical Practice
Citation Excerpt :
The prevalence of PNP in type 2 diabetes varies between 18% and 35% for European study populations [89–98]. In general, reported prevalence rates are somewhat higher for hospital-based study populations [90–92,94] than for primary care or population-based samples [89,96,97]. There is much less data on the occurrence of polyneuropathy in patients with undiagnosed diabetes screened by OGTT on population-level [99–101].
Diabetes is among the leading causes of death in the IDF Europe Region (EUR), continues to increase in prevalence with diabetic macro- and microvascular complications resulting in increased disability and enormous healthcare costs. In 2013, the number of people with diabetes is estimated to be 56 million in EUR with an overall estimated prevalence of 8.5%. However, estimates of diabetes prevalence in 2013 vary widely in the 56 diverse countries in EUR from 2.4% in Moldova to 14.9% in Turkey. Trends in diabetes prevalence also vary between countries with stable prevalence since 2002 for many countries but a doubling of diabetes prevalence in Turkey. For 2035, a further increase of nearly 10 million people with diabetes is projected for the EUR. Prevalence of type 1 has also increased over the past 20 years in EUR and there was estimated to be 129,350 cases in children aged 0–14 years in 2013. Registries provide valid information on incidence of type 1 diabetes with more complete data available for children than for adults.
There are large differences in distribution of risk factors for diabetes at the population level in EUR. Modifiable risk factors such as obesity, physical inactivity, smoking behaviour (including secondhand smoking), environmental pollutants, psychosocial factors and socioeconomic deprivation could be tackled to reduce the incidence of type 2 diabetes in Europe.
In addition, diabetes management is a major challenge to health services in the European countries. Improved networking practices of health professionals and other stakeholders in combination with empowerment of people with diabetes and continuous quality monitoring need to be further developed in Europe.
Epidemiology of polyneuropathy in diabetes and prediabetes
2014, Handbook of Clinical Neurology
Citation Excerpt :
Furthermore, diagnostic criteria for DSPN often include other parameters, such as clinical signs, monofilament sensitivity and electrophysiology, which are not adjusted for age. Interestingly, in a study from France, where VPT was adjusted for age, height and gender, there was no relationship between neuropathy and age (Delcourt et al., 1998). Data from Mauritius confirmed the increase in VPT with age in both diabetic and nondiabetic subjects (Shaw et al., 1998).
Diabetic distal symmetric sensorimotor polyneuropathy (DSPN) represents a major health problem, associated with excruciating neuropathic pain, increased morbidity and impaired quality of life. The understanding of its epidemiology is difficult due to methodological issues. Inconsistency in the selection of diagnostic procedures renders comparison between studies problematic. Further problems arise from selection bias due to the inclusion of hospital-based populations. DSPN affects approximately 30% of hospital-based populations, 20% of community-based samples, and 10% of the diabetic population identified by screening. Chronic painful DSPN is present in 13–26% of diabetic patients. Between 25% and 62% of patients with idiopathic peripheral neuropathy have prediabetes. Among pre-diabetic subjects, 11–25% exhibit peripheral neuropathy and 13–26% neuropathic pain. Evidence from population-based studies indicates that there is a gradient in the prevalence of neuropathy. Indeed, the highest frequency is found in patients with manifest diabetes mellitus, followed by individuals with impaired glucose tolerance, then impaired fasting glucose and, finally, those with normoglycemia. The most important etiologic factors are poor glycemic control, age, diabetes duration, visceral obesity, height, hypertension, age, smoking, hypoinsulinemia, and dyslipidemia. Clinic-based data suggest that DSPN is associated with increased mortality in diabetes, but confirmatory prospective population-based studies are required.
Prevalence of Diabetic Retinopathy in Various Ethnic Groups: A Worldwide Perspective
2012, Survey of Ophthalmology
The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of diabetic retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for diabetic retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of diabetic retinopathy, sight-threatening diabetic retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of diabetic retinopathy—such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia—ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems, genetic susceptibility, and epigenetics. The rates of nonproliferative diabetic retinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening diabetic retinopathy substantially improve the long-term diabetic retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of diabetic retinopathy around the world and highlight the need to reinforce ethnicity-based screening and treatment thresholds in diabetic retinopathy.
Albuminuria during the screening for diabetes in a semi-rural area (Kisantu City, DR Congo)
2010, Nephrologie et Therapeutique
Déterminer la prévalence de la microalbuminurie, la macroalbuminurie et l’insuffisance rénale au dépistage du diabète sucré (DS) et de l’hyperglycémie modérée à jeun (HMJ) ; identifier les déterminants de l’excrétion urinaire d’albumine (EUA) pathologique en zone semi-rurale de Kisantu/République démocratique du Congo.
Phase 1 : dépistage du DS (81 cas) et de l’HMJ (148 cas) dans la population (1898 sujets sélectionnés par sondage systématique). Phase 2 : dosage d’albuminurie, de créatinine sérique et estimation de la filtration glomérulaire (modification of the diet in renal disease [MDRD]). Les déterminants de l’EUA pathologique ont été recherchés par régression logistique.
La prévalence de la macroalbuminurie et celle de la microalbuminurie étaient respectivement de 12,0 et 45,2 % dans le DS versus 0 et 13,7 % dans l’HMJ. Les déterminants de l’EUA pathologique étaient le DS (OR ajusté : 7,01 ; IC à 95 % : 3,48–14,11), l’obésité centrale (OR ajusté : 2,36 [1,16–4,80]), l’âge supérieur à 60 ans (OR ajusté : 2,12 [1,05–4,40]), l’HTA (OR ajusté : 3,30 [1,39–7,82]) et la rétinopathie diabétique (OR non ajusté : 3,12 [1,54–6,26]). La prévalence de l’insuffisance rénale (MDRD < 60ml/min/1,73 m2) était de 21,4 % dans le DS et 3,8 % dans l’HMJ.
L’albuminurie pathologique est fréquente au dépistage du diabète et de l’HMJ en zone semi-rurale. Elle est surtout associée à l’âge supérieur à 60 ans, à l’obésité centrale et à l’HTA. La prise en charge précoce et intégrale du DS est indispensable pour prévenir l’insuffisance rénale dans la population.
To determine the prevalence of microalbuminuria, macroalbuminuria and renal insufficiency at the time of screening for diabetes and impaired fasting glucose in the semi-rural area of Kisantu/DR Congo, and to identify determinants of pathological urinary albumin excretion (UAE).
Step 1: diabetes (81 cases) and impaired fasting glucose (148 cases) tracking in the population (1898 subjects selected by a systematic survey). Step 2: urinary albumin and serum creatinine were measured and glomerular filtration rate was estimated (modification of the diet in renal disease [MDRD] equation). The determinants of pathological UAE were assessed by logistic regression.
The prevalence of macroalbuminuria and microalbuminuria in diabetes was 12.0 and 45.2% respectively versus 0 and 13.7% in impaired fasting glucose. Determinants of pathological UAE were: diabetes (adjusted OR [aOR]: 7.01; 95% CI: 3.48–14.11), central obesity (aOR: 2.36 [1.16–4.80]), age less that 60 years (aOR: 2.12 [1.05–4.40]), hypertension [aOR: 3.30 (1.39–7.82)] and diabetic retinopathy (aOR: 3.12 [1.54–6.26]). Renal insufficiency (MDRD < 60 ml/min/1.73 m²) prevalence was 21.4% in diabetes and 3.8% in impaired fasting glucose.
Microalbuminuria and macroalbuminuria are frequently detected during screening for diabetes and impaired fasting glucose in a semi-rural area in DR Congo. They are especially associated with age above 60 years, central obesity and hypertension. Early and integrated management of diabetes is essential to prevent renal failure in the population.

View all citing articles on Scopus

View full text

Original ArticlesLow Prevalence of Long-Term Complications in Non–Insulin-Dependent Diabetes Mellitus in France: A Multicenter Study

Abstract

Introduction

Section snippets

Study Sample

Results

Prevalence of Complications

Conclusion

Acknowledgements

J Diabet Complications

J Diabet Complications

Diabetes Res Clin Pract

Epidemiology of macrovascular disease and hypertension in diabetes mellitus,

Epidemiology of end-stage renal disease in patients with diabetes mellitusfrom the dark ages to the middle ages

Nephrol Dial Transplant

Common causes of blindness and visual handicap in the west of Scotland

Br J Ophthalmol

Prevalence and causes of visual impairment in Italy

Int J Epidemiol

Lower-extremity amputation in diabetic and nondiabetic patients. A population-based study in eastern Finland

Diabetes Care

Visual impairment in type 2 diabetic patientsA multicenter study in France

Acta Ophthalmol Scand

Vibration perception thresholdinfluence of age, height, sex, and smoking, and calculation of accurate centile values

Diabetic Med

The Wisconsin Epidemiologic Study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years

Arch Ophthalmol

Prevalence of diabetic complications in relation to risk factors

Diabetes

Diabetic retinopathy in Mexican Americans and non-Hispanic whites

Diabetes

Prevalence and risk factors of diabetic retinopathy in non-hispanic whites and hispanics with NIDDM, San Luis Valley Diabetes Study

Diabetes

Glycated haemoglobin, plasma glucose and diabetic retinopathyCross-sectional and prospective analyses

Diabetologia

The prevalence by staged severity of various type of diabetic neuropathy, retinopathy and nephropathy in a population-based cohortThe Rochester Diabetic Neuropathy Study

Neurology

A detailed study of risk factors for retinopathy and nephropathy in diabetes

Diabetes

MicroalbuminuriaA major risk factor in non-insulin-dependent diabetes. A 10-year follow-up study of 503 patients

Diabetic Med

Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European type 2 (non-insulin-dependent) diabetic patients

Diabetologia

Impact of late complications in type 2 diabetes in a Dutch population

Diabetic Med

Etude de la microalbuminurie dans une population de 653 patients diabétiques de type 1 et 2

Diabete Metab

Original Articles
Low Prevalence of Long-Term Complications in Non–Insulin-Dependent Diabetes Mellitus in France: A Multicenter Study