Diabet. Med. 29, 646–653 (2012)
Aims To estimate population values of health‐related quality of life (HRQL) in subjects with and without Type 2 diabetes mellitus across several large ...population‐based survey studies in Germany. Systematic differences in relation to age and sex were of particular interest.
Methods Individual data from four population‐based studies from different regions throughout Germany and the nationwide German National Health Interview and Examination Survey (GNHIES98) were included in a pooled analysis of primary data (N = 9579). HRQL was assessed using the generic index instrument SF‐36 (36‐item Short Form Health Survey) or its shorter version, the SF‐12 (12 items). Regression analysis was carried out to examine the association between Type 2 diabetes and the two component scores derived from the SF‐36/SF‐12, the physical component summary score (PCS‐12) and the mental component summary score (MCS‐12), as well as interaction effects with age and sex.
Results The PCS‐12 differed significantly by −4.1 points in subjects with Type 2 diabetes in comparison with subjects without Type 2 diabetes. Type 2 diabetes was associated with significantly lower MCS‐12 in women only. Higher age was associated with lower PCS‐12, but with an increase in MCS‐12, for subjects with and without Type 2 diabetes.
Conclusions Pooled analysis of population‐based primary data offers HRQL values for subjects with Type 2 diabetes in Germany, stratified by age and sex. Type 2 diabetes has negative consequences for HRQL, particularly for women. This underlines the burden of disease and the importance of diabetes prevention. Factors that disadvantage women with Type 2 diabetes need to be researched more thoroughly.
Aim
Our objective was to test the hypothesis that the prevalence of Type 2 diabetes increases with increasing regional deprivation even after controlling for individual socio‐economic status.
Methods
...We pooled cross‐sectional data from five German population‐based studies. The data set contained information on n = 11 688 study participants (men 50.1%) aged 45–74 years, of whom 1008 people had prevalent Type 2 diabetes (men 56.2%). Logistic multilevel regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for diabetes prevalence. We controlled for sex, age and lifestyle risk factors, individual socio‐economic status and regional deprivation, based on a new small‐area deprivation measure, the German Index of Multiple Deprivation.
Results
Adjusted for sex, age, body mass index (BMI), physical activity, smoking status and alcohol consumption, the prevalence of Type 2 diabetes showed a stepwise increase in risk with increasing area deprivation OR 1.88 (95% CI 1.16–3.04) in quintile 4 and OR 2.14 (95% CI 1.29–3.55) in quintile 5 compared with the least deprived quintile 1, even after controlling for individual socio‐economic status. Focusing on individual socio‐economic status alone, the risk of having diabetes was significantly higher for low compared with medium or high educational level OR 1.46 (95% CI 1.24–1.71) and for the lowest compared with the highest income group OR 1.53 (95% CI 1.18–1.99).
Conclusion
Regional deprivation plays a significant part in the explanation of diabetes prevalence in Germany independently of individual socio‐economic status. The results of the present study could help to target public health measures in deprived regions.
Abstract Aim This study compares health-related quality of life (HRQL) in patients with type 2 diabetes (T2DM) across treatment groups and explores gender differences. Methods Four regional surveys ...(KORA, CARLA, SHIP, DHS) and a national survey (GNHIES98) were pooled at individual level. HRQL was assessed with the SF-12/-36v1. Linear regression models were used to assess the effect of T2DM by treatment type (no medication; oral; oral/insulin combination; insulin) on the physical (PCS-12) and mental summary score (MCS-12) and the SF-6D, controlling for age, sex, study and covariates. We also performed an explanatory analysis of single items. Results PCS-12 scores and treatment type were associated (P-value 0.006), with lowest values for insulin treatment (–4.44 vs. oral; –4.41 vs. combination). MCS-12 scores were associated with treatment type and gender (P-value < 0.012), with lower scores for women undergoing oral (–4.25 vs. men) and combination treatment (–6.99 vs. men). Similar results were observed for SF-6D utilities and single items, related to mental health, social functioning, vitality and role limitation (emotional). Comorbidities were predictors of lower PCS-12 and SF-6D scores. Conclusions T2DM treatment impacts differently on physical and mental HRQL and on women and men. Further studies of gender-specific perceptions of T2DM treatment regimens are needed.
Aim
To analyse the association of neighbourhood unemployment with incident self‐reported physician‐diagnosed Type 2 diabetes in a population aged 45–74 years from five German regions.
Methods
Study ...participants were linked via their addresses at baseline to particular neighbourhoods. Individual‐level data from five population‐based studies were pooled and combined with contextual data on neighbourhood unemployment. Type 2 diabetes was assessed according to a self‐reported physician diagnosis of diabetes. We estimated proportional hazard models (Weibull distribution) in order to obtain hazard ratios and 95% CIs of Type 2 diabetes mellitus, taking into account interval‐censoring and clustering.
Results
We included 7250 participants residing in 228 inner city neighbourhoods in five German regions in our analysis. The incidence rate was 12.6 per 1000 person‐years (95% CI 11.4–13.8). The risk of Type 2 diabetes mellitus was higher in men hazard ratio 1.79 (95% CI 1.47–2.18) than in women and higher in people with a low education level hazard ratio 1.55 (95% CI 1.18–2.02) than in those with a high education level. Independently of individual‐level characteristics, we found a higher risk of Type 2 diabetes mellitus in neighbourhoods with high levels of unemployment quintile 5; hazard ratio 1.72 (95% CI 1.23–2.42) than in neighbourhoods with low unemployment (quintile 1).
Conclusions
Low education level and high neighbourhood unemployment were independently associated with an elevated risk of Type 2 diabetes mellitus. Studies examining the impact of the residential environment on Type 2 diabetes mellitus will provide knowledge that is essential for the identification of high‐risk populations.
What's new?
Research on the influence of the residential environment on incident Type 2 diabetes in Germany is missing.
We adapted an advanced model strategy to take account of the hierarchical data structure and to adjust for the interval‐censored information on incident Type 2 diabetes to avoid a common problem in follow‐up cohort studies.
This study shows that neighbourhood unemployment is associated with incident Type 2 diabetes in five German regions.
Diabet. Med. 29, e88–e95 (2012)
Aim In Germany, regional data on the prevalence of Type 2 diabetes mellitus are lacking for health‐care planning and detection of risk factors associated with this ...disease. We analysed regional variations in the prevalence of Type 2 diabetes and treatment with antidiabetic agents.
Methods Data of subjects aged 45–74 years from five regional population‐based studies and one nationwide study conducted between 1997 and 2006 were analysed. Information on self‐reported diabetes, treatment, and diagnosis of diabetes were compared. Type 2 diabetes prevalence estimates (95% confidence interval) from regional studies were directly standardized to the German population (31 December 2007).
Results Of the 11 688 participants of the regional studies, 1008 had known Type 2 diabetes, corresponding to a prevalence of 8.6% (8.1–9.1%). For the nationwide study, a prevalence of 8.2% (7.3–9.2%) was estimated. Prevalence was higher in men (9.7%; 8.9–10.4%) than in women (7.6%; 6.9–8.3%). The regional standardized prevalence was highest in the east with 12.0% (10.3–13.7%) and lowest in the south with 5.8% (4.9–6.7%). Among persons with Type 2 diabetes, treatment with oral antidiabetic agents was more frequently reported in the south (56.9%) and less in the northeast (46.0%), whereas treatment with insulin alone was more frequently reported in the northeast (21.6%) than in the south (16.4%).
Conclusion The prevalence of known Type 2 diabetes showed a southwest‐to‐northeast gradient within Germany, which is in accord with regional differences in the distribution of risk factors for Type 2 diabetes. Furthermore, the treatment with antidiabetic agents showed regional differences.
Disruption of metabolic homeostasis is an important factor in many diseases. Various metabolites have been linked to higher risk of morbidity and all-cause mortality using metabolomics in large ...population-based cohorts. In these studies, baseline metabolite levels were compared across subjects to identify associations with health outcomes, implying the existence of 'healthy' concentration ranges that are equally applicable to all individuals. Here, we focused on intra-individual changes in metabolite levels over time and their link to mortality, potentially allowing more personalized risk assessment. We analysed targeted metabolomics data for 134 blood metabolites from 1409 participants in the population-based CARLA cohort at baseline and after four years. Metabotypes of the majority of participants (59%) were extremely stable over time indicated by high correlation between the subjects' metabolite profiles at the two time points. Metabotype instability and, in particular, decrease of valine were associated with higher risk of all-cause mortality in 7.9 years of follow-up (hazard ratio (HR) = 1.5(95%CI = 1.0-2.3) and 0.2(95%CI = 0.1-0.3)) after multifactorial adjustment. Excluding deaths that occurred in the first year after metabolite profiling showed similar results (HR = 1.8(95%CI = 1.1-2.8)). Lower metabotype stability was also associated with incident cardiovascular disease (OR = 1.2(95%CI = 1.0-1.3)). Therefore, changes in the personal metabotype might be a valuable indicator of pre-clinical disease.
The objective of this study was to investigate the association between residential environment and type 2 diabetes. We pooled cross-sectional data from 5 population-based German studies (1997-2006): ...the Cardiovascular Disease, Living and Ageing in Halle Study, the Dortmund Health Study, the Heinz Nixdorf Recall Study, the Cooperative Health Research in the Region of Augsburg Study, and the Study of Health in Pomerania. The outcome of interest was the presence of self-reported type 2 diabetes. We conducted mixed logistic regression models in a hierarchical data set with 8,879 individuals aged 45-74 years on level 1; 226 neighborhoods on level 2; and 5 study regions on level 3. The analyses were adjusted for age, sex, social class, and employment status. The odds ratio for type 2 diabetes was highest in eastern Germany (odds ratio = 1.98, 95% confidence interval: 1.81, 2.14) and northeastern Germany (odds ratio = 1.58, 95% confidence interval: 1.40, 1.77) and lowest in southern Germany (reference) after adjustment for individual variables. Neighborhood unemployment rates explained a large proportion of regional differences. Individuals residing in neighborhoods with high unemployment rates had elevated odds of type 2 diabetes (odds ratio = 1.62, 95% confidence interval: 1.25, 2.09). The diverging levels of unemployment in neighborhoods and regions are an independent source of disparities in type 2 diabetes.
The objective of this study was to quantify body weight changes in German adult populations during the past decades.
Longitudinal analysis of seven cohort studies covering different age ranges ...between 18 and 83 years. Baseline examinations were between 1994 and 2007 and follow-up durations between 4.0 and 11.9 years. For each study, mean change in body weight per year and 10-year change in body mass index (BMI) classification were analyzed. For the middle age group of 45-64 years, meta-analysis was conducted to obtain an overall estimate for Germany.
Among men weight gain was highest in the youngest participants and decreased with advancing age. Among women weight gain was on a stable high level among those younger than 45 years and decreased at older age. Within 10 years, 30-40% of middle-aged participants with normal baseline weight became pre-obese or obese and 20-25% of those with pre-obesity at baseline became obese, whereas >80% of persons who were obese at baseline remained obese over time. The estimated average weight change in adults aged 45-64 years was 0.25 (95% confidence interval (CI): 0.18-0.33) kg/year among men and 0.24 (0.17-0.30) kg/year among women.
We could observe a moderate weight gain over the past years in German middle-aged populations of 0.25 kg/year. Obesity prevention needs to be targeted to specific subgroups in the population, especially to younger adults, who seem to be most vulnerable for gaining weight. Obesity intervention needs to be improved, as the majority of obese adults remained obese over time.
Leisure‐time physical activity is associated with better health and a reduced risk of all‐cause mortality. It is unclear if this association is also present with a high level of physical activity as ...it is found in professional athletes. In a population‐based retrospective cohort study, we compared the survival experience of all soccer players participating for Germany in international matches between 1908 and 2006 to that of the general population. To summarize survival experience, we calculated cumulative relative survival ratios (RSRs) from a life table. We included data of 812 international players, of which 428 (=52.7%) died during follow‐up. In all 13 intervals, cumulative observed survival was smaller than cumulative expected survival, resulting in cumulative RSRs being <1. The cumulative RSRs are statistically significantly different from 1 in all but the last interval. This impaired survival experience of the internationals translates into a loss of median residual lifetime of 1.9 years 95% confidence interval: 0.6, 3.2 years at the entry time into the cohort. This loss is mainly driven by the mortality of internationals from the earlier half of the observation period. Reasons for this might be poorer medical care in former times, internationals being killed in action during World War II, and a changing distribution of causes of death during the 20th century.
Aim
To validate the German Diabetes Risk Score within the population‐based cohort of the Cardiovascular Disease – Living and Ageing in Halle (CARLA) study.
Methods
The sample included 582 women and ...719 men, aged 45–83 years, who did not have diabetes at baseline. The individual risk of every participant was calculated using the German Diabetes Risk Score, which was modified for 4 years of follow‐up. Predicted probabilities and observed outcomes were compared using Hosmer–Lemeshow goodness‐of‐fit tests and receiver–operator characteristic analyses. Changes in prediction power were investigated by expanding the German Diabetes Risk Score to include metabolic variables and by subgroup analyses.
Results
We found 58 cases of incident diabetes. The median 4‐year probability of developing diabetes based on the German Diabetes Risk Score was 6.5%. The observed and predicted probabilities of developing diabetes were similar, although estimation was imprecise owing to the small number of cases, and the Hosmer–Lemeshow test returned a poor correlation (chi‐squared = 55.3; P = 5.8*10‐12). The area under the receiver–operator characteristic curve (AUC) was 0.70 (95% CI 0.64–0.77), and after excluding participants ≥66 years old, the AUC increased to 0.77 (95% CI 0.70–0.84). Consideration of glycaemic diagnostic variables, in addition to self‐reported diabetes, reduced the AUC to 0.65 (95% CI 0.58–0.71). A new model that included the German Diabetes Risk Score and blood glucose concentration (AUC 0.81; 95% CI 0.76–0.86) or HbA1c concentration (AUC 0.84; 95% CI 0.80–0.91) was found to peform better.
Conclusions
Application of the German Diabetes Risk Score in the CARLA cohort did not reproduce the findings in the European Prospective Investigation into Cancer and Nutrition (EPIC) Potsdam study, which may be explained by cohort differences and model overfit in the latter; however, a high score does provide an indication of increased risk of diabetes.
What's new?
The German Diabetes Risk Score (DRS), developed within the European Prospective Investigation into Cancer and Nutrition (EPIC) Potsdam study, has not been prospectively validated in a representative sample of the general population apart from EPIC.
The aim of this study was to validate the DRS in the Cardiovascular Disease – Living and Ageing in Halle (CARLA) study, a population‐based cohort with a high response rate, that provides a more representative sample than the EPIC‐Potsdam study.
The predictive ability of the DRS observed in the CARLA cohort was consistently lower than in the EPIC cohort, a finding that could reflect cohort differences and model overfit in the EPIC study.
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