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Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Tracking the Accelerating Epidemic: Its.

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Presentation on theme: "Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Tracking the Accelerating Epidemic: Its."— Presentation transcript:

1 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Tracking the Accelerating Epidemic: Its Causes and Outcomes AusDiab 2005 The Australian Diabetes, Obesity and Lifestyle Study

2 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2001 Baseline data from AusDiab 2000 The AusDiab survey carried out in 1999–2000 provides benchmark Australian prevalence dataThe AusDiab survey carried out in 1999–2000 provides benchmark Australian prevalence data 2000 findings, Australians 25 years old:2000 findings, Australians 25 years old: – 7.4% had diabetes (doubled since 1981) – 16.3% had pre-diabetes (IFG/IGT*) – 59.6% were mildly overweight or obese – 28.8% had hypertension – 51.2% had total cholesterol 5.5 mmol/L, and 20.5% had elevated triglycerides ( 2.0 mmol/L) – 2.5% had proteinuria, 6.4% had haematuria and 1.1% had elevated serum creatinine * IFG impaired fasting glucose; IGT impaired glucose tolerance.

3 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Aims of the five-year follow-up Describe the natural history of:Describe the natural history of: –Type 2 diabetes –Pre-diabetes (IFG/IGT*) –Associated cardiovascular disease, risk factors and complications Identify risk factors associated with worsening glucose tolerance status and diabetic complicationsIdentify risk factors associated with worsening glucose tolerance status and diabetic complications Measure the progression of renal disease in diabetic and non-diabetic populationsMeasure the progression of renal disease in diabetic and non-diabetic populations * IFG impaired fasting glucose; IGT impaired glucose tolerance.

4 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Definitions for prevalence and incidence 1999–2000 data: Prevalence – the proportion of people within a population who have a certain disease or condition at a particular time1999–2000 data: Prevalence – the proportion of people within a population who have a certain disease or condition at a particular time 2004–05 data: Incidence – number of new cases of a disease or condition arising in a population over a period of time2004–05 data: Incidence – number of new cases of a disease or condition arising in a population over a period of time

5 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Diabetes and pre-diabetes

6 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Diabetes mellitus Is a metabolic disorder with multiple causes characterised by chronically elevated blood glucose levelsIs a metabolic disorder with multiple causes characterised by chronically elevated blood glucose levels Predisposes individuals to:Predisposes individuals to: –Cardiovascular disease – Visual loss –Amputations – Renal failure Has many risk factors including obesity, hypertension and dyslipidaemiaHas many risk factors including obesity, hypertension and dyslipidaemia

7 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Classification values for the oral glucose tolerance test Plasma glucose (mmol/L) World Health Organization. Department of noncommunicable disease surveillance, 1999 Glucose tolerance Fasting glucose 2-hour glucose Diabetes or Impaired glucose tolerance (IGT) < 7.0 and 7.8–11.0 Impaired fasting glucose (IFG) 6.1–6.9 and and < 7.8 Normal glucose tolerance (NGT) < 6.1 and and < 7.8

8 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Diabetes in Australia: The last 20 years Thousands Year a) Busselton b) Nat Heart Foundation c) Aust Bureau Statistics d) Aust Bureau Statistics e) AusDiab

9 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2001 From 1999–2000 report: Age- and gender-specific prevalence (%) of diabetes Age group (years) Percentage

10 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2001 From 1999–2000 report: Age group (years) Age-specific prevalence (%) of IFG Percentage IFG impaired fasting glucose

11 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2001 From 1999–2000 report: Age group (years) Age-specific prevalence (%) of IGT Percentage IGT impaired glucose tolerance

12 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2001 From 1999–2000 report: Weighted prevalence (%) of associated conditions stratified by glucose tolerance status Glucose tolerance status Associated conditionDiabetesIFGIGTNormal Hypertension* Obesity (BMI 30 kg/m²) LDL ( 3.5 mmol/L) HDL ( 1.0 mmol/L) Triglycerides ( 2.0 mmol/L) * On treatment, or systolic pressure 140 mmHg, or diastolic pressure 90 mmHg IGT impaired glucose tolerance; IFG impaired fasting glucose.

13 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of diabetes according to gender Incidence (% per year)

14 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of diabetes according to baseline age Incidence (% per year) Baseline age (years)

15 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of diabetes according to baseline glucose tolerance status Incidence (% per year) Baseline glucose tolerance NGT normal glucose tolerance; IFG impaired fasting glucose; IGT impaired glucose tolerance.

16 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of IGT and IFG Incidence (% per year) IGT impaired glucose tolerance; IFG impaired fasting glucose.

17 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of diabetes according to baseline body mass index Baseline BMI status Incidence (% per year) Body mass index (BMI: weight/height 2 ) was categorised into three groups: (i) normal: BMI < 25.0 kg/m 2 ; (ii) overweight: kg/m 2 ; and (iii) obese: 30.0 kg/m 2.

18 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of diabetes according to baseline waist circumference categories Baseline waist circumference categories Incidence (% per year) Waist circumference: (i) normal: < 94.0 cm for males, < 80.0 cm for females; (ii) overweight: cm for males, cm for females; (iii) obese: cm for males, 88.0 cm for females.

19 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of diabetes according to baseline physical activity Baseline physical activities categories Incidence (% per year)

20 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of diabetes according to baseline hypertension status Baseline hypertension status Incidence (% per year) Hypertension (high blood pressure) was defined as having a blood pressure 140/90 mmHg and/or taking blood-pressure lowering medication.

21 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of diabetes according to baseline dyslipidaemia status Dyslipidaemia status at baseline Incidence (% per year) Dyslipidaemia was defined as those with triglycerides 2.0 mmol/L or high-density lipoprotein cholesterol levels < 1.0 mmol/L.

22 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of diabetes according to baseline metabolic syndrome status Baseline metabolic syndrome status Incidence (% per year) Metabolic syndrome was defined according to the definition by the International Diabetes Federation.

23 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Diabetes Key findings Every year 0.8% of Australian adults develop diabetesEvery year 0.8% of Australian adults develop diabetes Every day in Australia approximately 275 adults develop diabetesEvery day in Australia approximately 275 adults develop diabetes Those with pre-diabetes were 10–20 times more likely to develop diabetes than those with normal blood glucose levelsThose with pre-diabetes were 10–20 times more likely to develop diabetes than those with normal blood glucose levels Obesity, hypertension, dyslipidaemia, physical inactivity and the metabolic syndrome each increased the risk for developing diabetesObesity, hypertension, dyslipidaemia, physical inactivity and the metabolic syndrome each increased the risk for developing diabetes

24 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Obesity

25 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Body mass index classification Body mass index (kg/m 2 ) Normal< 25.0 Overweight25.0 – 29.9 Obese 30.0

26 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Classification of abdominal obesity by waist circumference Waist circumference (cm) Normal < 94.0 < 80.0 Overweight 94.0 – – 87.9 Obese MalesFemales

27 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2001 From 1999–2000 report: Age-specific prevalence (%) of obesity* by BMI & waist circumference Age (years) Classification Total BMI Males Females Persons Waist Males Females Persons * BMI 30 kg/m²; Waist circumference: males 102 cm; females 88 cm

28 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Mean weight change over five years according to baseline age Baseline age (years) Mean change in weight (kg) 25 – – – – – 74 75Total

29 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Mean body mass index change over five years according to baseline age Baseline age (years) Mean change in BMI (kg/m 2 ) 25 – – – – – 74 75Total

30 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Mean waist circumference change over five years according to baseline age Baseline age (years) Mean change in waist circumference (cm) 25 – – – – – 74 75Total

31 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Mean weight change over five years according to baseline body mass index status Mean weight change (kg) 1.0 Baseline BMI status

32 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Mean waist circumference change over five years according to baseline BMI status Mean waist circumference change (cm) 2.0 Baseline BMI status

33 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Baseline BMI status Incidence of obesity according to baseline body mass index status Incidence (% per year) 2.0

34 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne nNormal n (%) Overweight Obese Normal2,369 1,831 (77.3) 530 (22.4) 8 (0.34) Overweight2, (7.6) 1,917 (74.9) 449 (17.5) Obese1,356 6 (0.4) 120 (8.9) 1,230 (90.7) Total6,2852,0312,5671,687 Proportion of individuals classified by body mass index in 2004–05 according to baseline body mass index status BMI status at baseline BMI in 2004–05 Body mass index (BMI: weight/height 2 ) was categorised into three groups: (i) normal: BMI < 25.0 kg/m 2 ; (ii) overweight: kg/m 2 ; and (iii) obese: 30.0 kg/m 2.

35 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne nNormal n (%) Overweight Obese Normal2,496 1,752 (70.2) 628 (25.2) 116 (4.7) Overweight1, (18.4) 771 (47.1) 565 (34.5) Obese2, (2.0) 238 (11.0) 1,881 (87.0) Total6,2962,0971,6372,562 Proportion of individuals classified by waist circumference in 2004–05 according to baseline waist circumference categories Waist circumference categories in 2004–05 Waist circumference categories at baseline Waist circumference: (i) normal: < 94.0 cm for males, < 80.0 cm for females; (ii) overweight: cm for males, cm for females; (iii) obese: cm for males, 88.0 cm for females.

36 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Obesity Key findings People aged < 65 years showed an average weight increase of 1.8 kg over five yearsPeople aged < 65 years showed an average weight increase of 1.8 kg over five years People aged 65 years showed a loss in weight of 0.8 kg over the same periodPeople aged 65 years showed a loss in weight of 0.8 kg over the same period Waist circumference average gain over five years was 2.1 cm; greater in females than malesWaist circumference average gain over five years was 2.1 cm; greater in females than males Younger people gained more weight and had a greater increase in waist circumference than did older peopleYounger people gained more weight and had a greater increase in waist circumference than did older people Twice as many overweight people became obese as reverted to normalTwice as many overweight people became obese as reverted to normal

37 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Hypertension

38 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Role of hypertension High blood pressure is a risk factor for cardiovascular and renal diseaseHigh blood pressure is a risk factor for cardiovascular and renal disease For individuals with diabetes, high blood pressure is a risk factor for microvascular complications as well as cardiovascular diseaseFor individuals with diabetes, high blood pressure is a risk factor for microvascular complications as well as cardiovascular disease The baseline study found that 28.8% of adults 25 years of age were classified as hypertensive (BP 140/90 mmHg or taking BP lowering medication)The baseline study found that 28.8% of adults 25 years of age were classified as hypertensive (BP 140/90 mmHg or taking BP lowering medication)

39 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Classification of blood pressure Systolic blood Diastolic blood Blood-pressure pressure (mmHg) pressure (mmHg) lowering medication Systolic blood Diastolic blood Blood-pressure pressure (mmHg) pressure (mmHg) lowering medication Normal < 140 and < 90 and No Hypertension 140or 90 or Yes Guidelines Subcommittee. J Hypertens 1999; 17:

40 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2001 From 1999–2000 report: Prevalence (%) of adequate blood pressure * control among people on anti-hypertensive therapy Age (years) 25–3435–4445–5455–6465–7475+Total Males Females Persons *Systolic pressure 140 mmHg, and a diastolic pressure 90 mmHg, and on anti-hypertensive medication

41 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne n Normal BP n (%) Hypertension Normal BP 4,353 3,749 (86.1) 604 (13.9) Hypertension1, (18.0) 1,611 (82.0) Total6,3184,1032,215 Proportion of individuals classified with hypertension in according to baseline hypertension Hypertension status in 2004–05 Hypertension status at baseline

42 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of hypertension according to baseline age Incidence (% per year) Baseline age (years)

43 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of hypertension according to baseline glucose tolerance status Incidence (% per year) Baseline glucose tolerance status NGT normal glucose tolerance; IFG impaired fasting glucose; IGT impaired glucose tolerance; DM – diabetes mellitus

44 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of hypertension according to baseline body mass index status Baseline BMI status Incidence (% per year) BMI: Body mass index; where (i) normal was a BMI of < 25.0 kg/m 2 ; (ii) overweight was a BMI of kg/m 2 ; and (iii) obese was a BMI of 30.0 kg/m 2.

45 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of hypertension according to baseline smoking status Baseline smoking status Incidence (% per year)

46 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Hypertension Key findings 3.0% of adults develop hypertension every year3.0% of adults develop hypertension every year The risk increases with age from 1.0% per year at years of age to 8.4% per year at years of ageThe risk increases with age from 1.0% per year at years of age to 8.4% per year at years of age Those at greatest risk are people:Those at greatest risk are people: –With diabetes and pre-diabetes (females higher risk than males) –Who are overweight or obese (females higher risk than males) –Who smoke (males higher risk than females)

47 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Metabolic syndrome

48 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Significance of the metabolic syndrome The metabolic syndrome is characterised by central or abdominal obesity, and a clustering of cardiovascular risk factors, such as:The metabolic syndrome is characterised by central or abdominal obesity, and a clustering of cardiovascular risk factors, such as: –Abnormal glucose tolerance –Raised triglycerides –Decreased HDL-cholesterol –Hypertension –Hyperinsulinaemia (with underlying insulin resistance) The metabolic syndrome confers a higher risk of diabetes and cardiovascular diseaseThe metabolic syndrome confers a higher risk of diabetes and cardiovascular disease

49 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Waist circumference Europids: 94 cm males, 80 cm females South and South-East Asians: 90 cm males, 80 cm females Plus two or more of the following: Raised triglyceridesRaised triglycerides 1.7 mmol/L or specific treatment for this lipid abnormality 1.7 mmol/L or specific treatment for this lipid abnormality Reduced HDL-CReduced HDL-C < 1.03 mmol/L in males; < 1.29 mmol/L in females or specific treatment for this lipid abnormality Raised blood pressureRaised blood pressure Systolic 130 mmHg or diastolic 85 mmHg or treatment of previously diagnosed hypertension Raised plasma glucoseRaised plasma glucose Fasting plasma glucose 5.6 mmol/L or previously diagnosed type 2 diabetes Classification of the metabolic syndrome Threshold Component Alberti KG et al. Lancet 2005; 366:

50 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of the metabolic syndrome according to gender Incidence (% per year) 3.0

51 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of the metabolic syndrome according to baseline age Incidence (% per year) Baseline age (years)

52 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of the metabolic syndrome according to baseline waist circumference categories Baseline waist circumference categories Incidence (% per year) Waist circumference: (i) normal: < 94.0 cm for males, < 80.0 cm for females; (ii) overweight: cm for males, cm females; (iii) obese: cm for males, 88.0 cm for females.

53 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of the metabolic syndrome according to baseline physical activity Baseline physical activity status Incidence (% per year)

54 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of the metabolic syndrome according to baseline glucose tolerance status Incidence (% per year) Baseline glucose tolerance status NGT normal glucose tolerance; IFG impaired fasting glucose; IGT impaired glucose tolerance; DM – diabetes mellitus

55 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Metabolic syndrome Key findings The risk of developing the metabolic syndrome:The risk of developing the metabolic syndrome: –Was six times greater in people who were obese than those who were normal weight –Was two times greater in people with diabetes than those with normal glucose tolerance –Was greater in physically inactive people –Increased with increasing age –Was greater for males than females

56 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Chronic kidney disease

57 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Significance of chronic kidney disease Individuals with chronic kidney disease are at increased risk of end-stage renal failure, and premature cardiovascular disease 1,2Individuals with chronic kidney disease are at increased risk of end-stage renal failure, and premature cardiovascular disease 1,2 The incidence of end-stage kidney disease is 95 cases/million population per annum 3The incidence of end-stage kidney disease is 95 cases/million population per annum 3 Diabetes is a leading cause – responsible for 30% of all new cases 3Diabetes is a leading cause – responsible for 30% of all new cases 3 1. Anavekar NS et al. N Engl J Med 2004; 351: Go AS et al. N Engl J Med 2004; 351: McDonald SP et al. The 28th report of the Australia and New Zealand Dialysis and Transplant Registry 2006.

58 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Definitions Estimated impaired glomerular filtration rate, eGFR, defined as < 60 mL/min/1.73 m 2Estimated impaired glomerular filtration rate, eGFR, defined as < 60 mL/min/1.73 m 2 Abnormal albuminuria defined as spot urine albumin:creatinine 2.5 mg/mmol for males and 3.5 mg/mmol for femalesAbnormal albuminuria defined as spot urine albumin:creatinine 2.5 mg/mmol for males and 3.5 mg/mmol for females

59 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of impaired glomerular filtration rate according to gender Incidence (% per year)

60 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of impaired glomerular filtration rate according to baseline age Incidence (% per year) Baseline age (years)

61 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of impaired glomerular filtration rate according to baseline glucose tolerance status Incidence (% per year) Baseline glucose tolerance status NGT normal glucose tolerance; IFG impaired fasting glucose; IGT impaired glucose tolerance; DM diabetes mellitus.

62 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of impaired glomerular filtration rate according to baseline hypertension status Baseline hypertension status Incidence (% per year) Hypertension (high blood pressure) was defined as having a blood pressure 140/90 mmHg and/or taking blood-pressure lowering medication.

63 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of albuminuria according to gender Incidence (% per year) 1.0

64 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of albuminuria according to baseline age Incidence (% per year) Baseline age (years)

65 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of albuminuria according to baseline glucose tolerance status Incidence (% per year) Baseline glucose tolerance status NGT normal glucose tolerance; IFG impaired fasting glucose; IGT impaired glucose tolerance; DM – diabetes mellitus

66 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Incidence of albuminuria according to baseline hypertension status Baseline hypertension status Incidence (% per year) Hypertension (high blood pressure) was defined as having a blood pressure 140/90 mmHg and/or taking blood-pressure lowering medication.

67 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Chronic kidney disease Key findings Approximately 1% of adults developed chronic kidney disease each yearApproximately 1% of adults developed chronic kidney disease each year Approximately 1% of adults developed albuminuria each yearApproximately 1% of adults developed albuminuria each year People with hypertension have three times the risk of developing impaired GFR and albuminuriaPeople with hypertension have three times the risk of developing impaired GFR and albuminuria People with diabetes have five times the risk of developing albuminuria, and twice the risk of developing reduced kidney functionPeople with diabetes have five times the risk of developing albuminuria, and twice the risk of developing reduced kidney function

68 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Mortality

69 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Mortality rates AusDiab 2005 examined the 5-year all-cause mortality rates for males and females, for different age groups and for different levels of glucose toleranceAusDiab 2005 examined the 5-year all-cause mortality rates for males and females, for different age groups and for different levels of glucose tolerance The relative mortality risk was calculated for independent risk factorsThe relative mortality risk was calculated for independent risk factors Over a median time of 5.2 years there were 355 deaths (208 males, 147 females). This represents a mortality rate of 6.1 per 1,000 person yearsOver a median time of 5.2 years there were 355 deaths (208 males, 147 females). This represents a mortality rate of 6.1 per 1,000 person years

70 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Total mortality according to baseline glucose tolerance status Mortality rate (per 1000 py) Baseline glucose tolerance NGT normal glucose tolerance; IFG impaired fasting glucose; IGT impaired glucose tolerance; NDM newly diagnosed diabetes; KDM previously diagnosed diabetes.

71 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Relative risk of mortality for people with pre-diabetes and diabetes compared with people with NGT* Baseline glucose tolerance status * After accounting for other risk factors. Bars represent 95% confidence intervals NGT IGTIFGNDMKDM NGT normal glucose tolerance; IFG impaired fasting glucose; IGT impaired glucose tolerance; NDM newly diagnosed diabetes; KDM previously diagnosed diabetes. All-cause mortality hazard ratio

72 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Relative risk of mortality associated with various risk factors* Baseline risk factors Hypertension Albuminuria Impaired GFR Smoking CVD KDM All–cause mortality hazard ratio * After accounting for other risk factors. Bars represent 95% confidence intervals

73 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Baseline glucose tolerance status among those dying of cardiovascular disease 33% 20% 13% 21% NGT normal glucose tolerance; KDM – previously diagnosed diabetes; NDM – newly diagnosed diabetes IFG impaired fasting glucose; IGT impaired glucose tolerance.

74 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2001 From 1999–2000 report: Prevalence (%) of smoking status among Australian residents Smoking status Percentage

75 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2001 From 1999–2000 report: Year Trends in the age-standardised* prevalence (%) of hypertension: 1980 – 2000 * Age standardised to the 1991 Australian population ABS. Population by age and sex. Canberra: ABS, 1999 Percentage

76 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Mortality Key findings Over five years:Over five years: –People with previously known diabetes were twice as likely to die as were those with normal glucose tolerance –People with previously known diabetes had a similar risk of mortality to smokers and people with previous cardiovascular disease –Pre-diabetes was associated with a 45 55% increase in mortality risk –Over two-thirds of all cardiovascular disease deaths occurred in people with diabetes or pre-diabetes

77 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Survey methods and response rates

78 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Sampling frame for the AusDiab follow-up 2004 – 05 Individuals participating in the baseline survey n = 11,247 Individuals ineligible for invitation n = 459 Requested no further contact = 128 Deceased = 310 Excluded* = 21 Total individuals eligible for invitation to AusDiab 2004–05 n = 10,788 * Excluded – included participants who had moved into a nursing facility classified for high care, or were ineligible due to chronic or terminal illness

79 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Response rates to the AusDiab survey 2004 – 5 Eligible participants 10,788 Cancelled 1,990 Participated in AusDiab survey 2004–05 8,798 Attendance at external pathology laboratory 137 Health conditions telephone questionnaire only 2,261 On-site attendance 6,400

80 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne StateNumberOn-sitePathologySelf-reportedOverall eligibletestinglaboratorymedicalresponders attendance*conditions only n n (%) n (%) n (%) n (%) Response rates by state or territory VIC1, (57.5)52 (3.6)337 (23.6)1,210 (84.7) WA1, (64.9)28 (1.8)210 (13.8)1,228 (80.5) NSW1, (59.7)14 (1.0)323 (22.1)1,209 (82.9) TAS1,7001,102 (64.8)2 (0.1)296 (17.4)1,400 (82.4) SA1, (55.6)29 (1.7)467 (27.5)1,441 (84.8) NT1, (58.4)5 (0.4)189 (15.7)895 (74.5) QLD1, (54.6) 7 (0.4)433 (24.8)1,394 (79.7) ACT25 15 (60.0) 0 (0)6 (24.0)21 (84.0) Total10,7886,400 (59.3)137 (1.3)2,261 (21.0)8,798 (81.6) * External pathology laboratory facilities were either not available or were limited in TAS, SA, NT and QLD

81 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Sponsors Abbott AustralasiaAbbott Australasia AlphapharmAlphapharm AstraZenecaAstraZeneca Aventis PharmaAventis Pharma Bio-Rad LaboratoriesBio-Rad Laboratories Bristol-Myers SquibbBristol-Myers Squibb City Health Centre – Diabetes Service, CanberraCity Health Centre – Diabetes Service, Canberra Department of Health and Community Services, Northern TerritoryDepartment of Health and Community Services, Northern Territory Department of Health and Human Services, TasmaniaDepartment of Health and Human Services, Tasmania Department of Health, NSWDepartment of Health, NSW Department of Health, WADepartment of Health, WA Department of Health, SADepartment of Health, SA Department of Human Services, VICDepartment of Human Services, VIC Diabetes AustraliaDiabetes Australia Diabetes Australia Northern TerritoryDiabetes Australia Northern Territory Eli Lilly AustraliaEli Lilly Australia Estate of the Late Edward WilsonEstate of the Late Edward Wilson GlaxoSmithKlineGlaxoSmithKline Highpoint Shopping CentreHighpoint Shopping Centre Jack Brockhoff FoundationJack Brockhoff Foundation Janssen-CilagJanssen-Cilag Kidney Health AustraliaKidney Health Australia Marian & EH Flack TrustMarian & EH Flack Trust Menzies Research InstituteMenzies Research Institute Merck Sharp & DohmeMerck Sharp & Dohme MultiplexMultiplex Novartis PharmaceuticalsNovartis Pharmaceuticals Novo Nordisk PharmaceuticalsNovo Nordisk Pharmaceuticals Pfizer Pty LtdPfizer Pty Ltd Pratt FoundationPratt Foundation Queensland HealthQueensland Health Roche Diangonostics AustraliaRoche Diangonostics Australia Royal Prince Alfred Hospital, SydneyRoyal Prince Alfred Hospital, Sydney Sanofi-SynthelaboSanofi-Synthelabo The AusDiab study gratefully acknowledges the generous support given by: National Health and Medical Research Council (NHMRC) Australian Government Department of Health and Aging

82 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne Contributors Principal Investigators Stan Bennett Australian Institute of Health and Welfare Damien Jolley Monash Institute of Health Services Research, Monash University Terry Dwyer AMMurdoch Childrens Research Institute Stephen ColagiuriDepartment of Endocrinology, Prince of Wales Hospital Pat Phillips Department of Endocrinology, Queen Elizabeth Hospital Kerin ODeaDepartment of Medicine, University of Melbourne Liz BinghamDepartment of Health and Human Services, Tasmania Steve ChadbanRoyal Prince Alfred Hospital and University of Sydney Terry CoyneSchool of Population Health, University of Queensland John McNeilDepartment of Epidemiology and Preventive Medicine, Monash University Neville OwenSchool of Population Health, University of Queensland Kevan PolkinghorneDepartment of Nephrology, Monash Medical Centre Robyn TappDepartment of Epidemiology and Preventive Medicine, Monash University Hugh TaylorCentre for Eye Research Australia Andrew TonkinDepartment of Epidemiology and Preventive Medicine, Monash University Tien WongCentre for Eye Research Australia Paul Z Zimmet AOInternational Diabetes Institute Robert Atkins AMDepartment of Epidemiology and Preventive Medicine, Monash University Timothy Welborn AODepartment of Medicine, University of Western Australia Jonathan ShawInternational Diabetes Institute Associate Investigators Collaborators

83 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne AusDiab report authors D DunstanD Dunstan P ZimmetP Zimmet T WelbornT Welborn R SicreeR Sicree T ArmstrongT Armstrong R AtkinsR Atkins A CameronA Cameron J ShawJ Shaw S ChadbanS Chadban E BarrE Barr D MaglianoD Magliano P ZimmetP Zimmet K PolkinghorneK Polkinghorne R AtkinsR Atkins D DunstanD Dunstan S MurrayS Murray J ShawJ Shaw 1999/2000 report 2004/2005 report

84 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne AusDiab Staff AusDiab Project Manager: Shirley MurrayAusDiab Project Manager: Shirley Murray Epidemiologists: Elizabeth Barr, Adrian Cameron, David Dunstan, Dianna Magliano, Richard Sicree.Epidemiologists: Elizabeth Barr, Adrian Cameron, David Dunstan, Dianna Magliano, Richard Sicree. IDI Field Staff: Annaliese Bonney, Nicole Meinig, Theresa Whalen.IDI Field Staff: Annaliese Bonney, Nicole Meinig, Theresa Whalen. IDI Support Staff: Travis Clarke, Gay Filby, Sue Fournel, Hasan Jahangir, Larna Prout, Carol Robinson, Marc Seifman, Debbie Shaw, Lisa Southgate, Ray Spark, Kajen Vivekananthan, Jonathan Zimmerman.IDI Support Staff: Travis Clarke, Gay Filby, Sue Fournel, Hasan Jahangir, Larna Prout, Carol Robinson, Marc Seifman, Debbie Shaw, Lisa Southgate, Ray Spark, Kajen Vivekananthan, Jonathan Zimmerman. Other contributors: Theresa Dolphin, Irene Tam, Gabriella Tikellis, Adam Meehan, Genevieve Healy, Sarah White.Other contributors: Theresa Dolphin, Irene Tam, Gabriella Tikellis, Adam Meehan, Genevieve Healy, Sarah White.

85 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne AusDiab information For more information and publications visit: Reports and newsletters available: AusDiab Report 2001AusDiab Report 2001 AusDiab Report 2006AusDiab Report 2006 Newsletter September 2004Newsletter September 2004 Newsletter September 2006Newsletter September 2006 http//:www.diabetes.com.au/research.php?regionID=181&page=ausdiab_home


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