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  • 1
    Electronic Resource
    Electronic Resource
    Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn Study (1995)
    Springer
    Diabetologia 38 (1995), S. 86-96 
    Details
    ISSN: 1432-0428
    Keywords: Key words Non-insulin-dependent diabetes mellitus ; impaired glucose tolerance ; specific insulin ; peripheral arterial disease ; epidemiology ; population-based survey ; Caucasians.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We investigated the cross-sectional association between peripheral arterial disease and glycaemic level in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population. Subjects treated with oral hypoglycaemic agents or insulin were classified as having known diabetes mellitus (KDM) (n = 67). Using two oral glucose tolerance tests, and based on World Health Organisation criteria, all other participants were categorized as having a normal (NGT) (n = 288), an impaired (IGT) (n = 170), or a diabetic (NDM) (n = 106) glucose tolerance. Prevalence rates of ankle-brachial pressure index less than 0.90 were 7.0 %, 9.5 %, 15.1 % and 20.9 % in NGT, IGT, NDM and KDM subjects, respectively (chi-square test for linear trend: p 〈 0.01). Prevalence rates of any peripheral arterial disease (ankle-brachial pressure index 〈 0.90, at least one monophasic or absent Doppler flow curve or vascular surgery) were 18.1 %, 22.4 %, 29.2 % and 41.8 % in these categories (chi-square test for linear trend: p 〈 0.0001). The prevalence of any peripheral arterial disease was higher in KDM and NDM than in NGT (p 〈 0.03, p 〈 0.0001, respectively), whereas no statistically significant difference was demonstrated between IGT and NGT. The same applied when using the ankle-brachial pressure index criterion. Logistic regression analyses showed that any arterial disease was significantly associated with HbA1 c, fasting and 2-h post-load plasma glucose after correction for cardiovascular risk factors (odds ratios and 95 % confidence intervals 1.35; 1.10–1.65 per %, 1.20; 1.06–1.36 and 1.06; 1.01–1.12 per mmol/l, respectively), whereas it was not associated with fasting and 2-h post-load specific insulin. Ankle-brachial pressure indices were not associated with either plasma glucose parameters or insulin in univariate or multivariate analyses. In conclusion, parameters of glucose tolerance are independently associated with any peripheral arterial disease, whereas insulin is not. [Diabetologia (1995) 38: 86–96]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050257
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  • 2
    Electronic Resource
    Electronic Resource
    Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn Study (1995)
    Springer
    Diabetologia 38 (1995), S. 86-96 
    Details
    ISSN: 1432-0428
    Keywords: Non-insulin-dependent diabetes mellitus ; impaired glucose tolerance ; specific insulin ; peripheral arterial disease ; epidemiology ; population-based survey ; Caucasians
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We investigated the cross-sectional association between peripheral arterial disease and glycaemic level in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population. Subjects treated with oral hypoglycaemic agents or insulin were classified as having known diabetes mellitus (KDM) (n=67). Using two oral glucose tolerance tests, and based on World Health Organisation criteria, all other participants were categorized as having a normal (NGT) (n=288), an impaired (IGT) (n=170), or a diabetic (NDM) (n=106) glucose tolerance. Prevalence rates of ankle-brachial pressure index less than 0.90 were 7.0%, 9.5%, 15.1% and 20.9% in NGT, IGT, NDM and KDM subjects, respectively (chi-square test for linear trend:p〈0.01). Prevalence rates ofany peripheral arterial disease (ankle-brachial pressure index 〈0.90, at least one monophasic or absent Doppler flow curve or vascular surgery) were 18.1%, 22.4%, 29.2% and 41.8% in these categories (chi-square test for linear trend:p〈0.0001). The prevalence ofany peripheral arterial disease was higher in KDM and NDM than in NGT (p〈0.03,p〈0.0001, respectively), whereas no statistically significant difference was demonstrated between IGT and NGT. The same applied when using the anklebrachial pressure index criterion. Logistic regression analyses showed thatany arterial disease was significantly associated with HbA1c, fasting and 2-h postload plasma glucose after correction for cardiovascular risk factors (odds ratios and 95% confidence intervals 1.35; 1.10–1.65 per %, 1.20; 1.06–1.36 and 1.06; 1.01–1.12 per mmol/l, respectively), whereas it was not associated with fasting and 2-h post-load specific insulin. Ankle-brachial pressure indices were not associated with either plasma glucose parameters or insulin in univariate or multivariate analyses. In conclusion, parameters of glucose tolerance are independently associated withany peripheral arterial disease, whereas insulin is not. [Diabetologia (1995) 38: 86–96]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02369357
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  • 3
    Electronic Resource
    Electronic Resource
    Intra-individual variation of glucose, specific insulin and proinsulin concentrations measured by two oral glucose tolerance tests in a general Caucasian population: the Hoorn Study (1996)
    Springer
    Diabetologia 39 (1996), S. 298-305 
    Details
    ISSN: 1432-0428
    Keywords: Intra-individual variation ; glucose ; specific insulin ; proinsulin ; oral glucose tolerance test ; reproducibility
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We studied the intra-individual variation in plasma glucose, specific serum insulin and serum pro-insulin concentrations, measured by two 75-g oral glucose tolerance tests in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population without a history of diabetes mellitus. The intra-individual variation was assessed by the standard deviation of the test-retest differences (SDdif). For subjects with normal (n=246), impaired glucose tolerance (n=198), and newly detected diabetes (n=80) classified at the first test, the following (SDdif/median level of individual average scores) were found: fasting glucose: 0.4/5.4, 0.5/5.9 and 0.7/7.2 mmol/l; 2-h glucose: 1.3/5.6, 1.8/8.5 and 2.3/12.8 mmol/l; fasting insulin: 23/76, 32/89 and 30/ 116 pmol/l; 2-h insulin: 190/303, 278/553 and 304/626 pmol/l; fasting proinsulin: 4/8, 6/13 and 9/18 pmol/l; 2-h proinsulin: 19/49, 23/84 and 33/90 pmol/l, respectively. In both glucose, proinsulin and insulin concentrations the total intra-individual variation was predominantly determined by biological variation, whereas analytical variation made only a minor contribution. The SDdif can easily be interpreted, as 95% of the random test-retest differences will be less than 2 · SDdif, or in terms of percentage, less than (2 · SDdif/median level of individual average scores) · 100. Therefore, for subjects with normal glucose tolerance, 95% of the random test-retest differences will be less than 15% (fasting glucose), 46% (2-h glucose), 61% (fasting insulin), 125% (2-h insulin), 100% (fasting proinsulin) and 78% (2-h proinsulin) of the median value of the individual average scores. No substantial independent association of either age, gender or obesity with the intra-individual variation in glucose, proinsulin, or insulin concentrations was found.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00418345
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  • 4
    Electronic Resource
    Electronic Resource
    Intra-individual variation of glucose, specific insulin and proinsulin concentrations measured by two oral glucose tolerance tests in a general Caucasian population: the Hoorn Study (1996)
    Springer
    Diabetologia 39 (1996), S. 298-305 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Intra-individual variation ; glucose ; specific insulin ; proinsulin ; oral glucose tolerance test ; reproducibility.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We studied the intra-individual variation in plasma glucose, specific serum insulin and serum proinsulin concentrations, measured by two 75-g oral glucose tolerance tests in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population without a history of diabetes mellitus. The intra-individual variation was assessed by the standard deviation of the test-retest differences (SDdif). For subjects with normal (n = 246), impaired glucose tolerance (n = 198), and newly detected diabetes (n = 80) classified at the first test, the following (SDdif/median level of individual average scores) were found: fasting glucose: 0.4/5.4, 0.5/5.9 and 0.7/7.2 mmol/l; 2-h glucose: 1.3/5.6, 1.8/8.5 and 2.3/12.8 mmol/l; fasting insulin: 23/76, 32/89 and 30/116 pmol/l; 2-h insulin: 190/303, 278/553 and 304/626 pmol/l; fasting proinsulin: 4/8, 6/13 and 9/18 pmol/l; 2-h proinsulin: 19/49, 23/84 and 33/90 pmol/l, respectively. In both glucose, proinsulin and insulin concentrations the total intra-individual variation was predominantly determined by biological variation, whereas analytical variation made only a minor contribution. The SDdif can easily be interpreted, as 95 % of the random test-retest differences will be less than 2 · SDdif, or in terms of percentage, less than (2 · SDdif/median level of individual average scores) · 100. Therefore, for subjects with normal glucose tolerance, 95 % of the random test-retest differences will be less than 15 % (fasting glucose), 46 % (2-h glucose), 61 % (fasting insulin), 125 % (2-h insulin), 100 % (fasting proinsulin) and 78 % (2-h proinsulin) of the median value of the individual average scores. No substantial independent association of either age, gender or obesity with the intra-individual variation in glucose, proinsulin, or insulin concentrations was found. [Diabetologia (1996) 39: 298–305]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00418345
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  • 5
    Electronic Resource
    Electronic Resource
    Microalbuminuria is strongly associated with NIDDM and hypertension, but not with the insulin resistance syndrome: the Hoorn Study (1998)
    Springer
    Diabetologia 41 (1998), S. 694-700 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Microalbuminuria ; insulin resistance syndrome ; non-diabetic subjects ; non-insulin-dependent diabetes mellitus ; hypertension ; population.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Microalbuminuria is a strong predictor of cardiovascular disease. The aim of this study was to investigate whether microalbuminuria is part of a cluster of risk factors, the insulin resistance syndrome (IRS), or whether it is only associated with, and presumably a complication of, hypertension and non-insulin-dependent diabetes mellitus (NIDDM). An age-, sex- and glucose tolerance-stratified random sample from a 50–75 year old general population (n = 622) was investigated. The urinary albumin-to-creatinine ratio was measured in an early morning spot urine sample. Microalbuminuria was defined as an albumin-to-creatinine ratio greater than 2.0 mg/mmol. We considered, as IRS-related variables, fasting hyperinsulinaemia, insulin resistance (IR; calculated from the formula of the homeostasis model assessment), dyslipidaemia, glucose intolerance, hypertension and waist-to-hip ratio (WHR). Dyslipidaemia was defined as levels of HDL-cholesterol in the lowest and / or levels of triglyceride in the highest tertile. Fasting insulin levels, IR and WHR were divided into tertiles; the highest tertiles were compared to the lowest tertiles. Age-, sex- and glucose tolerance-adjusted analyses showed microalbuminuria to be significantly associated with hypertension, NIDDM and WHR. In multiple logistic regression analyses, microalbuminuria showed independent associations with hypertension, NIDDM and WHR, with odds ratios (ORs [95 % confidence interval]) of 3.33 (1.86–5.96), 2.26 (1.14–4.48) and 2.49 (1.09–5.70), respectively. No associations were found with impaired glucose tolerance, hyperinsulinaemia, IR or dyslipidaemia. Multiple logistic regression analyses in diabetic and non-diabetic subjects separately showed that microalbuminuria was independently associated only with hypertension (ORs 4.31 and 2.69). In this Caucasian population, microalbuminuria was associated with hypertension, NIDDM and WHR and not with other variables of the IRS. It is therefore likely that microalbuminuria is a complication of hypertension and NIDDM, and not an integral part of the IRS. [Diabetologia (1998) 41: 694–700]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050970
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  • 6
    Electronic Resource
    Electronic Resource
    Hyperglycaemia is associated with all-cause and cardiovascular mortality in the Hoorn population: the Hoorn Study (1999)
    Springer
    Diabetologia 42 (1999), S. 926-931 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Glucose ; HbA1 c ; hyperglycaemia ; cardiovascular mortality ; Hoorn population.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aims/hypothesis. The degree of glycaemia has been shown to be associated with all-cause and cardiovascular mortality in diabetic subjects. Whether this association also exists in the general population is still controversial. We studied the predictive value of fasting plasma glucose, 2-hour post-load glucose and HbA1 c in a population-based cohort of 2363 older (50–75 years) subjects, without known diabetes. Methods. Relative risks (RR) of all-cause and cardiovascular mortality were estimated by Cox proportional hazards model, adjusting for age and sex, and additionally for known cardiovascular risk factors. Results. During 8 years of follow-up, 185 subjects died; 98 of cardiovascular causes. Fasting plasma glucose was only predictive in the diabetic range, although the risks started to increase at about 6.1 mmol/l. Post-load glucose and HbA1 c values were, even within the non-diabetic range, associated with an increased risk (p for linear trend 〈 0.05). These increased risks were mostly, but not completely, attributable to known cardiovascular risk factors. After exclusion of subjects with newly diagnosed diabetes or with pre-existent cardiovascular disease (n = 551), a 5.8 mmol/l increase of post-load glucose (corresponding to two standard deviations of the population distribution) was associated with a higher age-adjusted and sex-adjusted risk of all-cause (RR 2.24) and cardiovascular mortality (RR 3.40) (p 〈 0.05). After additional adjustment for known cardiovascular risk factors, these relative risks were still statistically significant, with values of 2.20 and 3.00 respectively (p 〈 0.05). Conclusion/interpretation. High glycaemic variables, especially 2-h post-load glucose concentrations and to a lesser extent HbA1 c values, indicate a risk of all-cause and cardiovascular mortality in a general population without known diabetes. [Diabetologia (1999) 42: 926–931]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051249
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  • 7
    Electronic Resource
    Electronic Resource
    Fasting proinsulin and 2-h post-load glucose levels predict the conversion to NIDDM in subjects with impaired glucose tolerance: The Hoorn Study (1996)
    Springer
    Diabetologia 39 (1996), S. 113-118 
    Details
    ISSN: 1432-0428
    Keywords: Impaired glucose tolerance ; non-insulin-dependent diabetes mellitus ; glucose tolerance test ; proinsulin ; specific insulin ; beta-cell function ; insulin resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aims of the present study were to observe the natural history of impaired glucose tolerance and to identify predictors for development of non-insulin-dependent diabetes mellitus (NIDDM). A survey of glucose tolerance was conducted in subjects aged 50–74 years, randomly selected from the registry of the middle-sized town of Hoorn in the Netherlands. Based on the mean values of two oral glucose tolerance tests subjects were classified in categories of glucose tolerance according to the World Health Organization criteria. All subjects with impaired glucose tolerance (n=224) were invited to participate in the present study, in which 70% (n=158) were subsequently enrolled. During follow-up subjects underwent a repeated paired oral glucose tolerance test. The mean follow-up time was 24 months (range 12–36 months). The cumulative incidence of NIDDM was 28.5% (95% confidence interval 15–42%). Age, sex, and anthropometric and metabolic characteristics at baseline were analysed simultaneously as potential predictors of conversion to NIDDM using multiple logistic regression. The initial 2-h post-load plasma glucose levels and the fasting proinsulin levels were significantly (p〈0.05) related to the incidence of NIDDM. Anthropometric characteristics, the 2-h post-load specific insulin levels and the fasting proinsulin/fasting insulin ratio were not related to the incidence of NIDDM. These results suggest that beta-cell dysfunction rather than insulin resistance plays the most important role in the future development of diabetes in a high-risk Caucasian population.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400421
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  • 8
    Electronic Resource
    Electronic Resource
    Carotid artery stenosis is related to blood glucose level in an elderly Caucasian population: the Hoorn Study (1997)
    Springer
    Diabetologia 40 (1997), S. 290-298 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Non-insulin-dependent diabetes mellitus ; impaired glucose tolerance ; specific insulin ; carotid artery stenosis ; epidemiology ; population-based survey ; Caucasians.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Cross-sectional associations between carotid artery stenosis (CAS) on the one hand, and parameters of glycaemia and specific insulin levels on the other, were investigated in an age, sex, and glucose tolerance stratified random sample from a 50–74-year-old Caucasian population. Subjects treated with insulin or oral hypoglycaemic agents were classified as having known diabetes mellitus (KDM) (n = 66). Using two oral glucose tolerance tests, and based on the World Health Organisation criteria, all other participants were classified as having a normal (NGT) (n = 287), an impaired (IGT) (n = 169) or a diabetic (NDM) (n = 106) glucose tolerance. CAS was defined haemodynamically using duplex scanning. The crude prevalences of only moderate (16–49 %) CAS were 6.6 %, 7.1 %, 5.7 % and 12.1 % in NGT, IGT, NDM and KDM subjects, respectively. For any severe ( ≥ 50 %) CAS, crude prevalences were 2.8 %, 4.7 %, 9.4 % and 7.6 %. The prevalence of any severe CAS was higher in NDM (p 〈 0.01) and KDM subjects (p = 0.07) than in NGT subjects. The prevalence of a history of stroke or transient ischaemic attack was 1.7 %, 1.8 %, 2.8 % and 1.5 % in NGT, IGT, NDM and KDM, respectively. In univariate logistic regression analysis, HbA1 c, serum fructosamine, fasting and 2-h post-load glucose were significantly associated with any severe CAS. In multivariate analyses controlling for other risk factors, only HbA1 c and 2-h post-load plasma glucose remained significantly associated (odds ratios: 1.29 per % and 1.09 per mmol/l, respectively) in separate models. No association could be shown between either fasting or 2-h post-load specific insulin and any severe CAS in either univariate or multivariate analyses. In conclusion, HbA1 c and 2-h post-load plasma glucose are independently associated with any severe CAS, whereas specific insulin is not. [Diabetologia (1997) 40: 290–298]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250050676
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  • 9
    Electronic Resource
    Electronic Resource
    Hyperproinsulinaemia in impaired glucose tolerance is associated with a delayed insulin response to glucose (1999)
    Springer
    Diabetologia 42 (1999), S. 177-180 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Impaired glucose tolerance ; insulin ; proinsulin ; hyperglycaemic clamp ; beta-cell function ; insulin sensitivity.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In subjects with impaired glucose tolerance hyperproinsulinaemia has been shown to be predictive for progression to Type II (non-insulin-dependent) diabetes mellitus. These findings are often interpreted as early indicators of an impaired beta-cell function. The aim of our study was to assess the potential determinants of hyperproinsulinaemia in subjects with impaired glucose tolerance. The study group consisted of 110 subjects, 45–74 years of age with mean 2 h plasma glucose concentrations between 8.6 and 11.1 mmol/l following two oral glucose tolerance tests. Subsequently, the hyperglycaemic clamp technique (10 mmol/l, with a priming infusion of 20 % glucose solution, 150 mg/kg) was used to assess the beta-cell function (time needed to reach the insulin peak) and insulin sensitivity (M/I value: glucose metabolised divided by insulin response, 150–180 min). Results showed that the intact-proinsulin:insulin ratio increased with increasing time needed to reach the insulin peak (0.065, 0.079 and 0.101; time needed to reach the insulin peak ≤ 5 min, 5 to 15 min, 〉 15 min; p 〈 0.05). The split-proinsulin:insulin ratio showed a similar association with the time needed to reach the insulin peak. These associations were independent of age, sex, body mass index and waist:hip ratio. In conclusion, this study shows that relative hyperproinsulinaemia is associated with an impaired beta-cell function in a study group of subjects with impaired glucose tolerance selected after two oral glucose tolerance tests. [Diabetologia (1999) 42: 177–180]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051136
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  • 10
    Electronic Resource
    Electronic Resource
    Glucose tolerance and other determinants of cardiovascular autonomic function: the Hoorn Study (2000)
    Springer
    Diabetologia 43 (2000), S. 561-570 
    Details
    ISSN: 1432-0428
    Keywords: Keywords Aging ; baroreflex ; Type II diabetes mellitus ; cardiovascular disease ; glucose intolerance ; heart-rate variability ; hypertension ; lifestyle ; autonomic nervous system ; obesity.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Aims/hypothesis. Currently, three categories of measures are used to assess cardiovascular autonomic dysfunction: measures of the Ewing-test, measures of heart-rate variability, and measures of baroreflex sensitivity. We studied the determinants of these measures obtained from cardiovascular autonomic function tests in the Hoorn Study. Methods. The study group (n = 631) consisted of a glucose-tolerance-stratified sample from a 50- to 75-year-old group of people. Cardiac cycle duration (RR interval) and continuous finger arterial pressure were measured under three conditions: during (a) spontaneous breathing, (b) six deep breaths over one minute, and (c) an active change in position from lying to standing. From these readings, ten measures of autonomic function were assessed (three Ewing, six heart-rate variability and one baroreflex sensitivity). As possible determinants we considered age, sex, glucose tolerance, cardiovascular disease, use of anti-hypertensive drugs, anthropometric factors, metabolic factors and lifestyle factors. Results. Multivariate analysis showed that eight of ten cardiovascular autonomic function measures were most strongly associated with glucose tolerance. Furthermore, measures were moderately associated with age, sex, waist-to-hip ratio, use of anti-hypertensive drugs, and insulin. The measures were weakly associated with coronary artery disease but not with lipids. The strongest determinants seemed to differ between subjects with and without diabetes: in the non-diabetic subjects the most strongly associated were age and use of anti-hypertensive drugs and in subjects with diabetes, insulin. No consistent differences in association between the three categories of measures were observed. Conclusion/interpretation. The strongest determinants of autonomic function were age, presence of diabetes and use of anti-hypertensive drugs. [Diabetologia (2000) 43: 561–570]
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001250051344
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