Jean-Marie Ekoé

The epidemiology of diabetes mellitus

The book highlights the dramatic rise of Type 2 diabetes in children, adolescents and the elderly throughout the world. One new section features prevention and screening of both Type1 and Type 2 diabetes. Other new chapters cover the epidemiology of obesity and the impact of nutrition, and review available guidelines for better worldwide glycemic control. Future challenges, including the effects of antipsychotic treatment and HIV infection and therapy on diabetes, are also addressed.

Cardiovascular burden and related risk factors among Nunavik (Quebec) Inuit: Insights from baseline findings in the circumpolar Inuit Health in Transition cohort study

BACKGROUND The Inuit are commonly portrayed to be somehow protected from cardiovascular diseases (CVDs) through their traditional lifestyle and diet. However, actual sociocultural transition and related major, modifiable risk factors have scarcely been quantified in the Inuit population. Such knowledge is extremely valuable in terms of public health intervention. METHODS A total of 887 Inuit residents from Nunavik, Quebec, participated in a cohort study. The estimates presented were derived from anthropometric and biological measurements gathered at the time of recruitment and enhanced by information collected in the medical file of each participant. All estimates were corrected for a complex sampling strategy and bootstrapped to ensure the representativeness of the general Nunavik population. RESULTS Overall, 19% of Inuit had a disease of the circulatory system according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Among all disorders, peripheral circulatory system disease was the most prevalent (9%). Prevalences of ischemic heart disease and cerebrovascular disease were of similar magnitude (2.5%). No significant difference in disease prevalence was noted between sexes. The major modifiable CVD risk factors were smoking (84%), obesity (49%) [corrected] (body mass index of greater than 30 kgm2) and elevated blood pressure (13085 mmHg or greater) (18%). Prevalences were globally higher among women. CONCLUSION The current belief that the Inuit are protected from CVD is seriously questioned by the results of the present study. Considering the extremely high prevalence of CVD risk factors, a population-based intervention reinforced for women is urgently needed to reduce their risk.

Prevalence Estimates of Diabetes and of Other Cardiovascular Risk Factors in the Two Largest Algonquin Communities of Quebec

OBJECTIVE To compare the prevalence of non-insulin-dependent diabetes mellitus (NIDDM) in the two largest Algonquin communities of Quebec (Canada) with that of other native groups and to describe the different patterns of NIDDM and other cardiovascular risk markers in these communities (River Desert [RD] and Lac Simon [LS]). RESEARCH DESIGN AND METHODS The population-based study targeted all residents aged 15 years and older. In the age-group considered here (30-64 years), there were 480 eligible subjects and 299 participants (50.8% in RD and 86.9% in LS). All except those with confirmed diabetes underwent an oral glucose tolerance test. Serum triglyceride and lipoprotein cholesterol levels, blood pressure, body mass index (BMI), and waist-to-hip ratio (WHR) were measured. RESULTS The age-standardized (world population) prevalence of NIDDM in women was twice as high in LS as in RD (48.6% vs. 23.9%). In men, it was 23.9% in LS and 16.3% in RD. Upper-body obesity followed the same pattern. In contrast, high-risk serum low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol levels were significantly more prevalent in RD than in LS, particularly among men. The rate of high blood pressure was twice as high in men as in women, with little community differences. When we controlled for age, sex, diabetic, and obesity status, mean fasting serum glucose remained significantly higher triglycerides and LDL cholesterol lower in LS than in RD. There was also an independent community effect on WHR but no on BMI. CONCLUSIONS The prevalence of NIDDM in LS women reaches the rate observed in Pima Indian women. The observed differences between two Algonquin communities suggest a highly heterogeneous pattern of NIDDM and cardiovascular disease risk factors in Amerindian populations, even within a given tribe and a limited geographic area.

Canadian Diabetes Association Technical Review:The Diabetic Foot and Hyperbaric Oxygen Therapy

RESUME Foot ulcers are a significant source of morbidity, mortality and diminished quality of life for patients with diabetes. Hyperbaric oxygen therapy (HBOT) has been proposed as a possible treatment. In this technical review, the results of clinical trials on the use of HBOT for diabetic foot ulcers are reviewed. Many of the studies examining the role of HBOT in the treatment of diabetic ulcers have been retrospective, nonrandomized and noncontrolled. In addition, most studies have included small patient populations with heterogeneous classes of ulcers. However, results of these studies suggest that HBOT may accelerate wound healing and reduce amputation in a subset of patients with diabetic ulcers. Most patients with Wagner grade 1 and 2 ulcers will heal with carefully administered conventional care (local wound care and efficacious offloading). Appropriate candidates for HBOT are patients with long-standing nonhealing Wagner grade 3 or higher ulcers with an adequately perfused capillary bed in the wound area (best assessed by the transcutaneous oxygen tension [TcPO 2] response to 100% oxygen challenge).

Effect of Maternal Diabetes on the Pattern of Selected Insulin Resistance Syndrome Parameters in Normal Glucose Tolerant Subjects of Two Algonquin Indian Communities in Quebec

OBJECTIVE To determine whether a maternal antecedent with diabetes has an effect on insulin resistance syndrome parameters. RESEARCH DESIGN AND METHODS We studied 352 Algonquin Indians from Quebec aged at least 15 years who had no personal antecedents with diabetes. Data concerned clinical and biological parameters and the parental antecedents with diabetes. RESULTS For subjects over > 30 years, fasting insulin and cholesterol levels were significantly higher in the group with a maternal history of diabetes than in the group with a paternal history. Significant differences were observed for serum triglyceride, BMI, and subscapular skinfold thickness when comparing subjects with a maternal history and those with no parental history of diabetes. Blood pressure and fasting glucose did not differ according to parental history. CONCLUSIONS Subjects of maternal antecedents with diabetes have known risk factors for NIDDM. This study does not identify whether there is a genetic or maternal environmental reason for this association.

Epidemiology of Insulin-Using Commercial Motor Vehicle Drivers: Major variability of state licensing requirements in the U.S.

OBJECTIVE Licensing agencies in many areas, including the U.S., prohibit insulin-using individuals from driving CMVs or large trucks. This study examined the debate over the risks of licensing insulin-using individuals to drive CMVs as an occupation, and the variations in regulations of different states. RESEARCH DESIGN AND METHODS As part of an ongoing review of the regulations governing interstate commerce in the U.S., we surveyed all 50 states and Washington, D.C. to determine the regulations concerning intrastate driving. We received responses from 48 states and D.C., representing 95% of the U.S. population. RESULTS Only 9 states reported preventing insulin users from acquiring a CMV license, whereas 39 states and D.C. permitted licensing within state boundaries. Of the states allowing insulin users to drive, 26 placed special requirements on CMV licensing. CONCLUSIONS The results indicate that, despite a standardized U.S. federal law for driving across states, enormous variability exists in the policies for driving within states, ranging from no restrictions to a complete ban on CMV driving for insulin users.

Epidemiology of obesity in relationship to some chronic medical conditions among Inuit and Cree Indian populations in New Quebec, Canada

The tremendous sociocultural, economic and environmental changes in North American native populations over the last 50 years have been accompanied by the appearance of new public health problems. The prevalence of ‘lifestyle’ diseases, obesity, hypertension and non-insulin dependent diabetes is increasing [1,2]. Disease patterns among Arctic populations are also changing following the introduction of Western culture and technology. Epidemiologic monitoring of specific health problems, for instance chronic diseases such as obesity, diabetes and hypertension is important if we are to understand this continuing process of acculturation. To our knowledge, ours was the first population-based screening for these chronic conditions among native populations of New Quebec. Our survey, which examined obesity, blood glucose levels, cholesterol and blood pressure in the native populations in New Quebec, is part of a continuous epidemiologic monitoring of the health status of the Cree and Inuit Indians in this peripolar region.

Considerations for Initiating a Sodium-Glucose Co-Transporter 2 Inhibitor in Individuals with Type 2 Diabetes Using Insulin

In order to meet and maintain glycemic control, pharmacological management of individuals with type 2 diabetes typically begins with metformin followed by the introduction of other oral antihyperglycemic agents as needed. In some patients, the aggressive and progressive degeneration of pancreatic β cell activity means insulin therapy will become a given. The need to routinely monitor blood glucose levels coupled with the undesirable effects associated with insulin-primarily hypoglycemia and weight gain-commonly contribute to physician and patient inertia. The new β-cell-independent sodium-glucose co-transporter 2 (SGLT2) inhibitors are approved for combination use with all of the currently approved oral and injectable antihyperglycemic classes. The addition of SGLT2 inhibitors to background insulin therapy has the potential to afford many benefits and, in some cases, may reduce the incidence of insulin-associated side effects. This article reviews the available literature on SGLT2 inhibitor-insulin combination therapy and underscores the issues that should be considered prior to introducing SGLT2 inhibitors to individuals with type 2 diabetes who are already on insulin (with or without other antihyperglycemic agents) to ensure individualization of therapy.