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

Slide 1Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Tracking the Accelerating Epidemic: Its Causes and Outcomes AusDiab 2005 The Australian Diabetes, Obesity and Lifestyle Study Slide 2Australian 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. Slide 3Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 4Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 5Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Diabetes and pre-diabetes Slide 6Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 7Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 7.0 7.0or 11.1 11.1 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 Slide 8Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Diabetes in Australia: The last 20 years 0 200 400 600 800 1000 808284 86 88909294 96 98 00 Thousands Year a) Busselton b) Nat Heart Foundation c) Aust Bureau Statistics d) Aust Bureau Statistics e) AusDiab Slide 9Australian 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 Slide 10Australian 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 Slide 11Australian 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 Slide 12Australian 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*69.343.550.121.1 Obesity (BMI 30 kg/m²)44.430.131.515.9 LDL ( 3.5 mmol/L)45.959.653.044.1 HDL ( 1.0 mmol/L)23.116.811.610.6 Triglycerides ( 2.0 mmol/L)42.931.431.116.0 * On treatment, or systolic pressure 140 mmHg, or diastolic pressure 90 mmHg IGT impaired glucose tolerance; IFG impaired fasting glucose. Slide 13Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of diabetes according to gender Incidence (% per year) Slide 14Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of diabetes according to baseline age Incidence (% per year) Baseline age (years) Slide 15Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 16Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of IGT and IFG Incidence (% per year) IGT impaired glucose tolerance; IFG impaired fasting glucose. Slide 17Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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: 25.0 29.9 kg/m 2 ; and (iii) obese: 30.0 kg/m 2. Slide 18Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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: 94.0 101.9 cm for males, 80.087.9 cm for females; (iii) obese: 102.0 cm for males, 88.0 cm for females. Slide 19Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of diabetes according to baseline physical activity Baseline physical activities categories Incidence (% per year) Slide 20Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 21Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 22Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 23Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 24Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Obesity Slide 25Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Body mass index classification Body mass index (kg/m 2 ) Normal< 25.0 Overweight25.0 – 29.9 Obese 30.0 Slide 26Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Classification of abdominal obesity by waist circumference Waist circumference (cm) Normal < 94.0 < 80.0 Overweight 94.0 – 101.9 80.0 – 87.9 Obese 102.0 88.0 MalesFemales Slide 27Australian 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) Classification25-3435-4445-5455-6465-7475+Total BMI Males17.017.520.525.520.511.619.1 Females12.219.426.031.929.714.921.8 Persons14.718.423.228.725.513.520.5 Waist Males13.624.627.435.841.236.826.6 Females17.125.637.646.752.243.033.9 Persons15.325.132.441.247.340.530.3 * BMI 30 kg/m²; Waist circumference: males 102 cm; females 88 cm Slide 28Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Mean weight change over five years according to baseline age Baseline age (years) Mean change in weight (kg) 25 – 34 35 – 44 45 – 54 55 – 64 65 – 74 75Total - 0.3 - 2.2 Slide 29Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Mean body mass index change over five years according to baseline age Baseline age (years) Mean change in BMI (kg/m 2 ) 25 – 34 35 – 44 45 – 54 55 – 64 65 – 74 75Total - 0.2 1.0 Slide 30Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Mean waist circumference change over five years according to baseline age Baseline age (years) Mean change in waist circumference (cm) 25 – 34 35 – 44 45 – 54 55 – 64 65 – 74 75Total 3. 0 2.0 3.0 Slide 31Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Mean weight change over five years according to baseline body mass index status Mean weight change (kg) 1.0 Baseline BMI status Slide 32Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Mean waist circumference change over five years according to baseline BMI status Mean waist circumference change (cm) 2.0 Baseline BMI status Slide 33Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Baseline BMI status Incidence of obesity according to baseline body mass index status Incidence (% per year) 2.0 Slide 34Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 nNormal n (%) Overweight Obese Normal2,369 1,831 (77.3) 530 (22.4) 8 (0.34) Overweight2,560 194 (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: 25.0 29.9 kg/m 2 ; and (iii) obese: 30.0 kg/m 2. Slide 35Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 nNormal n (%) Overweight Obese Normal2,496 1,752 (70.2) 628 (25.2) 116 (4.7) Overweight1,637 301 (18.4) 771 (47.1) 565 (34.5) Obese2,163 44 (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: 94.0 101.9 cm for males, 80.087.9 cm for females; (iii) obese: 102.0 cm for males, 88.0 cm for females. Slide 36Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 37Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Hypertension Slide 38Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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) Slide 39Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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: 151 83. Slide 40Australian 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 Males55.845.337.428.720.134.3 Females75.575.959.247.643.233.746.4 Persons75.566.452.642.637.329.341.4 *Systolic pressure 140 mmHg, and a diastolic pressure 90 mmHg, and on anti-hypertensive medication Slide 41Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 n Normal BP n (%) Hypertension Normal BP 4,353 3,749 (86.1) 604 (13.9) Hypertension1,965 354 (18.0) 1,611 (82.0) Total6,3184,1032,215 Proportion of individuals classified with hypertension in 2004 05 according to baseline hypertension Hypertension status in 2004–05 Hypertension status at baseline Slide 42Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of hypertension according to baseline age Incidence (% per year) Baseline age (years) Slide 43Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 44Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 25.029.9 kg/m 2 ; and (iii) obese was a BMI of 30.0 kg/m 2. Slide 45Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of hypertension according to baseline smoking status Baseline smoking status Incidence (% per year) Slide 46Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 25 34 years of age to 8.4% per year at 65 74 years of ageThe risk increases with age from 1.0% per year at 25 34 years of age to 8.4% per year at 65 74 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) Slide 47Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Metabolic syndrome Slide 48Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 49Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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: 1059 62. Slide 50Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of the metabolic syndrome according to gender Incidence (% per year) 3.0 Slide 51Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of the metabolic syndrome according to baseline age Incidence (% per year) Baseline age (years) Slide 52Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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: 94.0 101.9 cm for males, 80.087.9 cm females; (iii) obese: 102.0 cm for males, 88.0 cm for females. Slide 53Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of the metabolic syndrome according to baseline physical activity Baseline physical activity status Incidence (% per year) Slide 54Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 55Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 56Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Chronic kidney disease Slide 57Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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: 1285 95. 2. Go AS et al. N Engl J Med 2004; 351: 1296 305. 3. McDonald SP et al. The 28th report of the Australia and New Zealand Dialysis and Transplant Registry 2006. Slide 58Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 59Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of impaired glomerular filtration rate according to gender Incidence (% per year) Slide 60Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of impaired glomerular filtration rate according to baseline age Incidence (% per year) Baseline age (years) Slide 61Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 62Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 63Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of albuminuria according to gender Incidence (% per year) 1.0 Slide 64Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Incidence of albuminuria according to baseline age Incidence (% per year) Baseline age (years) Slide 65Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 66Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 67Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 68Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Mortality Slide 69Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 70Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 71Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 72Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Relative risk of mortality associated with various risk factors* Baseline risk factors 0 1 2 3 4 Hypertension Albuminuria Impaired GFR Smoking CVD KDM All–cause mortality hazard ratio * After accounting for other risk factors. Bars represent 95% confidence intervals Slide 73Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 74Australian 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 Slide 75Australian 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 Slide 76Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 77Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 Survey methods and response rates Slide 78Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 79Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 80Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 StateNumberOn-sitePathologySelf-reportedOverall eligibletestinglaboratorymedicalresponders attendance*conditions only n n (%) n (%) n (%) n (%) Response rates by state or territory VIC1,429821 (57.5)52 (3.6)337 (23.6)1,210 (84.7) WA1,526990 (64.9)28 (1.8)210 (13.8)1,228 (80.5) NSW1,458871 (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) SA1,700945 (55.6)29 (1.7)467 (27.5)1,441 (84.8) NT1,202702 (58.4)5 (0.4)189 (15.7)895 (74.5) QLD1,748 954 (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 Slide 81Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005Sponsors 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 Slide 82Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 83Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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 Slide 84Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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. Slide 85Australian Diabetes, Obesity and Lifestyle Study (AusDiab) International Diabetes Institute Melbourne 2006 2005 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