Burke J P, Williams K, Gaskill S P, Hazuda H P, Haffner S M, Stern M P
Department of Medicine, University of Texas Health Science Center at San Antonio, 78284-7873, USA.
Arch Intern Med. 1999 Jul 12;159(13):1450-6. doi: 10.1001/archinte.159.13.1450.
The prevalence of type 2 diabetes has increased in the early part of the 20th century, particularly in developing countries. There is now evidence that the prevalence also continues to increase in developed countries, including the United States. However, it is unknown whether this increase is due to a rise in the incidence of diabetes or to decreasing diabetic mortality or both.
Participants in the San Antonio Heart Study, who were nondiabetic at baseline and who returned for a 7- to 8-year follow-up examination, were examined for secular trends in the incidence of type 2 diabetes. Risk factors for diabetes, such as obesity, were also examined. Patients were enrolled in the San Antonio Heart Study from 1979 to 1988 and 7- to 8-year incidence of diabetes was determined from 1987 to 1996.
A significant secular trend in the 7- to 8-year incidence of type 2 diabetes was observed in Mexican Americans (5.7% for participants enrolled in 1979 to 15.7% for participants enrolled in 1988). In non-Hispanic whites, the incidence increased from 2.6% for participants enrolled in 1980 to 9.4% for participants enrolled in 1988 (P = .07) . After adjusting for age and sex, the secular trend remained significant in Mexican Americans and borderline significant in non-Hispanic whites. This indicates that between 1987 and 1996 the 7- to 8-year incidence of type 2 diabetes approximately tripled in both ethnic groups. The overall secular trend also remained significant after adjusting for additional risk factors for diabetes, such as obesity. A rising secular trend in obesity was also observed.
There has been a significant increasing secular trend in the incidence of type 2 diabetes in Mexican Americans and a borderline significant trend in non-Hispanic whites participating in the San Antonio Heart Study. Unlike other cardiovascular risk factors such as lipid levels, cigarette smoking, and blood pressure, which are either declining or under progressively better medical management and control, and unlike cardiovascular mortality, which is also declining, obesity and type 2 diabetes are exhibiting increasing trends. Thus, obesity and diabetes could easily become the preeminent US public health problem.
20世纪初2型糖尿病的患病率有所上升，尤其是在发展中国家。现在有证据表明，包括美国在内的发达国家的患病率也在持续上升。然而，尚不清楚这种上升是由于糖尿病发病率的上升，还是糖尿病死亡率的下降，抑或是两者兼而有之。
圣安东尼奥心脏研究的参与者在基线时无糖尿病，并返回进行7至8年的随访检查，以研究2型糖尿病发病率的长期趋势。还对肥胖等糖尿病危险因素进行了检查。患者于1979年至1988年参加圣安东尼奥心脏研究，并于1987年至1996年确定了7至8年的糖尿病发病率。
在墨西哥裔美国人中观察到2型糖尿病7至8年发病率有显著的长期趋势（1979年入组的参与者为5.7%，1988年入组的参与者为15.7%）。在非西班牙裔白人中，发病率从1980年入组的参与者的2.6%上升到1988年入组的参与者的9.4%（P = 0.07）。在调整年龄和性别后，墨西哥裔美国人的长期趋势仍然显著，非西班牙裔白人则接近显著。这表明在1987年至1996年期间，两个种族群体中2型糖尿病的7至8年发病率大约增加了两倍。在调整了肥胖等其他糖尿病危险因素后，总体长期趋势仍然显著。肥胖的长期趋势也在上升。
在参加圣安东尼奥心脏研究的墨西哥裔美国人中，2型糖尿病发病率有显著上升的长期趋势，在非西班牙裔白人中则有接近显著的趋势。与其他心血管危险因素如血脂水平、吸烟和血压不同，后者要么在下降，要么在逐步改善的医疗管理和控制之下，也与心血管死亡率的下降不同，肥胖和2型糖尿病呈现上升趋势。因此，肥胖和糖尿病很容易成为美国首要的公共卫生问题。
