McDermott Robyn A, McCulloch Bradley G, Campbell Sandra K, Young Dallas M
Division of Health Sciences, University of South Australia, Adelaide, SA, Australia.
Med J Aust. 2007 May 21;186(10):505-8. doi: 10.5694/j.1326-5377.2007.tb01023.x.
To (i) assess changes in clinical indicators of adults diagnosed with diabetes and (ii) estimate changes in risk factors and incidence of diabetes among adults without diabetes living in the Torres Strait and Northern Peninsula Area Health Service District in Queensland from 1999 to 2005.
(i) Annual audit of clinical records of Torres Strait Islander adults on diabetes registers in 21 primary care clinics, and (ii) a 5-year follow up of a community cohort of 207 Torres Strait Islander adults without diabetes who participated in the Well Person's Health Check in 2000-01 and 2005-06.
Weight, height, waist circumference, fasting blood sugar (those without diabetes) and glycated haemoglobin (HbA1c; those with diabetes) levels, blood pressure (BP), fasting triglyceride and high-density lipoprotein cholesterol levels, urinary albumin-to-creatinine ratio and smoking status.
The number of adults included on the diabetes register increased from 555 in 1999 to 1024 in 2005. The mean age of patients diagnosed with diabetes decreased from 53.3 to 51.5 years, and their mean weight increased from 86.8 kg to 95.6 kg. Mean HbA1c level remained unchanged at about 9%, but the proportion with HbA1c level < 7% increased from 18.4% to 26.1%, and the proportion prescribed insulin increased from 14% in 2002 to 22% in 2005. The proportion with BP < 140/90 mmHg increased from 40.3% in 1999 to 66.8% in 2005. In the sample of 207 adults without diabetes, from 2000 to 2006, there was a weight gain of about 1 kg per person per year, and an annual increase in waist circumference of 0.8 cm in men and 1.2 cm in women. Crude incidence of diabetes was 29 (95% CI, 19-41) per 1000 person-years. There was a significant increase in diastolic blood pressure and fasting blood sugar levels, and no change in smoking habits.
Clinical care of adults with diabetes has improved and more people with diabetes are being diagnosed. However, weight gain and high rates of glycaemia remain a challenge and will result in a large burden of complications, including renal failure. Incidence data from this sample extrapolate to 120 (95% CI, 103-147) new cases of diabetes in the District each year. Urgent action to improve nutrition, decrease smoking and increase physical activity is required to improve metabolic fitness in younger people.
(i) 评估被诊断患有糖尿病的成年人的临床指标变化；(ii) 估计1999年至2005年居住在昆士兰州托雷斯海峡和北半岛地区卫生服务区的无糖尿病成年人的危险因素变化及糖尿病发病率。
(i) 对21家初级保健诊所糖尿病登记册上的托雷斯海峡岛民成年人的临床记录进行年度审计；(ii) 对2000 - 2001年和2005 - 2006年参加健康体检的207名无糖尿病的托雷斯海峡岛民成年人社区队列进行为期5年的随访。
体重、身高、腰围、空腹血糖（无糖尿病者）和糖化血红蛋白（HbA1c；糖尿病患者）水平、血压（BP）、空腹甘油三酯和高密度脂蛋白胆固醇水平、尿白蛋白与肌酐比值以及吸烟状况。
糖尿病登记册上的成年人数量从1999年的555人增加到2005年的1024人。被诊断患有糖尿病的患者平均年龄从53.3岁降至51.5岁，平均体重从86.8千克增至95.6千克。平均HbA1c水平保持在约9%不变，但HbA1c水平<7%的比例从18.4%增至26.1%，使用胰岛素治疗的比例从2002年的14%增至2005年的22%。血压<140/90 mmHg的比例从1999年的40.3%增至2005年的66.8%。在207名无糖尿病成年人的样本中，从2000年到2006年，每人每年体重增加约1千克，男性腰围每年增加0.8厘米，女性腰围每年增加1.2厘米。糖尿病的粗发病率为每1000人年29例（95%可信区间，19 - 41）。舒张压和空腹血糖水平显著升高，吸烟习惯无变化。
糖尿病成年人的临床护理有所改善，更多糖尿病患者被诊断出来。然而，体重增加和高血糖率仍然是一个挑战，将导致包括肾衰竭在内的大量并发症负担。根据该样本的发病率数据推断，该地区每年有120例（95%可信区间，103 - 147）新的糖尿病病例。需要采取紧急行动改善营养、减少吸烟并增加体育活动，以提高年轻人的代谢健康水平。
