Gonzélez C, Stern M P, Mitchell B D, Valdez R A, Haffner S M, Pérez B A
Center for Diabetes Studies, American British Cowdray Hospital, Mexico City, Mexico.
Diabetes Care. 1994 May;17(5):397-404. doi: 10.2337/diacare.17.5.397.
To compare the clinical status of type II diabetic subjects identified in two population-based surveys, one performed in Mexico City, Mexico and the other in San Antonio, Texas.
In a low income area of Mexico City, 3,517 age-eligible (35-64 years of age) individuals were randomly selected of whom 3,319 were interviewed at home and 2,198 were examined in a clinic (response rates 62.5%). In San Antonio, 2,357 similarly aged low-income Mexican Americans were randomly selected of whom 2,076 were interviewed at home and 1,511 were examined (response rate 64.1%). Oral glucose tolerance tests were performed at both sites and diabetes was diagnosed according to the World Health Organization (WHO) criteria. In Mexico City, 288 type II diabetic individuals were identified, and 255 were identified in San Antonio. The following variables were measured: height, weight, subscapular and triceps skinfolds, waist-to-hip circumference ratios (WHR), systolic and diastolic blood pressure (random 0 sphygmomanometer), fasting and 2-h postglucose load glucose and insulin concentrations, and fasting total-cholesterol, HDL-cholesterol, and triglyceride (TG) levels. A food frequency questionnaire was used to estimate total calories and the percentage of calories derived from protein, fat, and carbohydrate. Only type II diabetic patients were included in the analyses. Age-adjustment was performed by analysis of covariance for continuous variables and by the Mantel-Haenszel procedure for discrete variables.
The mean age, the percentage newly diagnosed cases, and the percentage of males were similar in both sites. The percentage of diabetic patients treated with oral agents was significantly higher in Mexico City (56.9 vs. 72.7% in San Antonio and Mexico City, respectively, P < 0.001), whereas the percentage treated with insulin was significantly higher in San Antonio (18.8 vs. 2.1% for San Antonio and Mexico City, respectively, P < 0.001). A significant difference was observed in the percentage of calories derived from carbohydrate (61.7-63.2 vs. 47.1-47.5% for Mexico City and San Antonio, respectively, P < 0.001) and fat (18.4-20.0 and 30.1-33.0% for Mexico City and San Antonio, respectively, P < 0.001). Body mass index (BMI) was higher in San Antonio (27.6-30.4 vs. 30.2-32.9% for Mexico City and San Antonio, respectively, P < 0.05). Total serum cholesterol was similar at both sites. HDL cholesterol, however, was lower in Mexico City, both in newly and in previously diagnosed patients (30.5-35.8 vs. 39.6-43.3 mg/dl in Mexico City and San Antonio, respectively, P < 0.001). TG levels were higher in Mexico City patients (187-249 vs. 167-179 mg/dl in Mexico City and San Antonio, respectively, P < 0.001). The association between diabetes and the anthropometric and metabolic variables was similar in Mexico City and San Antonio with the following exceptions: Diabetes in Mexico City was associated with less of an elevation in BMI, WHR, and fasting insulin concentration and less of a reduction in the 2-h postoral glucose load insulin concentration compared with diabetes in San Antonio. In addition, although diabetes was associated with a lower HDL in San Antonio subjects, no association appeared between diabetes and HDL in Mexico City subjects.
Diabetic subjects in Mexico City were more likely to be treated with oral agents and less likely to be treated with insulin compared with San Antonio patients. Previously diagnosed diabetic subjects in San Antonio had higher BMIs than diabetic subjects in Mexico City. Diabetic subjects in Mexico City ate less fat but more carbohydrate than those in San Antonio. TG levels were higher and HDL-cholesterol levels were lower in Mexico City diabetic subjects compared with those in San Antonio. San Antonio diabetic subjects had lower HDL levels than nondiabetic subjects but, in Mexico City, HDL levels were similar in diabetic subjects and nondiabetic subjects...
比较在两项基于人群的调查中确诊的II型糖尿病患者的临床状况，一项调查在墨西哥的墨西哥城开展，另一项在得克萨斯州的圣安东尼奥开展。
在墨西哥城的一个低收入地区，随机选取了3517名符合年龄要求（35 - 64岁）的个体，其中3319人在家中接受了访谈，2198人在诊所接受了检查（应答率62.5%）。在圣安东尼奥，随机选取了2357名年龄相仿的低收入墨西哥裔美国人，其中2076人在家中接受了访谈，1511人接受了检查（应答率64.1%）。两个地点均进行了口服葡萄糖耐量试验，并根据世界卫生组织（WHO）标准诊断糖尿病。在墨西哥城，确诊了288例II型糖尿病患者，在圣安东尼奥确诊了255例。测量了以下变量：身高、体重、肩胛下和肱三头肌皮褶厚度、腰臀围比（WHR）、收缩压和舒张压（随机0血压计）、空腹及葡萄糖负荷后2小时的血糖和胰岛素浓度，以及空腹总胆固醇、高密度脂蛋白胆固醇和甘油三酯（TG）水平。使用食物频率问卷来估计总热量以及蛋白质、脂肪和碳水化合物所提供热量的百分比。分析仅纳入II型糖尿病患者。连续变量通过协方差分析进行年龄调整，离散变量通过Mantel - Haenszel方法进行年龄调整。
两个地点的平均年龄、新诊断病例百分比和男性百分比相似。在墨西哥城，接受口服药物治疗的糖尿病患者百分比显著更高（分别为56.9%和72.7%，圣安东尼奥和墨西哥城，P < 0.001），而在圣安东尼奥，接受胰岛素治疗的百分比显著更高（分别为18.8%和2.1%，圣安东尼奥和墨西哥城，P < 0.001）。在碳水化合物所提供热量的百分比方面观察到显著差异（墨西哥城和圣安东尼奥分别为61.7 - 63.2%和47.1 - 47.5%，P < 0.001）以及脂肪所提供热量的百分比（墨西哥城和圣安东尼奥分别为18.4 - 20.0%和30.1 - 33.0%，P < 0.001）。圣安东尼奥的体重指数（BMI）更高（墨西哥城和圣安东尼奥分别为27.6 - 30.4和30.2 - 32.9%，P < 0.05）。两个地点的总血清胆固醇相似。然而，无论是新诊断还是既往诊断的患者，墨西哥城的高密度脂蛋白胆固醇均较低（墨西哥城和圣安东尼奥分别为30.5 - 35.8和39.6 - 43.3 mg/dl，P < 0.001）。墨西哥城患者的TG水平更高（墨西哥城和圣安东尼奥分别为187 - 249和167 - 179 mg/dl，P < 0.001）。墨西哥城和圣安东尼奥糖尿病与人体测量和代谢变量之间的关联相似，但有以下例外：与圣安东尼奥的糖尿病相比，墨西哥城的糖尿病与BMI、WHR和空腹胰岛素浓度升高较少以及口服葡萄糖负荷后2小时胰岛素浓度降低较少相关。此外，虽然糖尿病与圣安东尼奥受试者的高密度脂蛋白降低相关，但在墨西哥城受试者中糖尿病与高密度脂蛋白之间未显示出关联。
与圣安东尼奥的患者相比，墨西哥城的糖尿病患者更有可能接受口服药物治疗，而接受胰岛素治疗的可能性较小。圣安东尼奥既往诊断的糖尿病患者的BMI高于墨西哥城的糖尿病患者。墨西哥城的糖尿病患者比圣安东尼奥的患者摄入的脂肪更少但碳水化合物更多。与圣安东尼奥的糖尿病患者相比，墨西哥城的糖尿病患者TG水平更高，高密度脂蛋白胆固醇水平更低。圣安东尼奥的糖尿病患者高密度脂蛋白水平低于非糖尿病患者，但在墨西哥城，糖尿病患者和非糖尿病患者的高密度脂蛋白水平相似……
