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The Evidence Base forDiabetes Care
Edited by
R. WilliamsNuffield Institue for Health, University of Leeds,
Leeds, UK
W. HermanDepartment of Internal Medicine, University of
Michigan, Ann
Arbor, USA
A.-L. KinmonthDepartment of Public Health and Primary Care,
Institute of Public Health, Cambridge, UK
N. J. WarehamDepartment of Public Health and Primary Care,
Institute of Public Health, Cambridge, UK
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The Evidence Base for Diabetes Care
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The Evidence Base forDiabetes Care
Edited by
R. WilliamsNuffield Institue for Health, University of Leeds,
Leeds, UK
W. HermanDepartment of Internal Medicine, University of
Michigan, Ann
Arbor, USA
A.-L. KinmonthDepartment of Public Health and Primary Care,
Institute of Public Health, Cambridge, UK
N. J. WarehamDepartment of Public Health and Primary Care,
Institute of Public Health, Cambridge, UK
00 Williams pp. i-xii Final 5/8/02 10:39 am Page iii
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Contents
Contributors List . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
1. The Evidence Base for Diabetes Care . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . 1Rhys Williams, William Herman,
Ann-Louise Kinmonth andNicholas J. Wareham
PART I: EVIDENCE-BASED DEFINITION AND CLASSIFICATION
2. Classification of Diabetes . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . 13Max de Courten
3. Evidence-Based Definition and Classification: A Commentary .
. . . . . 37Steve ORahilly
PART II: PREVENTION OF DIABETES
4. Prevention of Type 1 Diabetes . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . 45Jay S. Skyler
5. Can Bombing the Immune System Achieve Lasting Peace in
thePancreas?: A Commentary . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . 69Edwin A. M. Gale
6. Prevention of Type 2 Diabetes . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . 75Richard F. Hamman
7. Missed and Newly Recovered Potential for the Prevention of
Type 2 Diabetes: A Commentary . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . 177Jaakko Tuomilehto
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PART III: EARLY DETECTION, SCREENING AND CASE FINDINGIN TYPE 2
DIABETES
8. The Evidence to Screen for Type 2 Diabetes Mellitus . . . . .
. . . . . . . . 191Michael M. Engelgau and K.M. Venkat Narayan
9. Understanding and Avoiding the Adverse Psychological Effects
of Screening: A Commentary . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . 235Theresa M. Marteau
PART IV: GESTATIONAL DIABETES
10. Gestational Diabetes Mellitus . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . 245David R. McCance
11. Gestational Diabetes Mellitus: A Commentary . . . . . . . .
. . . . . . . . . . . 285Thomas A. Buchanan
PART V: GLYCAEMIC CONTROL
12. Can Intensive Glycemic Management in Type 1 Diabetes Reduce
Morbidity and Mortality? . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . 291William Herman
13. Intensive Glycaemic Management in Type 1 Diabetes: A
Commentary . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . 317Brian M. Frier
14. Does Tight Control of Hyperglycaemia Limit Morbidity and
Mortality in Type 2 Diabetes ? . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . 333Amanda Adler
15. Does Tight Control of Hyperglycaemia Limit Mortality in Type
2 Diabetes?: A Commentary . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . 349R. John Jarrett
PART VI: PREVENTION OF COMPLICATIONS
16. The Effectiveness of Interventions Aimed at Weight Loss, and
other Effects of Diet and Physical Activity in Achieving Control of
Diabetes and Preventing its Complications . . . . . . . . . . . . .
355Nicholas J. Wareham
vi Contents
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17. Prevention of Hypertension . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . 389John Fuller
18. Prevention of Hyperlipidaemia . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . 413Trevor J. Orchard and Linda
Fried
19. What is the Evidence that Changing Tobacco Use Reduces the
Incidence of Diabetic Complications? . . . . . . . . . . . . . . .
. . . . . . . . . . . . 449Deborah L. Wingard, Elizabeth
Barrett-Connor and NicoleWedick
20. Prevention of Complications: A Commentary . . . . . . . . .
. . . . . . . . . . . 475David Simmons
PART VII: TREATMENT OF ESTABLISHED COMPLICATIONS
21. Treatment of Retinopathy . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . 501T. Mark Johnson and Ron
M. Kurtz
22. Treatment of Nephropathy . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . 513Akinlolu Ojo
23. Treatment of Periodontal Disease . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . 523George W. Taylor and Sara G.
Grossi
24. Treatment of Diabetic Neuropathy . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . 555Zachary Simmons and Eva L.
Feldman
25. Cardiac Complications and their Management . . . . . . . . .
. . . . . . . . . . . 577Aman Chugh, Kim A. Eagle and Rajendra H.
Mehta
26. Treatment of Cerebrovascular Disease . . . . . . . . . . . .
. . . . . . . . . . . . . . 607Susan L. Hickenbottom
27. Treatment of Peripheral Vascular Disease . . . . . . . . . .
. . . . . . . . . . . . . 631Allen D. Hamdan and Frank B.
Pomposelli Jr.
28. Epidemiology of Diabetic Foot Ulcers and Amputations:
Evidence for Prevention . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . 641Gayle E. Reiber and William R.
Ledoux
Contents vii
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29. Can Established Diabetic Complications be Reversed? The
Evidence for Secondary Prevention . . . . . . . . . . . . . . . . .
. . . . . . . . 667Ken Shaw
PART VIII: DELIVERY OF CARE
30. What is the Evidence that Increasing Participation of
Individuals in Self-management Improves the Processes and Outcomes
of Care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . 681Debra Roter and Ann-Louise
Kinmonth
31. Promoting Self-Management in Primary Care Settings:
Limitations and Opportunities: A Commentary . . . . . . . . . . . .
. . . . . . . 701Michael G. Goldstein
32. Delivering Care to the Population . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . 711Simon Griffin and Rhys
Williams
33. Delivering Care to the Population: A Commentary . . . . . .
. . . . . . . . . 723Urban Rosenqvist
PART IX: CONTINUING EDUCATION
34. Keeping Up to Date Through Lifelong Learning . . . . . . . .
. . . . . . . . . . 729David Pencheon and John Wright
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . 753
viii Contents
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Contributors List
AMANDA ADLER Diabetes Trials Unit, Radcliffe Infirmary,
WoodstockRoad, Oxford OX2 6EH, UK
ELIZABETH Department of Family and Preventive Medicine,
BARRETT-CONNOR University of California, San Diego, 9500 Gilman
Drive,
La Jolla, CA 92093-0607, USA
THOMAS Medicine, Obstetrics and Gynaecology, and
PhysiologyBUCHANAN and Biophysics, USC Keck School of Medicine,
6602
General Hospital, 1200 N States Street, Los Angeles,
CA90089-9317, USA
AMAN CHUGH 1500 East Medical Center Drive, Division of
Cardiology, Level B1, Ann Arbor, Michigan 48109, USA
MAX DE COURTEN Office of the WHO Representative for South
Pacific, POBox 113, Suva, Fiji Islands
KIM EAGLE University Hospital, 1500 E Medical Center Drive, 3910
Taubman Center, Box 0366, Ann Arbor, MI 48109-0366, USA
MICHAEL Division of Diabetes Translation Mailstop K-10, 477
ENGELGAU Buford Highway NE, Atlanta, GA 30341-3724, USA
EVA FELDMAN Department of Neurology, University of
MichiganHealth System, 4414 Kresge III, Box 0588, 200 ZinaPritcher
Place, Ann Arbor, MI 48109, USA
LINDA FRIED Renal Section, VA Pittsburgh Healthcare System,
4N167University Drive, Pittsburgh, PA 15213, USA
BRIAN FRIER Department of Diabetes, Royal Infirmary of
Edinburgh,Edinburgh EH3 9YW, Scotland, UK
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JOHN FULLER Department of Epidemiology and Public Health,
University College London, 1-19 Torrington Place, London WC1E 6BT,
UK
EDWIN GALE Medical School Unit, Southmead Hospital, Bristol BS10
5NB, UK
MICHAEL G. Clinical Education and Research, Bayer Institute for
GOLDSTEIN Health Care Communication, 400 Morgan Lane, West
Haven, CT 06516, USA
SIMON GRIFFIN Department of Public Health and Primary
Care,University of Cambridge, Institute of Public Health,University
Forvie Site, Robinson Way, Cambridge CB22SR, UK
SARA GROSSI Department of Oral Biology, State University of New
York at Buffalo, 135 Foster Hall, Buffalo, NY 14214,USA
ALLEN HAMDAN 110 Francis Street, Suite 5B, Boston MA 02215,
USA
RICHARD HAMMAN Department of Preventive Medicine and Biometrics,
Box B-119, 4200 East Ninth Avenue, Denver, CO 80262,USA
WILLIAM HERMAN Department of Internal Medicine and Epidemiology,
1500 East Medical Center Drive, 3920 Taubman Center,Box 0345, Ann
Arbor, MI 48109, USA
SUSAN Department of Neurology, University of Michigan
HICKENBOTTOM Health System, 1914 Taubman Center, Box 0316, 1500
E
Medical Center Drive, Ann Arbor, MI 48109, USA
R. JOHN JARRETT 45 Bishopsthorpe Road, London SE26 4PA, UK
T. MARK JOHNSON Bert M. Glaser National Retina Institute, 901
DulaneyValley Road, Suite 200 Baltimore, MD 21204, USA
ANN-LOUISE General Practice and Primary Care Research Unit,
KINMONTH Dept. of Public Health & Primary Care, Institute
of
Public Health, University Forvie Site, Robinson Way, Cambridge
CB2 2SR, UK
RON KURTZ Department of Ophthalomolgy, University of
California,Irvine Dept. of Opthalmology, 118 Med Surge I, Irvine,CA
92697-4375, USA
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WILLIAM LEDOUX Health Research Scientist, VA Puget Sound, MS
151,1660 S Columbia Way, Seattle, WA 98108, USA
THERESA MARTEAU Guys, Kings and St Thomass Medical School,
KingsCollege, Guys Campus, London Bridge, London SE19RT, UK
DAVID MCCANCE Regional Centre for Endocrinology and Diabetes,
Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland,UK
RAJENDRA MEHTA Department of Internal Medicine, Division of
Cardiology, Veterans Hospital, 1215 Fuller Road 111A,7E Ann Arbor,
MI 48105, USA
K. M. VENKAT Division of Diabetes Translation, Mailstop K-10,
477 NARAYAN Buford Highway NE, Atlanta, GA 30341-3724, USA
AKINLOLU OJO Department of Internal Medicine, University
ofMichigan Health System, 3914 E Taubman Center, Box 0364, 1500 E
Medical Center Drive, Ann Arbor, MI 48109-0364, USA
STEVE ORAHILLY Department of Medicine and Clinical Biochemistry,
Box157, Addenbrookes Hospital, Cambridge CB2 2QQ,UK
TREVOR ORCHARD Department of Epidemiology, Graduate School of
PublicHealth, University of Pittsburgh, Diabetes and LipidResearch,
3512 Fifth Avenue, Pittsburgh, PA 15213,USA
DAVID PENCHEON Eastern Region Public Health Observatory,
Institute ofPublic Health, University Forvie Site, Robinson
Way,Cambridge CB2 2SR, UK
FRANK B. Division of Vascular Surgery, Department of Surgery,
POMPOSELLI JR Beth Israel Deaconess Medical Center, Harvard
Medical
School, Boston, Massachusetts, USA
GAYLE REIBER Department of Health Services and Epidemiology,
Univeristy of Washington, VA Research Career Scientist,VA Fuget
Sound Health Care System (152), 1660 SouthColumbian Way, Seattle,
WA 98108, USA
URBAN Department of Public Health Uppsala Science Park,
ROSENQVIST S-751 853, Uppsala, Sweden
Bombing the Immune System xi
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DEBRA ROTER Department of Health Policy and Management, John
Hopkins School of Public Health, 624 NBroadway, Rm 750, Baltimore,
MD 21205, USA
KEN SHAW Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY,
UK
DAVID SIMMONS Department of Rural Health, University of
Melbourne, Snepparton 3632, PO Box 6500, Victoria, Australia
ZACHARY SIMMONS Division of Neurology, Penn State College of
Medicine, M.S. Hershey Medical Center, Hershey, PA 17033, USA
JAY S. SKYLER Division of Endocrinology, Diabetes and
Metabolism,University of Miami, Chairman, NIDDK Type 1Diabetes
TrialNet, 1450 NW 10th Avenue Suite 3061,Miami, Florida 33136,
USA
GEORGE TAYLOR Department of Cardiology, Restorative Sciences and
Endodontics, The University of Michigan School ofDentistry, 1011 N
University, Ann Arbor, MI 48109-1078, USA
JAAKKO Diabetes and Genetic Epidemiology Unit, Department
TUOMILEHTO of Epidemiology and Health Promotion, National
Public Health Institute, Department of Public Health,University
of Helsinki, Mannerheimintie 166, 00300Helsinki, Finland
NICHOLAS J. Department of Public Health and Primary Care,
InstituteWAREHAM of Public Health, University Forvie Site, Robinson
Way,
Cambridge CB2 2SR, UK
NICOLE WEDICK Department of Family and Preventive
Medicine,University of California, San Diego, 9500 Gilman Drive,La
Jolla, CA 92093-0607, USA
RHYS WILLIAMS Nuffield Institute for Health, University of
Leeds, 71-75Clarendon Road, Leeds LS2 9PL, UK
DEBORAH Division of Epidemiology, Department of Family and
WINGARD Preventive Medicine, University of California, San
Diego,
9500 Gilman Drive, La Jolla, CA 92093-0607, USA
JOHN WRIGHT Bradford Royal Infirmary, Bradford BD9 6RJ, UK
xii The Evidence Base for Diabetes Care
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1
The Evidence Base for DiabetesCare
RHYS WILLIAMS, WILLIAM HERMAN, ANN-LOUISEKINMONTH AND NICHOLAS
J. WAREHAM
Nuffield Institute for Health, Leeds LS2 9PL, UK
DIABETES
Diabetes is increasingly common throughout the world. Its
prevalence is wellover 5% in many developed countries1, and is
rising in the USA25, the UK6,and, most strikingly, in developing
countries710 and among indigenouspeoples11,12. Although most of
this rise is the result of an increased incidenceand, probably, an
increased detection of type 2 diabetes, type 1 diabetes is
alsoincreasing in frequency, particularly in young children13. An
earlier age ofonset for type 2 diabetes is also reported, with
diagnosis now occurring inchildren and adolescents1517.
For people with diabetes, whether type 1 or type 2, the disorder
can have aprofound influence on all aspects of life and can affect
most organs of thebody. In the current absence of a cure, it is
present for life. In addition, familymembers, friends and work
colleagues are all closely involved in living with thedisorder. The
long-term effects of diabetes result from its vascular
complica-tions; the microvascular complications of retinopathy,
neuropathy and nephro-pathy, and the macrovascular complications of
cardiovascular disease, cerebro-vascular disease and peripheral
vascular disease. Without intervention thesemay produce visual
impairment, lower limb ulceration and gangrene, renalfailure and
premature and sudden death.
Diabetes is thus an increasingly important health and economic
issue forthose who have the disorder, those who provide them with
health care andthose who fund and plan the provision of that care.
A complex set of decisionstaken by individuals and organisations
determines how health care is deliveredto people with diabetes.
Historically such decisions have been taken in a rather
The Evidence Base for Diabetes Care. Edited by R. Williams, W.
Herman, A.-L. Kinmonth and N. J. Wareham. 2002 John Wiley &
Sons, Ltd
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