Long-term significance of gestational carbohydrate intolerance: a longitudinal study.

Severe forms of GDM have been conclusively associated with significantly increased risk of developing DM later on in life. The long-term significance of GIGT has not yet been definitely elucidated. The study was set up to compare the present carbohydrate metabolism status and anthropomorphic characteristics of women diagnosed as suffering from abnormal carbohydrate tolerance during pregnancy eight years previously with those recorded as having normal glucose tolerance. The prevalence of present abnormal glucose tolerance was significantly higher in women who had been noted to have carbohydrate intolerance during their pregnancy, the prevalence depending on the gestational severity (10.0% in normal glucose tolerance, 36.4% in borderline GIGT; 66.7% in GIGT). Women whose overweight or obese status persists or develops after their pregnancy were statistically more likely to develop abnormal glucose tolerance later on in life (11.9-12.5% in normal-overweight BMI, 38.2% in obese BMI). A maternal and sibling, but not paternal, family history of diabetes was also a statistically significant risk factor. GIGT appears to be a definite risk factor for the development of carbohydrate metabolism problems later on in life, this being related to the severity during pregnancy and the presence or development of obesity. It is proposed that women diagnosed to suffer from GIGT should be regularly monitored after the pregnancy, particularly if other risk factors such as obesity are also present.

Risk factors for gestational impaired glucose tolerance in the Maltese population: a cross-sectional study.

Screening criteria for impaired carbohydrate metabolism problems during pregnancy include the use of specified risk factors, which are generally considered to be inadequate. The value of these risk factors in a population characterised by a high prevalence of abnormal carbohydrate metabolism is investigated. The study identified biological characteristics such as a maternal age >35 years, previous early pregnancy loss, a maternal family history of DM/IGT, pre-prandial glucosuria and an operative delivery with resuscitation as significant risk factors for the development of G-IGT. There appeared to be no statistical association with a history of multiparity, previous perinatal loss, congenital anomalies or macrosomia and a parental and grandparent family history of DM/IGT. There appeared to be a statistical difference in fasting blood glucose values, but no difference in glycosated haemoglobin. The risk factors for the development of G-IGT are shown to have a high specificity and negative predictive value, but overall moderate to low sensitivity and positive predictive values when used in isolation. The prevalence of the various identified risk factors was very high, a feature which would require at least a third of the population to be screened with an oral glucose tolerance test. These features suggest that the historical and clinical risk criteria are not ideal screening tools to identify G-IGT and a routine early third-trimester oral glucose tolerance test remains the ideal screening tool to identify these cases.

Retinopathy in Maltese type 2 diabetic patients.

Since diabetes is a major health problem in Malta a study was conducted to gain a better insight into one of its most common complications, that of retinopathy. A random sample of 200 cases of adult onset diabetes with retinopathy who attended the main hospital's diabetes clinic was assessed by an experienced ophthalmologist. Non-proliferative retinopathy was subdivided into three degrees of severity according to the number of microaneurysms, haemorrhages, exudates, and intraretinal microvascular abnormalities present while proliferative retinopathy included also advanced eye disease. Data on medical and family histories was gathered from personal interrogation and counterchecked from hospital files. A medical examination searched for other concomitant disease. The 124 females and 73 males were similarly aged with a mean of 59.5 +/- 11.5 years. The mean age at onset of diabetes was 44.4 +/- 7.9 years: no significant differences were seen between the grades of retinopathy or the sexes. Onset of eye disease was first detected at a mean age of 56.9 +/- 7.0 years. The great majority (82%) of retinopathy cases occurred after 10 years of diabetes. Males appeared to develop eye disease (especially non-proliferative) at a younger age (53.4 +/- 7.6 vs 58.9 +/- 6.6 years, p < 0.01) and after a shorter duration of diabetes (10.1 +/- 6.6 vs 14.0 +/- 7.8 years, p < 0.001) than females. Severity of retinopathy was strongly associated (p < 0.001), in females rather more than in males, with poor glycaemic control, use of insulin, presence of proteinuria and decreasing vision; and less markedly (p < 0.01) with duration of diabetes of more than 10 years, neuropathy and glaucoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology in Malta from routine health information.

OBJECTIVE: To estimate the prevalence of diabetes in the Maltese Islands from data regarding drug consumption, and to assess the prescribing habits and management attitudes of local doctors. METHODOLOGY: The prescribed average daily dose of each type of anti-diabetic drug was calculated from random representative samples of patients (total 1,444) attending the Health Department's primary and secondary health centres as well as of patients seeing their private practitioners. This constituted circa 16% of the total estimated number of diabetics on drug therapy in Malta. The quantities of drugs consumed were obtained both from Government and private industry sources, whilst relevant data on therapy modalities, including proportions of patients on a combination of anti-diabetic preparations, were obtained from records held at the Dept. of Health. RESULTS: Applying the appropriate formulae (as proposed by Eurodiab. subarea C 1989 programme) the global prevalence of diabetes worked out to be 5.22%, an underestimate of circa 12% of the figure extrapolated from the recent population based epidemiological studies. Overall 51% of cases were treated with 'diet only', whilst less than 10% of subjects were managed with insulin. Compared to patients attending the better staffed and equipped health centres, those seeing their private physicians were proportionately less frequently put on insulin (5.7% vs 11.7%), and were prescribed a slightly higher mean daily dose (1.7 vs. 1.4 tab) of glibenclamide suggesting the need of better education of the patient (and probably also of the physician). CONCLUSION: This type of study proved to be relatively simple and inexpensive to perform. Although it cannot replace epidemiological field surveys it can still give a reasonably fair (albeit with limitations) estimate of diabetes prevalence in a population. Moreover it permits an important insight into local public health indicating ways to improve diabetes care.

Abnormal glucose tolerance in the Maltese. A population-based longitudinal study of the natural history of NIDDM and IGT in Malta.

A population-based longitudinal study of abnormal glucose tolerance in the adult Maltese, carried out within the WHO-assisted National Diabetes Programme, has recently been completed. During the 6-year interval abnormal as compared to normal glucose tolerance was found to be related to a significantly higher mortality: the age-adjusted relative risks of death were 3.3 times in diabetic females and greater than 2 times in IGT and diabetic males. In the repeat epidemiological survey 1422 subjects (66.8% of the initial sample) were reinvestigated with the oral GTT being interpreted according to WHO's 1985 recommendations. The age-standardised prevalence rates, in the 35-69-year-old males and females, were respectively 12.89% and 13.24% for IGT and 9.07% and 10.77% for diabetes. These gradually increased after age 40, IGT peaking in the 60+ year groups and diabetes 10 years later. Heredity (especially diabetes in close relatives) seemed a major influence, whilst excess body weight appeared the more important associated environmental factor. The incidence levels (% per annum) of diabetes during the interval were 0.71 for normoglycaemics and 5.1 for IGTs; this seven times higher risk in the latter was slightly lower in females than males, but significantly higher in the less than 60-year-olds compared to older subjects. Of the initial IGTs 36% remained IGT and 33% reverted to normal glucose tolerance, whilst 11% of the initial normoglycaemics deteriorated to IGT. The determinants more strongly influencing worsening of glucose tolerance were age (greater than 50 years), baseline glycaemia (fasting greater than 5.5 mmol/l and a 2-h post-load glycaemia greater than 9.5 mmol/l) and initial body mass index (greater than 27 kg/m2). In conclusion the data permit a better insight into the natural history of, and risk factors for, disturbed glucose tolerance in this community.

Type 1 diabetes in the Maltese Islands.

The prevalence of Type 1 diabetes in Malta was estimated by identifying all cases aged less than 32 years by the end of 1987 who had attended the island's principal diabetic clinic. The age-adjusted prevalence rate for 0-19 year olds was 110.3 per 100,000 (girls 126.2 (n = 65), boys 95.3 (n = 52]. The mean annual incidence, during the period 1980-1987, in 0-19 year olds was 13.3 per 100,000 (n = 113, girls 14.1 and boys 12.6). Males developed Type 1 diabetes 2.1 years later than females (13.7 +/- 6.9 (+/- SD) vs 11.6 +/- 6.7 years). The commonest age of onset was 10 to 14 years. The peak period of onset occurred during the cooler months of November to February. The incidence rates are close to those in Nordic countries and indicate that Type 1 diabetes in Malta is underestimated.