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EPIDEMIOLOGY,AETIOLOGY AND PUBLIC HEALTH ASPECTS OF DIABETES MELLITUS

Objective

The European Community Concerted Action on the Epidemiology and Prevention of Diabetes involved nearly 100 centres throughout Europe and comprised three sub-areas of research:
(A) The epidemiology and aetiopathogenesis of insulin-dependent diabetes mellitus (IDDM);
(B) The complications and mortality in IDDM;
(C) The epidemiology of diabetes from routine health information.
The European Community concerted action on the epidemiology and prevention of diabetes involved nearly 100 centres throughout Europe and comprised 3 subareas of research:
the epidemiology and aetiopathogenesis of insulin dependent diabetes mellitus (IDDM);
the complications and mortality in IDDM;
the epidemiology of diabetes from routine health information.

In subarea A the incidence of IDDM in children aged up to 15 years was studied in 24 regions in Europe and Israel. Incidence rates varied widely from 4.6 (northern Greece) to 42.9 (Finland) cases per 100000 per year. There was an unexpectedly high incidence in Sardinia, which had the second highest rate recorded in Europe.

In subarea B the frequency of diabetic complications in representative samples of IDDM patients attending 31 European diabetes centres was investigated. A total of 3279 IDDM patients were studied using standardized methods. There was a wide variation in the frequency of complications between the centres. Incipient diabetic renal disease, characterized by elevated urinary albumin excretion rates (microalbuminuria) varied in frequency between 13% and 34%, while the prevalence of diabetic retinopathy ranged from 28% to 59%. Imported associations of raised blood pressure with several complications, such as cardiovascular disease, renal disease and retinopathy were shown and these findings may have preventive implications.

In subarea C studies were carried out of the death certification and coding practices related to diabetes in several European countries. Physician registration of diabetes as the underlying cause of death varied between 21% (France) and 35% (Germany). There were even larger variations in national coding of the same death certificates.

A study of the utilization of drug sales data for epidemiological purposes was also carried out. In 3 European countries, estimation of diabetes prevalence through drug consumption gave results 4 to 20% lower than those from field surveys. A wide variety of prescribing habits for diabetic patients in Europe was demonstrated.

A monograph entitled 'Diabetes in Europe' will be published in 1994.
The objectives of EURODIAB Sub-area A were:
- To characterize the incidence of IDDM in various regions of the EC and Europe;
- To confirm or refute existing evidence of a south-north gradient in IDDM incidence;
- To prepare the way for further studies to determine the nature of genetic and environmental factors and their (inter)actions in the aetiology and pathogenesis of IDDM.

The objectives of EURODIAB Sub-area B were:
- To measure the frequency of renal, retinal, neuropathic and macrovascular complications in representative samples of IDDM patients attending 31 clinics in 16 European countries, using standardised, validated methods;
- To measure the distribution of established and putative risk factors (exposures) for these complications, including, for example, blood pressure, plasma lipids, urinary albumin excretion, fibrinogen, quality of glycaemic control, genetic markers and dietary factors;
- To examine the relation complications and exposures, within and across centres. Examples of specific relations to be examined are:

1 the relation between blood pressure and urinary albumin excretion;
2 the relation between dietary protein intake and urinary albumin excretion;
3 the relation between blood pressure and retinopathy;
4 the relation between severe hypoglycaemia, and autonomic neuropathy;
5 the relation between dietary fat intake, serum lipids and cardiovascular disease;
6 the relation between smoking and microvascular complications.

The objectives of EURODIAB Sub-area C were:
- To validate the available routine sources of health information relating to diabetes in EC member states, in particular hospital admission data, drug consumption statistics and mortality data based on death certification;
- To utilise this validated health information as a means of estimating variations in diabetes prevalence throughout the EC member countries;
- To prepare a compilation, critically assessed, of existing epidemiological data relating to diabetes in Europe, which would serve as a background resource for future research into the aetiology of the disease and its complications and their prevention.

Funding Scheme

CON - Coordination of research actions

Coordinator

University College London
Address
Gower Street
WC1E 6BT London
United Kingdom