A Population'based Study of
|
|
- Laura Stafford
- 6 years ago
- Views:
Transcription
1 A Population'based Study of Diabetes Mortality JAMES W. OCHI, M.D., L. JOSEPH MELTO III, M.D., PASQUALE J. PALUMBO, M.D., AD CHU-PI CHU, M.S. In a population-based investigation among the residents of Rochester, Minnesota, the diabetes mortality rate was 8. per, person-years with diabetes as the underlying cause of death, 3. per, person-years with diabetes as an underlying or contributory cause, and 8.7 per, person-years if all deaths among diabetic individuals were counted. Diabetes was not mentioned on the certificate in 6% of the 8 diabetic deaths during 6-7. When the clinical characteristics of the subgroup of mortality cases in 6 were compared with those of the prevalence cases on January 7, it was found that mortality cases tended to be older, were more often on insulin therapy, and were more likely to have macro- and microvascular complications. Because mortality data are sometimes used to infer trends and characteristics for the diabetic population at large, it is important to recognize these biases. DIABETES CARE 8; 8:-. Cause-specific mortality data are routinely collected on the entire population of this country, and it is tempting to use this information in the management of disease control programs. Unfortunately, mortality data have well-recognized deficiencies where diabetes mellitus is concerned. Attention has been focused on the incomplete reporting of diabetes as an underlying or contributing cause of death, " but selection bias, in terms of those diabetes-related deaths that are and are not reported, may also pose a problem. Moreover, little is known of the quantitative and qualitative relationships between the mortality cases and the living diabetic individuals in the community. The objectives of the present study were () to make a population-based comparison of diabetic mortality rates determined from death certificates versus the actual death rate among diabetic residents of the community and () to contrast the clinical characteristics of the mortality cases with those of the resident population of living diabetic patients. MATERIALS AD METHODS Rochester, Minnesota, is well suited for studies of the natural history of diabetes mellitus because comprehensive unit medical records for the residents are available and because these records are accessible through a central index of diagnoses made by essentially all medical care providers utilized by the local population. This index includes the diagnoses made among outpatients seen in clinic consultations (including all office visits), emergency room visits, house calls, and nursing home care, as well as diagnoses recorded among hospital inpatients, at autopsy, and on death certificates. The potential of this data system for population-based studies has been described previously. The original medical records of the patients identified through the index were retrieved and reviewed for an initial diagnosis of diabetes in the 3-yr period, -7- The diagnostic criteria used for diabetes mellitus have been reported in detail in an earlier paper. 6 While our criteria were somewhat more generous than those proposed by the ational Diabetes Data Group, 7 we have shown that the differences have little practical effect on the resulting clinical spectrum of diabetes or on survival rates. 8 The diagnostic criteria used resulted in an incidence cohort of 3 Rochester residents with diabetes mellitus newly diagnosed between and 6, while 33 additional incidence cases were identified between 7 and 7- The prevalence of diabetes among Rochester residents was assessed on January 7 and again on January 7. Because of the incidence and prevalence data and the rather complete follow-up available on these patients, we were confident of identifying all diabetic individuals who were local residents at the time of death in the -yr period, 6-7. Diabetes mortality rates were determined from this group of deaths using as a denominator the entire population of Rochester; age- and sex-specific person-years at risk were estimated from DIABETES CARE, VOL. 8 O. 3, MAY-JUE 8
2 POPULATIO-BASED STUDY OF DIABETES MORTALITY/J. W. OCHI AD ASSOCIATES decennial census data. The underlying cause of death was obtained from each death certificate, and these were grouped into cause-specific categories for this report. Diabetes was accepted as a contributing cause of death if mentioned on either part or part of the death certificate. Clinical characteristics near the time of death for the mortality cases who died during calendar year 6 were compared with those of the prevalence cases on January 7. The fasting blood glucose value used in this comparison was the value closest to January 7. The fasting blood glucose levels were divided as recommended by West into "mildly elevated" (^ mg/dl whole venous blood), "moderately elevated" (- mg/dl), and "severely elevated" (> 3 mg/dl). Obesity was approximated by relative weight, expressed as percentage of standard weight for height and calculated using recommended height-weight tables; patients were considered obese whose relative weight was % or more of the standard value for a given height. Therapeutic regimens were classified as insulin (with or without other therapy), oral agent (with or without diet but without insulin), or diet alone (no insulin or oral agents) as of the time nearest to January 7. The characterization of specific clinical types of diabetes generally followed ational Diabetes Data Group recommendations, 7 although as explained in detail in a separate report some modifications were required in the context of a retrospective study using existing medical records. Diabetic "complications" were classified as macrovascular (angina pectoris, myocardial infarction, sudden unexpected death, stroke, transient ischemic attack, or peripheral vascular disease) or microvascular (retinopathy or diabetic renal disease). Complications on the prevalence day and before death included a history of any one or more of these. RESULTS Four hundred twenty-eight Rochester residents (3 men and women) who had diabetes according to the study criteria died in the -yr period, 6 7. Of these, diabetes was listed as the underlying cause of death in (.3%), including two instances where diabetes was also the direct cause of death. For additional fatalities (7.8%), diabetes was listed as a contributing cause of death. Diabetes was mentioned nowhere on the death certificate in 6 cases (6.%). Mortality rates would vary, of course, based on the definition of a diabetes-related death. Consequently, we calculated the rates in three different ways: from death certificates where diabetes () was listed as the underlying cause of death, or () was listed as an underlying or contributing cause, and (3) counting all deaths that occurred among diabetic indi- TABLE Diabetes mellitus mortality rates using different sources of data among Rochester, Minnesota, residents (6-7) Diabetes listed as underlying cause Diabetes listed as underlying or contributory cause Total diabetic deaths age group Rate* Rate" Rate* Men < Subtotal Women < Subtotal Total (crude) (adjusted)! 'Mortality per, person-years. tdirectly adjusted to the age and sex distribution of 7 United States whites. DIABETES CARE, VOL. 8 O. 3, MAY-JUE 8
3 POPULATIO-BASED STUDY OF DIABETES MORTALTIY/J. W. OCH AD ASSOCIATES viduals, regardless of the death certificate information. Diabetes mortality rates using these different definitions are displayed in Table. The diabetes mortality rate calculated in the usual manner, employing the underlying cause of death, was 8. per, person-years (adjusted.3 per, person-years; % confidence interval 6. to.), based on 7,6 person-years at risk. If a diabetic death were taken to mean any death where diabetes was mentioned on the death certificate, the mortality rate would be 3. per, person-years (adjusted 3. per, person-years; % confidence interval 3.3--), almost four times as great as the traditionally calculated figure. Diabetes was listed as a contributing cause of death about three times as often as it was claimed to be the underlying cause of death. Finally, if a diabetic death were taken to mean any death in an individual with previously diagnosed diabetes by our criteria, the overall diabetes mortality rate would be 8.7 per, person-years (adjusted -6 per, person-years; % confidence interval ), a figure over g times as great as the all-death-certificate rate and almost times higher than the rate based on the underlying cause of death. For purposes of comparison, the total crude mortality rate among Rochester residents in 7 was 78 per, population. Although the actual age- and sex-specific mortality rates would be quite different depending on the definition used (Table ), the proportionate distribution of deaths by age and sex would be roughly comparable in each instance except for the excess of elderly women noted when the underlying cause of death was diabetes. Mortality rates with the latter definition were greater among women than men (.3 versus 6. per, person-years); this difference persisted even after age adjustment (.3 versus 8. per, person-years) but was not statistically significant (P >.). Under the second definition, the diabetes death rate among men was greater than that for women (3.8 versus 3. per, personyears), although this difference was greatly augmented by age adjustment of the rates (. versus 7.8 per, personyears; P <.). This difference resulted from the greater male death rate with diabetes as a contributory cause of death (36.6 versus 8. per, person-years after age adjustment). Although not shown in Table, male rates were also greater for those deaths where diabetes was not mentioned on the death certificate (8. versus. per, personyears after age adjustment). Thus, the male:female ratio of age-adjusted mortality rates for all diabetic deaths was.: (8. versus 6. per, person-years; P <.). The distributions of underlying cause of death were fairly comparable for those deaths where diabetes was listed anywhere on the death certificate and for the total diabetic deaths in Rochester during 6-7 (Table ), although there were some differences in the distribution of underlying causes for those diabetic deaths where diabetes was not mentioned. Cardiovascular disease, especially coronary heart disease but also arteriosclerosis and stroke, represented the most common cause of death, accounting for 7%, %, and %, respectively, of the three groups shown in Table. Diabetes per se was overrepresented, of course, among those with diabetes noted on the death certificate. Malignancy and "other" causes were more frequent among diabetic residents whose death certificates did not mention diabetes. The distributions of the other, less common, causes of death were not strikingly different from one patient group to the next. The mortality cases were quite unrepresentative, however, TABLE Distribution of underlying causes of death using different sources of data among Rochester, Minnesota, residents with diabetes who died 6-7 Underlying cause of death Diabetes listed on death certificate % Diabetes not mentioned on death certificate % Total diabetic deaths % Coronary heart disease Arteriosclerosis Stroke Diabetes Malignancy Pneumonia Liver disease Renal disease Obstructive pulmonary disease Rheumatic heart disease Pulmonary embolism Other DIABETES CARE, VOL. 8 O. 3, MAY-JUE 8
4 POPULATIO-BASED STUDY OF DIABETES MORTALITY/J. W. CH AD ASSOCIATES - QMen - E Women Incidence cases (-6) Age at initial diagnosis Distribution by age Mortality cases (6-7) and sex (Percent of total) S* Age at death o m Prevalence cases ( Jan 7) Age on prevalence day F/G. I. Distribution by age and sex of Rochester, Minnesota, residents with diabetes, comparing incidence, prevalence, and mortality cases. of incidence and prevalence cases of diabetes in the community. As might be expected, the mortality cases were relatively much older than either incidence or prevalence patients (Figure ). However, substantial differences were also noted when the clinical characteristics near the time of death for the mortality cases of 6 were compared with those of the 8 prevalence cases on January 7 (Table 3). The distribution of clinical types of diabetes was fairly comparable between mortality and prevalence cases, but the proportion of mortality cases on insulin therapy was greater and the proportion on diet alone much less than for prevalence cases (P =.). The 6 mortality cases had fasting blood glucose levels much like those of the prevalence cases and a similarly low proportion with the classic triad of diabetes symptoms. A greater proportion of mortality cases were thin, as indicated by being less than % of the standard weight for height, but the distributions of relative weight for mortality and prevalence cases were not statistically significantly different (P >.). However, the patients who had died were much more likely to have had one or more of the microvascular (P <.) and especially the macrovascular complications (P <.) of diabetes as compared with the prevalence cases. DISCUSSIO The fact that diabetes mellitus is a major public health problem is apparent despite any inaccuracies and biases in the mortality data. However, the nature and magnitude of potential biases is of great importance to those who would use routinely collected mortality data to study diabetes epidemiology or to manage diabetes control programs. Underestimation of diabetes-related deaths is the bias that has received the most attention. The existing mortality reporting system only allows for one condition as the underlying cause of death, even though other significant and sometimes related diseases exist in the same patient. We found that diabetes was listed as the underlying cause of death on 7% of the death certificates in which diabetes was mentioned as either an underlying or contributing cause. This is similar to the proportion found in other studies, " 3 " although reported values vary from % 3 to %. The Rochester figure is identical to the average reported for states in the ational Diabetes Control Program. This form of underestimation of diabetes' contribution to mortality seems to result mostly from the recording of vascular complications (directly or indirectly related to diabetes mellitus), which are listed instead as the underlying cause of death. Mi3 A second and more difficult source of underestimation lies with the deaths among diabetic individuals that are not acknowledged on the death certificate at all. Diabetes was not mentioned on 33% of the death certificates of members of the British Diabetic Association. 3 However, these individuals may have been unrepresentative of the larger population of diabetic patients since about one-third were under yr of age when enrolled. Among diabetic patients known to the Joslin Clinic,.8% had no mention of diabetes on their death certificates. Reporting may be better among those more severely affected patients and those who are attended at tertiary care centers, however, since population-based studies TABLE 3 Clinical characteristics of Rochester, Minnesota, diahetic residents near the time of death during calendar year 6, or on prevalence day January 7 Clinical type (%) Insulin-dependent Obese non-insulin-dependent onohese non-insulin-dependent Secondary diabetes Treatment (%) Insulin Oral agents Diet alone Fasting blood glucose Median value Mild (%) Moderate (%) Severe (%) Classic symptoms One or more (%) Relative weight (%) <% -% >% Complications present Macrovascular (%) Microvascular (%) Mortality cases 6 ( = ) mg/dl Prevalence cases 7 ( = 8) mg/dl DIABETES CARE, VOL. 8 O. 3, MAY-JUE 8 7
5 POPULATIO-BASED STUDY OF DIABETES MORTALITY/J. W. CH AD ASSOCIATES indicate that diabetes is not mentioned in from one-half 6 to three-quarters 7 of the deaths that actually occur in this group of patients. We discovered that diabetes was not listed on the death certificates of 6% of the deaths among patients with known diabetes. This figure is very similar to the estimated 6% underreporting of diabetic deaths nationally, as judged using death certificate data and a total number of diabetic deaths derived from differences between estimated national incidence and prevalence rates (Dr. Maureen Harris, personal communication). The distribution of causes of death also varied somewhat depending on how diabetic deaths were defined. Other investigators " agree with our finding that circulatory disorders dominate the recorded underlying causes of death in diabetic patients, with coronary heart disease comprising the major portion. However, the mortality cases in the present study who did not have diabetes listed on the death certificate were relatively much more likely to die from malignancy or "other" causes, i.e., trauma; 3 and it may be true that diabetes played no role in many of these deaths. Other work has shown, for example, that the risk of subsequent malignancy is not increased among individuals with diabetes. 8 When the incidence cohort of diabetic Rochester residents was studied, 8 the actuarially estimated cumulative death rate was 6% by yr after the initial diagnosis of diabetes, while the expected rate for members of the general population of like age and sex was 6%. With an attributable risk of death on the order of 3%, it is reasonable to assume that a substantial portion of diabetic deaths may be related to the underlying disease but that the majority of deaths are unrelated. This issue has been discussed at length by others.' It is most important to note, however, that the mortality cases cannot be taken to represent a sample of incidence nor even of prevalence cases of diabetes in the community. The total mortality rate for diabetic residents 6-7 was only % of the prevalence rate for diabetes in Rochester on January 7. Thus, the mortality data vastly underestimate diabetes prevalence. Moreover, the mortality cases were much older, on average, and had quite different clinical characteristics. Mortality cases appear to provide a very unreliable indicator of the clinical spectrum of diabetes among those still alive, by virtue of greatly overestimating the impact of the macro- and microvascular complications of diabetes mellitus. Because mortality data are sometimes used to infer trends and characteristics for the diabetic population at large, it is important to recognize the biases that occur with this approach. ACKOWLEDGMETS: The authors thank Lois Bartz for help in data collection and Janet R. King for assistance in preparing the manuscript. This investigation was supported in part by research grants from the American Diabetes Association and the ational Institutes of Health (AM-38). From Mayo Medical School, Department of Medical Statistics and Epidemiology, and Division of Endocrinology, Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota. Address reprint requests to Dr. L. J. Melton III, Department of Medical Statistics and Epidemiology, Mayo Clinic, Rochester, Minnesota. REFERECES Tokuhata, G. K., Miller, W., Digon, E., and Hartman, T.: Diabetes mellitus: an underestimated public health problem. J. Chronic Dis. 7; 8:3-3. Marks, H. H.: Diabetes mortality in the general population. In Joslin's Diabetes Mellitus. Marble, A., White, P., Bradley, R. R, and Krall, L. P., Eds. Philadelphia, Lea & Febiger, 7:3-. 3 Bale, G. S., and Entmacher, P. S.: Estimated life expectancy of diabetics. Diabetes 77; 6:3-38. U.S. Department of Health, Education, and Welfare: Diabetes Data Compiled 77. Washington, D.C, Government Printing Office, 78 (DHEW publication o. IH78-68). Kurland, L. T., Elveback, L. R., andobrega, F. T: Population studies in Rochester and Olmsted County, Minnesota, -68. In The Community as an Epidemiologic Laboratory: A Casebook of Community Studies. Kessler, I.., and Levin, M. L., Eds. Baltimore, Johns Hopkins Press, 7: Palumbo, P. J., Elveback, L. R., Chu, C. P., Connolly, D. C, and Kurland, L. T.: Diabetes mellitus: incidence, prevalence, survivorship, and causes of death in Rochester, Minnesota, -7. Diabetes 76; : ational Diabetes Data Group: Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 7; 8: Melton, L. J., Palumbo, P. J., Dwyer, M. S., and Chu, C. P.: Impact of recent changes in diagnostic criteria on the apparent natural history of diabetes mellitus. Am. J. Epidemiol. 83; 7:- 6. West, K. M.: Standardization of definition, classification, and reporting in diabetes-related epidemiologic studies. Diabetes Care 7; :6-76. Standard for definitions of overweight and obesity. In Obesity in Perspective. Bray, G. A., Ed. Bethesda, Md., ational Institutes of Health, (DHEW publication o. IH7-7O8). " Melton, L. J., Palumbo, P. J., and Chu, C. P.: Incidence of diabetes mellitus by clinical type. Diabetes Care 83; 6:7-86. Langberg, R.: Diabetes mellitus mortality in the United States -67. In ational Center for Health Statistics. Rockville, Md., U.S. Department of Health, Education, and Welfare, Division of Vital Statistics, Public Health Service 7:-;- (Public Health Service publication o. -Series, o. ). 3 Fuller, J. H., Elford, J., Goldblatt, P., and Adelstein, A. M.: Diabetes mortality: new light on an underestimated public health problem. Diabetologia 83; :336-. Chamblee, R. F., and Evans, M. C: ew dimensions in cause of death statistics. Am. J. Public Health 8; 7:6-7. Sinnock, P., Holman, R. C., Most, R., and Teutsch, S.: Assessment of diabetes morbidity/mortality data in diabetes control program states. In Proceedings th Annual Diabetes Control Conference, Lexington, Ky., May -3, 8. Lexington, Ky., Center for Disease Control, 8: DIABETES CARE, VOL. 8 O. 3, MAY-JUE 8
6 POPULATIO-BASED STUDY OF DIABETES MORTALITY/J. W. OCHI AD ASSOCIATES 6 O'Sullivan, J. B., and Mahan, C. M: Mortality related to l8 Ragozzino, M., Melton, L. J., Chu, C. P., and Palumbo, P. J.: diabetes and blood glucose levels in a community study. Am. J. Subsequent cancer risk in the incidence cohort of Rochester, Min- Epidemiol. 8; 6: nesota, residents with diabetes mellitus. J. Chronic Dis. 8; 3:3-7 Bender, A. P., Sprafka, J. M., Jagger, H., Wannamaker, J.,. and Muckala, K. H.: Incidence, prevalence, mortality and popu- Melton, L. J., Ochi, J. W., Palumbo, P. J., and Chu, C. P.: lation-based profile of diabetes mellitus in Wadena, Minnesota, 8. Sources of disparity in the spectrum of diabetes mellitus at incidence Minn. Med. 83; 66:-6. and prevalence. Diabetes 83; 6:7-3. DIABETES CARE, VOL. 8 O. 3, MAY-JUE 8
IMPACT OF RECENT CHANGES IN DIAGNOSTIC CRITERIA ON THE APPARENT NATURAL HISTORY OF DIABETES MELLITUS
AMERICAN JOURNAL OF EPIDIMIOLOCY Copyright 1983 by The Johns Hopkins University School of Hygiene and Public Health All rights reserved Vol. 117, No. 6 Fruited in U.SA. IMPACT OF RECENT CHANGES IN DIAGNOSTIC
More informationDiabetes Incidence in Rochester, Minnesota Burke et al. Impact of Case Ascertainment on Recent Trends in Diabetes Incidence in Rochester, Minnesota
American Journal of Epidemiology Copyright 2002 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 155, No. 9 Printed in U.S.A. Diabetes Incidence in Rochester, Minnesota Burke
More informationNatural History of Stroke in Rochester, Minnesota, 1955 Through 1969: An Extension of a Previous Study, 1945 Through 1954
Natural History of Stroke in Rochester, Minnesota, Through : An Extension of a Previous Study, Through BY NOBUTERU MATSUMOTO, M.D./ JACK P. WHISNANT, M.D., LEONARD T. KURLAND, M.D., AND HARUO OKAZAKI,
More informationDiabetes and Decline in Heart Disease Mortality in US Adults JAMA. 1999;281:
ORIGINAL CONTRIBUTION and Decline in Mortality in US Adults Ken Gu, PhD Catherine C. Cowie, PhD, MPH Maureen I. Harris, PhD, MPH MORTALITY FROM HEART disease has declined substantially in the United States
More informationOriginal Contributions. Prospective Comparison of a Cohort With Asymptomatic Carotid Bruit and a Population-Based Cohort Without Carotid Bruit
98 Original Contributions Prospective Comparison of a Cohort With Carotid Bruit and a Population-Based Cohort Without Carotid Bruit David O. Wiebers, MD, Jack P. Whisnant, MD, Burton A. Sandok, MD, and
More informationEpidemiologic Characteristics of Mortality from Diabetes
Epidemiologic Characteristics of Mortality from Diabetes With Acidosis or Coma, United States, 197-78 ROBERT C. HOLMAN, MS, CHARLES A. HERRON, MD, AND POMEROY SNNOCK, PHD Abstract: Deaths due to diabetes
More informationImproving the Comparability of Diabetes Mortality Statistics in the U.S. and Mexico
Epidemiology/Health Services Research O R I G I N A L A R T I C L E Improving the Comparability of Diabetes Mortality Statistics in the U.S. and Mexico CHRISTOPHER J.L. MURRAY, MD, DPHIL 1,2,3 RODRIGO
More informationA factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes
A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Hypotheses: Among individuals with type 2 diabetes, the risks of major microvascular
More informationImproving the comparability of diabetes mortality statistics in the United States and Mexico
Diabetes Care Publish Ahead of Print, published online October 24, 2007 Improving the comparability of diabetes mortality statistics in the United States and Mexico Christopher JL Murray (MD, DPhil) 1&2&3,
More informationINFLAMMATORY COLON DISEASE IN ROCHESTER, MINNESOTA,
GASTROENTEROLOGY Copyright 1972 by The Williams & Wilkins Co. Vol. 62, No.5 Printed in U.S.A. INFLAMMATORY COLON DISEASE IN ROCHESTER, MINNESOTA, 1935-1964 RICHARD E. SEDLACK, M.D., FRED T. NOBREGA, M.D.,
More informationAge and the Burden of Death Attributable to Diabetes in the United States
American Journal of Epidemiology Copyright 2002 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 156, No. 8 Printed in U.S.A. DOI: 10.1093/aje/kwf111 Age and the Burden of
More informationIncidence of diabetes mellitus in Oslo, Norway
British Journal ofpreventive and Social Medicine, 1977, 31, 251-257 Incidence of diabetes mellitus in Oslo, Norway 1956-65 HANS JACOB USTVEDT AND ERNST OLSEN From the Life Insurance Companies' Institute
More informationDiabetes Care 23: , 2000
Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E Relationship Between Diabetes and Mortality A population study using record linkage CHRISTOPHER LL. MORGAN, MSC CRAIG J.
More informationRelative Contributions of Incidence and Survival to Increasing Prevalence of Adult-Onset Diabetes Mellitus: A Population-based Study
American Journal of Epidemiology Copyright O 1997 by The Johns Hopkins University School of Hygiene and Public Health All rtght3 reserved Vol 146, No 1 Printed in U SA. Relative Contributions of Incidence
More informationOnline Supplementary Material
Section 1. Adapted Newcastle-Ottawa Scale The adaptation consisted of allowing case-control studies to earn a star when the case definition is based on record linkage, to liken the evaluation of case-control
More informationFrequency of Dyslipidemia and IHD in IGT Patients
Frequency of Dyslipidemia and IHD in IGT Patients *Islam MS, 1 Hossain MZ, 2 Talukder SK, 3 Elahi MM, 4 Mondal RN 5 Impaired glucose tolerance (IGT) is often associated with macrovascular complications.
More informationADVANCE post trial ObservatioNal Study
Hot Topics in Diabetes 50 th EASD, Vienna 2014 ADVANCE post trial ObservatioNal Study Sophia Zoungas The George Institute The University of Sydney Rationale and Study Design Sophia Zoungas The George Institute
More informationMicrovascular Disease in Type 1 Diabetes
Microvascular Disease in Type 1 Diabetes Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine The Course
More informationTennessee Department of Health in collaboration with Tennessee State University and University of Tennessee Health Science Center
Tennessee Department of Health in collaboration with Tennessee State University and University of Tennessee Health Science Center 2006 Tennessee Department of Health 2006 ACKNOWLEDGEMENTS CONTRIBUTING
More informationThe MAIN-COMPARE Registry
Long-Term Outcomes of Coronary Stent Implantation versus Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Disease Revascularization for Unprotected Left MAIN Coronary Artery Stenosis:
More informationDiabetologia 9 Springer-Verlag 1981
Diabetologia (1981) 20:587-591 Diabetologia 9 Springer-Verlag 1981 Prognosis of Diabetes Mellitus in a Geographically Defined Population G. Panzram and R. Zabel-Langhennig Outpatient Department of Internal
More informationHypertension is an important factor in premature death,
Effect of Hypertension on Mortality in Pima Indians Maurice L. Sievers, MD; Peter H. Bennett, MB, MRCP, FFCM; Janine Roumain, MD, MPH; Robert G. Nelson, MD, PhD Background The effect of hypertension on
More informationHEALTH PROMOTION AND CHRONIC DISEASE PREVENTION PROGRAM OREGON STATE OF THE HEART AND STROKE REPORT 2001 PREPARED BY.
OREGON STATE OF THE HEART AND STROKE REPORT 2001 PREPARED BY THE OREGON DEPARTMENT OF HUMAN SERVICES HEALTH SERVICES HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION PROGRAM www.healthoregon.org/hpcdp Contents
More informationThis chapter examines the sociodemographic
Chapter 6 Sociodemographic Characteristics of Persons with Diabetes SUMMARY This chapter examines the sociodemographic characteristics of persons with and without diagnosed diabetes. The primary data source
More informationMayo Clinic Proceedings August 2018 Issue Summary
Greetings, I am Dr Karl Nath, the Editor-in-Chief of Mayo Clinic Proceedings, and I am pleased to welcome you to the multimedia summary for the journal s August 2018 issue. There are 4 articles this month
More informationIntermediate Methods in Epidemiology Exercise No. 4 - Passive smoking and atherosclerosis
Intermediate Methods in Epidemiology 2008 Exercise No. 4 - Passive smoking and atherosclerosis The purpose of this exercise is to allow students to recapitulate issues discussed throughout the course which
More information7/6/2012. University Pharmacy 5254 Anthony Wayne Drive Detroit, MI (313)
University Pharmacy 5254 Anthony Wayne Drive Detroit, MI 48202 (313) 831-2008 Be able to identify the signs of a heart attack or stoke Identify what puts you at a higher risk for cardiovascular disease,
More informationLipid Management 2013 Statin Benefit Groups
Clinical Integration Steering Committee Clinical Integration Chronic Disease Management Work Group Lipid Management 2013 Statin Benefit Groups Approved by Board Chair Signature Name (Please Print) Date
More informationInformation Management. A System We Can Count On. Chronic Conditions. in the Central East LHIN
Information Management A System We Can Count On Chronic Conditions in the Central East LHIN Health System Intelligence Project October 2007 Table of Contents About HSIP..................................ii
More informationA nationwide population-based study. Pai-Feng Hsu M.D. Shao-Yuan Chuang PhD
The Association of Clinical Symptomatic Hypoglycemia with Cardiovascular Events and Total Death in Type 2 Diabetes Mellitus A nationwide population-based study Pai-Feng Hsu M.D. Shao-Yuan Chuang PhD Taipei
More informationAppendix Identification of Study Cohorts
Appendix Identification of Study Cohorts Because the models were run with the 2010 SAS Packs from Centers for Medicare and Medicaid Services (CMS)/Yale, the eligibility criteria described in "2010 Measures
More informationThe Impact of Diabetes Mellitus and Prior Myocardial Infarction on Mortality From All Causes and From Coronary Heart Disease in Men
Journal of the American College of Cardiology Vol. 40, No. 5, 2002 2002 by the American College of Cardiology Foundation ISSN 0735-1097/02/$22.00 Published by Elsevier Science Inc. PII S0735-1097(02)02044-2
More informationTemporal Trends in Prevalence of Diabetes Mellitus in a Population-Based Cohort of Incident Myocardial Infarction and Impact of Diabetes on Survival
ORIGINAL TEMPORAL TRENDS ARTICLE IN PREVALENCE OF DM IN COHORT OF INCIDENT MI Temporal Trends in Prevalence of Diabetes Mellitus in a Population-Based Cohort of Incident Myocardial Infarction and Impact
More informationPOOR LONG-TERM SURVIVAL AFTER ACUTE MYOCARDIAL INFARCTION AMONG PATIENTS ON LONG-TERM DIALYSIS
POOR LONG-TERM SURVIVAL AFTER ACUTE MYOCARDIAL INFARCTION AMONG PATIENTS ON LONG-TERM DIALYSIS CHARLES A. HERZOG, M.D., JENNIE Z. MA, PH.D., AND ALLAN J. COLLINS, M.D. ABSTRACT Background Cardiovascular
More informationManaging Diabetes for Improved Health and Economic Outcomes
Managing Diabetes for Improved Health and Economic Outcomes Based on a presentation by David McCulloch, MD Presentation Summary The contribution of postprandial glucose to diabetes progression and diabetes-related
More informationAsthma J45.20 Mild, uncomplicated J45.21 Mild, with (acute) exacerbation J45.22 Mild, with status asthmaticus
A Fib & Flutter I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation I48.3 Typical atrial flutter Asthma J45.20 Mild, uncomplicated J45.21 Mild, with
More informationThe MAIN-COMPARE Study
Long-Term Outcomes of Coronary Stent Implantation versus Bypass Surgery for the Treatment of Unprotected Left Main Coronary Artery Disease Revascularization for Unprotected Left MAIN Coronary Artery Stenosis:
More informationThe Burden of Cardiovascular Disease in North Carolina. Justus-Warren Heart Disease and Stroke Prevention Task Force April 11, 2018
The Burden of Cardiovascular Disease in North Carolina Justus-Warren Heart Disease and Stroke Prevention Task Force April 11, 2018 Purpose 1. To detail the burden of heart disease and stroke in North Carolina
More informationTransient Ischemic Attacks and Risk of Stroke in an Elderly Poor Population
Transient Ischemic Attacks and Risk of Stroke in an Elderly Poor Population BY A. M. OSTFELD, M.D., R. B. SHEKELLE, Ph.D., AND H. L. KLAWANS, M.D. Abstract: Transient Ischemic A t tacks and Risk of Stroke
More informationIs There An Association?
Is There An Association? Exposure (Risk Factor) Outcome Exposures Risk factors Preventive measures Management strategy Independent variables Outcomes Dependent variable Disease occurrence Lack of exercise
More informationCommunity Health Profile: Minnesota, Wisconsin, & Michigan Tribal Communities 2006
Community Health Profile: Minnesota, Wisconsin, & Michigan Tribal Communities 26 This report is produced by: The Great Lakes EpiCenter If you would like to reproduce any of the information contained in
More informationDeterminants of the decline in mortality attributable
Temporal Trends in the Incidence of Coronary Disease Theresa J. Arciero, Steven J. Jacobsen, MD, PhD, Guy S. Reeder, MD, Robert L. Frye, MD, Susan A. Weston, MS, Jill M. Killian, BS, Véronique L. Roger,
More informationThe Burden Report: Cardiovascular Disease & Stroke in Texas
The Burden Report: Cardiovascular Disease & Stroke in Texas Texas Cardiovascular Health and Wellness Program www.dshs.state.tx.us/wellness Texas Council on Cardiovascular Disease and Stroke www.texascvdcouncil.org
More informationSouthview Medical Center. Community Benefit Plan & Implementation Strategy
201 4 Southview Medical Center Community Benefit Plan & Implementation Strategy TABLE OF CONTENTS INTRODUCTION... 2 Southview Medical Center Service Area... 2 Community Health Needs Assessment... 2 Data
More informationMethods of Calculating Deaths Attributable to Obesity
American Journal of Epidemiology Copyright 2004 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 160, No. 4 Printed in U.S.A. DOI: 10.1093/aje/kwh222 Methods of Calculating
More informationSelected Overweight- and Obesity- Related Health Disorders
Selected Overweight- and Obesity- Related Health Disorders HIGHLIGHTS Obesity and overweight are predisposing factors for the development of type 2 diabetes mellitus, coronary heart disease, stroke, osteoarthritis
More informationThe Diabetes Link to Heart Disease
The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM
More informationSupplementary Online Content
Supplementary Online Content Steinhubl SR, Waalen J, Edwards AM, et al. Effect of a home-based wearable continuous electrocardiographic monitoring patch on detection of undiagnosed atrial fibrillation
More informationPREVALENCE OF AND MORTALITY FROM
Brit. J. prev. soc. Med. (1964), 18, 202-209 PREVALENCE OF AND MORTALITY FROM CORONARY ARTERY DISEASE IN MEN BY R. G. RECORD AND A. G. W. WHITFIELD From the Medical School, University of Birmingham It
More informationDiabetes Mellitus Type 2 Evidence-Based Drivers
This module is supported by an unrestricted educational grant by Aventis Pharmaceuticals Education Center. Copyright 2003 1 Diabetes Mellitus Type 2 Evidence-Based Drivers Driver One: Reducing blood glucose
More informationChapter 4: Cardiovascular Disease in Patients With CKD
Chapter 4: Cardiovascular Disease in Patients With CKD The prevalence of cardiovascular disease is 68.8% among patients aged 66 and older who have CKD, compared to 34.1% among those who do not have CKD
More informationHealthy Montgomery Obesity Work Group Montgomery County Obesity Profile July 19, 2012
Healthy Montgomery Obesity Work Group Montgomery County Obesity Profile July 19, 2012 Prepared by: Rachel Simpson, BS Colleen Ryan Smith, MPH Ruth Martin, MPH, MBA Hawa Barry, BS Executive Summary Over
More informationMedical Declaration Form. Important information to read before completing the form:
Administered by Medical Declaration Form Important information to read before completing the form: Pre-Existing Medical conditions Travel insurance only provides cover for emergency medical events that
More informationSherri Homan, RN, PhD Public Health Epidemiologist March 2009 Update
Sherri Homan, RN, PhD Public Health Epidemiologist March 2009 Update Report Authors Wayne Schramm Kris Kummerfeld Contributors Anita Berwanger Linda Powell Karen Connell Lisa Britt Andy Hunter Joseph Stockbauer
More informationCritical Review Form Therapy
Critical Review Form Therapy A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects, Lancet-Neurology 2007; 6: 953-960 Objectives: To evaluate the effect of
More informationElevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes
Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E Elevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes FRANK B. HU, MD 1,2,3 MEIR J. STAMPFER,
More informationC O R EVENT ID: FORM CODE: VERSION: C DATE: 04/01/10
O. M. B. 0925-0281 Exp. 04/30/2013 ARIC Atherosclerosis Risk in Communities COROER / MEDICAL EXAMIER FORM C O R EVET ID: FORM CODE: VERSIO: C DATE: 04/01/10 LAST AME: IITIALS: Public reporting burden for
More informationStatistical Fact Sheet Populations
Statistical Fact Sheet Populations At-a-Glance Summary Tables Men and Cardiovascular Diseases Mexican- American Males Diseases and Risk Factors Total Population Total Males White Males Black Males Total
More informationPage County Virginia
Page County Virginia Health Needs Assessment Part 2 Health Status Assessment October, 2001 Compiled and Printed by Blue Ridge Area Health Education Center James Madison University Page County, Virginia
More informationLucia Cea Soriano 1, Saga Johansson 2, Bergur Stefansson 2 and Luis A García Rodríguez 1*
Cea Soriano et al. Cardiovascular Diabetology (2015) 14:38 DOI 10.1186/s12933-015-0204-5 CARDIO VASCULAR DIABETOLOGY ORIGINAL INVESTIGATION Open Access Cardiovascular events and all-cause mortality in
More informationUlster, Ireland. Submitted: 21 June 2009; Revised: 24 January 2010; Published: 13 September 2010 Petrazzuoli F, Soler JK, Buono N, Dobbs F
O R I G I N A L R E S E A R C H Quality of care for hypertensive patients with type 2 diabetes in a rural area of Southern Italy: is the recording of patient data and the achievement of quality indicators
More informationJAMA. 2011;305(24): Nora A. Kalagi, MSc
JAMA. 2011;305(24):2556-2564 By Nora A. Kalagi, MSc Cardiovascular disease (CVD) is the number one cause of mortality and morbidity world wide Reducing high blood cholesterol which is a risk factor for
More informationSCIENTIFIC STUDY REPORT
PAGE 1 18-NOV-2016 SCIENTIFIC STUDY REPORT Study Title: Real-Life Effectiveness and Care Patterns of Diabetes Management The RECAP-DM Study 1 EXECUTIVE SUMMARY Introduction: Despite the well-established
More informationWhy is Earlier and More Aggressive Treatment of T2 Diabetes Better?
Blood glucose (mmol/l) Why is Earlier and More Aggressive Treatment of T2 Diabetes Better? Disclosures Dr Kennedy has provided CME, been on advisory boards or received travel or conference support from:
More informationAHA Clinical Science Special Report: November 10, 2015
www.canheart.ca High-density lipoprotein cholesterol and cause-specific mortality: A population-based study of more than 630,000 individuals without prior cardiovascular conditions Dennis T. Ko, MD, MSc;
More informationData Sources, Methods and Limitations
Data Sources, Methods and Limitations The main data sources, methods and limitations of the data used in this report are described below: Local Surveys Rapid Risk Factor Surveillance System Survey The
More informationTable S1: Diagnosis and Procedure Codes Used to Ascertain Incident Hip Fracture
Technical Appendix Table S1: Diagnosis and Procedure Codes Used to Ascertain Incident Hip Fracture and Associated Surgical Treatment ICD 9 Code Descriptions Hip Fracture 820.XX Fracture neck of femur 821.XX
More informationBaldness and Coronary Heart Disease Rates in Men from the Framingham Study
A BRIEF ORIGINAL CONTRIBUTION Baldness and Coronary Heart Disease Rates in Men from the Framingham Study The authors assessed the relation between the extent and progression of baldness and coronary heart
More informationESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES
ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES Pr. Michel KOMAJDA Institute of Cardiology - IHU ICAN Pitie Salpetriere Hospital - University Pierre and Marie Curie, Paris (France) DEFINITION A
More informationCommunity Health Profile: Minnesota, Wisconsin & Michigan Tribal Communities 2005
Community Health Profile: Minnesota, Wisconsin & Michigan Tribal Communities 25 This report is produced by: The Great Lakes EpiCenter If you would like to reproduce any of the information contained in
More informationLEADER Liraglutide and cardiovascular outcomes in type 2 diabetes
LEADER Liraglutide and cardiovascular outcomes in type 2 diabetes Presented at DSBS seminar on mediation analysis August 18 th Søren Rasmussen, Novo Nordisk. LEADER CV outcome study To determine the effect
More informationLower Risk of Death With SGLT2 Inhibitors in Observational Studies: Real or Bias? Diabetes Care 2018;41:6 10
6 Diabetes Care Volume 41, January 2018 PERSPECTIVES IN CARE Lower Risk of Death With SGLT2 Inhibitors in Observational Studies: Real or Bias? Diabetes Care 2018;41:6 10 https://doi.org/10.2337/dc17-1223
More informationNORTH MISSISSIPPI MEDICAL CENTER MEDICAL CENTER. Stroke: Are you at risk? A guide to stroke risk factors & resources at ACUTE STROKE UNIT
North Mississippi Medical Center Acute Stroke Unit 830 South Gloster Street Tupelo, MS 38801 (662) 377-3000 or 1-800-THE DESK (1-800-843-3375) www.nmhs.net Stroke: Are you at risk? A guide to stroke risk
More informationHealth Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients / September 2010
Health Services Utilization and Medical Costs Among Medicare Atrial Fibrillation Patients / September 2010 AF Stat is sponsored by sanofi-aventis, U.S. LLC, which provided funding for this report. Avalere
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Chan PS, Nallamothu BK, Krumholz HM, et al. Long-term outcomes
More informationORIGINAL INVESTIGATION. Longitudinal Incidence and Prevalence of Adverse Outcomes of Diabetes Mellitus in Elderly Patients
ORIGINAL INVESTIGATION Longitudinal Incidence and Prevalence of Adverse Outcomes of Diabetes Mellitus in Elderly Patients M. Angelyn Bethel, MD; Frank A. Sloan, PhD; Daniel Belsky, BA; Mark N. Feinglos,
More informationHanyang University Guri Hospital Chang Beom Lee
Hanyang University Guri Hospital Chang Beom Lee Meal prayer, Van Brekelenkam 17 th C Introduction 2012 ADA/EASD Position Statement Proper Patients for Pioglitazone β-cell Preservation by Pioglitazone Benefit
More informationTHE FRAMINGHAM STUDY Protocol for data set vr_soe_2009_m_0522 CRITERIA FOR EVENTS. 1. Cardiovascular Disease
THE FRAMINGHAM STUDY Protocol for data set vr_soe_2009_m_0522 CRITERIA FOR EVENTS 1. Cardiovascular Disease Cardiovascular disease is considered to have developed if there was a definite manifestation
More informationIT HAS been estimated that congestive
ORIGINAL INVESTIGATION Congestive Heart Failure in the Community Trends in Incidence and Survival in a 1-Year Period Michele Senni, MD; Christophe M. Tribouilloy, MD, PhD; Richard J. Rodeheffer, MD; Steven
More informationDiabetic Foot Ulcers Data Points #2
Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008 Diabetic Foot Ulcers Data Points #2 Diabetes mellitus, a metabolic disorder characterized by elevated
More informationDUKECATHR Dataset Dictionary
DUKECATHR Dataset Dictionary Version of DUKECATH dataset for educational use that has been modified to be unsuitable for clinical research or publication (Created Date and Time: 28OCT16 14:35) Table of
More informationAndrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION
2 Hyperlipidemia Andrew Cohen, MD and Neil S. Skolnik, MD CONTENTS INTRODUCTION RISK CATEGORIES AND TARGET LDL-CHOLESTEROL TREATMENT OF LDL-CHOLESTEROL SPECIAL CONSIDERATIONS OLDER AND YOUNGER ADULTS ADDITIONAL
More informationIndividual Study Table Referring to Item of the Submission: Volume: Page:
2.0 Synopsis Name of Company: Abbott Laboratories Name of Study Drug: Meridia Name of Active Ingredient: Sibutramine hydrochloride monohydrate Individual Study Table Referring to Item of the Submission:
More informationN Engl J Med 2018;378: DOI: /NEJMoa Lin, Wan-Ting 2018/06/27
N Engl J Med 2018;378:1200-10. DOI: 10.1056/NEJMoa1710895 Lin, Wan-Ting 2018/06/27 1 Introduction Gout is a chronic illness characterized by hyperuricemia, arthropathy, tophus development, and urolithiasis
More informationMacrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?
Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists
More informationCARDIOVASCULAR EVENTS IN POLYCYSTIC OVARY SYNDROME
CARDIOVASCULAR EVENTS IN POLYCYSTIC OVARY SYNDROME Enrico Carmina Executive Director & CEO of Androgen Excess & PCOS Society Professor of Endocrinology Department of Health Sciences and Mother and Child
More informationMortality following acute myocardial infarction (AMI) in
In-Hospital Mortality Among Patients With Type 2 Diabetes Mellitus and Acute Myocardial Infarction: Results From the National Inpatient Sample, 2000 2010 Bina Ahmed, MD; Herbert T. Davis, PhD; Warren K.
More information5. Cardiovascular Disease & Stroke
5. Cardiovascular Disease & Stroke 64: Self-Reported Heart Disease 66: Heart Disease Management 68: Heart Disease Mortality 70: Heart Disease Mortality Across Life Span 72: Stroke Mortality 185: Map 3:
More informationProcess Measure: Screening for Adult Obstructive Sleep Apnea
Process Measure: Screening for Adult Obstructive Sleep Apnea Measure Description Description Type of Measure All patients aged 18 years and older at high risk for obstructive sleep apnea (OSA) with documentation
More informationI ing therapy, the most commonly used index
WHEN MAY ENDOMETRIAL CANCER BE CONSIDERED CURED? RICHARD R. MONSON, MD,* BRIAN MACMAHON, &ID,* AND JAMES H. AUSTIN, MD+ To assess when a woman may be considered cured following treatment for endometrial
More informationPresent value cost-savings to Medicaid over 25 years
cost-savings from switching would be realized 2 relies on assumptions about the fraction of aggregate medical expenditures avoided and the rate at which they are realized over a 25-year period. In particular,
More informationURINARY TRACT INFECTION IN DIABETICS
URINARY TRACT INFECTION IN DIABETICS Pages with reference to book, From 2 To 5 Rukhsana Naseer, Surraiya Obaidullah, Zulfiqar Haider ( PMRC Research Centre, Fatima Jinnah Medical College, Lahore. ) Abstract
More informationThe United Kingdom Prospective
Professional issues The UKPDS: a nursing perspective Marilyn Gallichan Article points 1The UKPDS followed up more than 5000 patients from 23 centres for a median of 10 years. 2The findings provide a powerful
More informationData Fact Sheet. Congestive Heart Failure in the United States: A New Epidemic
National Heart, Lung, and Blood Institute Data Fact Sheet Congestive Heart Failure National Heart, Lung, and Blood Institute National Institutes of Health Data Fact Sheet Congestive Heart Failure in the
More informationMedicare and Medicaid Payments
and Payments The following table includes information about payments made by and for the 17 medical conditions/surgical procedures included in this Hospital Performance Report. This analysis is based on
More informationFinland and Sweden and UK GP-HOSP datasets
Web appendix: Supplementary material Table 1 Specific diagnosis codes used to identify bladder cancer cases in each dataset Finland and Sweden and UK GP-HOSP datasets Netherlands hospital and cancer registry
More informationPlasma fibrinogen level, BMI and lipid profile in type 2 diabetes mellitus with hypertension
World Journal of Pharmaceutical Sciences ISSN (Print): 2321-3310; ISSN (Online): 2321-3086 Published by Atom and Cell Publishers All Rights Reserved Available online at: http://www.wjpsonline.org/ Original
More informationEuroPrevent 2010 Fatal versus total events in risk assessment models
EuroPrevent 2010 Fatal versus total events in risk assessment models Pekka Jousilahti, MD, PhD,Research Professor National Institute for Health and Welfare, Finland Risk assessment models Estimates the
More informationImplications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes?
Implications of The LookAHEAD Trial: Is Weight Loss Beneficial for Patients with Diabetes? Boston, MA November 7, 213 Edward S. Horton, MD Professor of Medicine Harvard Medical School Senior Investigator
More informationManagement of Cardiovascular Disease in Diabetes
Management of Cardiovascular Disease in Diabetes Radha J. Sarma, MBBS, FACP. FACC. FAHA. FASE Professor of Internal Medicine Western University of Health Sciences. Director, Heart and Vascular Center Western
More information