risk factors for type 2 diabetes 2009 middle 2型糖尿病患者中的危险因素课件

The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC. Modifiable Risk Factors for Type 2 Diabetes 2009 Middle Eastern Region Epidemiology Supercourse Alexandria, Egypt Edward Gregg, PhD Epidemiology and Statistics Branch Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta, GA Key Steps in the Public Health Research Leading to Public Health Decision Making Surveillance and Descriptive Epidemiology Monitor health of the population Identify public health problems and their magnitude Evaluate levels of care Identify high risk populations amenable to intervention Analytic and Clinical Epidemiology: Identify modifiable risk factors Examine effectiveness of interventions in the clinical setting aimed at the individual Health Services Research, Cost-Effectiveness, Translation Research Examine the effectiveness of different health service, program, or policy-level interventions. Examine the cost effectiveness of successful interventions NormalIGT Type 2 DM Disability Death Complications Primary Secondary Tertiary prevention prevention prevention Range of Potential Priorities in the Public Health Response to DiabetesRange of Potential Priorities in the Public Health Response to Diabetes Control of complications and management of disability. Prevention of diabetes complications Assure access to care Prevention of diabetes among persons of high risk. Prevention and management of risk factors in the whole population. Common Study Designs Used in Epidemiologic Research Observational Studies Cross-sectional Retrospective (case control) Prospective (cohort studies) Ecologic Studies Intervention Studies Quasi-experimental studies Controlled intervention studies oClinical oHealth Service oCommunity Cost-effectiveness studies cross-sectional Retrospective cohort Intervention Yes No Risk factors: Characteristic of an individual or his/her environment that increases the chance of a health-related condition. Major Types: Causal vs non-causal Modifiable vs non modifiable Behavioral Physiologic Environmental Contextual How do we use risk factors? To contribute to understanding of etiology of disease. To guide the development of effective interventions. Bradford Hill Criteria for Evaluation of the Evidence of Causality Strength of Association Dose-response effect Temporality Consistency of evidence Biological plausibility Specificity of association Experimentation How do we use risk factors? To contribute to understanding of etiology of disease. To guide the development of effective interventions. To assist in efficient identification of people who will benefit from intervention. Step 1: Clinical Observations/Impressions “There are entirely too many diabetic patients in the country. Statistics for the last thirty years show so great an increase in the number that, unless this were in part explained by a better recognition of the disease, the outlook for the future would be startling.” ”The physician should take pride in the prevention of diabetes in his practice. Obese patients should be frankly told that they are candidates for diabetes”. ”But it is to the diabetic patient and his relatives that one can look most confidently for help in preventing diabetes. They should be encouraged to disseminate information about its prevention”. Joslin EP. The Prevention of Diabetes Mellitus JAMA 1921; 76 (2):79-84. Kahn et al., Nature, 2006 Evidence from observational epidemiology: Ecologic Studies Migration Studies: Association Between Westernization and Diabetes Prevalence in Susceptible Populations King, Diabetes Care, 1993; 1998; Diamond J, Nature, 2003 Indian Australian Aborigines Chinese Nauru New Guinea Schulz et al., Diabetes Care, 2006 Franco et al., Am J Epidemiol, 2007 Natural Experiments Clues from Descriptive Epidemiology Diabetes Prevalence among U.S. Adults Aged 20 - 74 BMI Category Obese III ( 40) Obese II (35-40) Obese I (30 -35) Overweight (25 -30) Normal / underweight ( 25 31-2.5 kg0.42 DPP, USA, 2002 3IGT BMI 24 34-5.2 kg0.42 Kosaka, Japan 2004 4IGT24-1.8 kg0.33 IDPP, India, 2006 3IGT26-0.3 kg0.72 Pan et al., 1997; Tuomilehto et al., 2001, Knowler et al., 2002 Application of Risk Scores to Public Health Intervention Application of Risk Scores to Public Health Intervention Schwarz, Horm Metab Res, 2008 Applications of Risk Scores to Diabetes Prevention in Finland And Germany Discussion Questions Are the modifiable risk factors in your country and region likely to be different from these? For the average individual? As predictors of tr