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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Innodata0470851945.jpg

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

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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

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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

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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

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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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