A right-hand shift of the distribution of fasting and post load glucose in northern Sweden between 1990 and 2009, and its predictors
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Background Recent Swedish studies have shown stable diabetes prevalence despite increasing obesity, but glucose levels may shift upwards below the diagnostic threshold for diabetes. Determinants for this shift are not consistently described, and may include obesity and obesity related factors such as the adipokine leptin.
Aims To explore secular trends in diabetes prevalence, glucose concentrations and glucose intolerance in northern Sweden, to evaluate if these trends are uniformly distributed throughout the spectrum of glucose concentrations, and to relate trends in glucose concentrations to traditional risk factors and leptin.
Methods Four cross-sectional population surveys between 1990 and 2009 with 7069 participants aged 25-64 years with an overall participation rate of 74.4%. Tukey mean-difference plot were used to examine changes in glucose distribution together with trend analyses in each decile of glucose distribution. Linear regression was used to estimate changes in glucose levels in relation to survey year and risk factors including leptin.
Results Fasting and post load glucose in women (all p<0.001) and post load glucose in men (p=0.004) increased, and the increase was seen in almost all deciles of glucose concentrations, but more pronounced in the upper deciles. In men, fasting glucose remained unchanged, though with an increase in lower deciles. The prevalence of impaired glucose tolerance rose in women from 7.8 to 14.5% and in men from 3.5 to 10.1% (all p=0.004), and the prevalence of impaired fasting glucose rose in women from 4.5 to 7.7% (p<0.001), but was unchanged in men. The prevalence of diabetes did not change and was 2009 in men 6.4%, and in women 6.5%. Leptin could, on top of traditional risk factors, in men partly explain the variance in fasting (p=0.008) and post load (p<0.001) glucose.
Conclusion The prevalence of diabetes did not increase in northern Sweden between 1986 and 2009, despite increasing fasting and post load glucose levels seen in most deciles of glucose distribution. Leptin is significantly associated with changes in fasting and post load glucose in men.
diabetes mellitus type 2, IFG, IGT, post load glucose, fasting glucose, leptin, prevalence, time trend, Northern Sweden MONICA
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:umu:diva-49382OAI: oai:DiVA.org:umu-49382DiVA: diva2:455495