Results

The understanding of the disease process of diabetes and the importance of the risk factors in development of the disease

The research group has found that 5.3% of the Danish population aged between 30 and 60 years has diabetes and that 60% of these persons are not diagnosed. The prevalence has increased by 60% among men and 20% among women over a 20-year period. In addition, the group has examined the prevalence of diabetes among Inuit living in Greenland. Here it was found that 10.8% of the men and 8.8% of the women had diabetes.

Overweight and obesity are known risk factors for diabetes and cardiovascular disease. The group has examined whether the same level of overweight and obesity has the same influence on known risk factors for cardiovascular disease among Danes and Inuit. When comparing Danes and Inuit with the same BMI (same degree of obesity), Danes have a poorer cardiovascular risk profile (higher blood pressure, higher level of cholesterol value) than Inuit. The same picture is obtained when comparing Danes with people from India. Therefore the group intends to use future projects to examine the influence of body composition on the development of diabetes in both white Caucasians and populations with a completely different lifestyle and ethnic background. For this purpose, the group is involved in two population studies: one in Greenland and one in Kenya.

Screening and early detection
We have developed a simple questionnaire for detecting persons with a high risk of having diabetes. This questionnaire reduces the need for blood tests by approximately 70% and reveals 75% of those with diabetes. The questionnaire has been validated in another Danish population and an Australian population. The research group has also examined whether screening using the questionnaire is achievable in the Danish health system. It was found that only 50% of the persons who received the questionnaire by post completed the questionnaire and then contacted their own GP, if necessary. As persons with another ethnic background than white Caucasians’ develop diabetes at an earlier age and at a lower BMI than white Caucasians, we validated the existing questionnaires on groups in the population with non-white Caucasian ethnic backgrounds. The ability of the questionnaire to identify persons with diabetes in these populations is poorer. Based on population data for 192,000 persons on a global level, the group developed a questionnaire for detecting diabetes. It has been modified to reflect the individual region’s risk profile.

Intervention
The research group is involved in two major intervention studies. One is a population-based study, Inter99. In this study, people with a high risk of developing cardiovascular disease are offered non-pharmacological intervention. This means that everyone with diabetes and reduced glucose tolerance is offered group-based intervention concerning nutrition, physical activity and smoking. The final 5-year follow-up is ongoing and the first results are expected in mid-2007.

The ADDITION study is a multicentre intervention study that assesses the effect of screening and early detection of the disease, and intensive treatment of newly diagnosed persons. The study is running in Denmark, England and Holland. On 1 June 2006, 2984 patients were included in the study: 1448 from Denmark, 1025 from England and 511 from Holland. The study will be completed on 1 July 2009.

The research group has developed two computer programs, Precard and Diacard, which can be used for persons with and without diabetes for risk evaluation of a person’s risk of developing cardiovascular disease. Based on a person’s risk profile (sex, age, BP, BMI, cholesterol figure, smoking status), the programs can calculate the absolute risk for dying or developing ischaemic heart disease or stroke. The risk reduction obtained from improving the individual risk factors can be calculated and displayed. The programs are used to give both the patient and the health care personnel an indication of which risk factors are the most important to treat or change.