Factors related to the development of diabetes during a 20-year follow-up.A prospective study in a homogeneous group of middle-aged men

Background and Aims: To investigate factors associated with the development of type 2 diabetes mellitus (DM) during a 20-year follow-up in a homogeneo us group of initially healthy middle-aged men with similar. socioeconomic s tatus. Methods and Results: We studied 1802 executives and businessmen, born 1919- 34, without type 2 DM at baseline and I with coronary heart disease (CHD) r isk factor measurements in 1974-75 Diagnosis of type 2 DM during the follow -up was based on entitlement to re-imbursement for type 2 DM medication dur ing 1975-1995 retrieved fr om national registers, self-report of type 2 DM or fasting blood glucose (greater than or equal to6.7 mmol/L in 1985-1986 ( 72% of the initial cohort re-evaluated). During the follow-up (up to 1995) type 2 DM was diagnosed using the above c riteria in 94 men (52%). At baseline, men who Inter developed type 2 DM smo ked more (p=0.01), and had significantly higher body mass index (BMI), syst olic and diastolic blood pressure, pulse pressure, serum triglycerides, and fasting and one-hour blood glucose. In a subset of high-risk men, those wh o developed type 2 DM also showed signs of white-coat effect on blood press ure (p=0.008). Already at baseline, the CHD risk score was 23% higher in fu ture type 2 DM subjects (p=0.008). Re-evaluation in 1985-1986 showed essent ially similar results for risk factors, but in addition LDL cholesterol wit hout lipid lowering drugs was significantly lower (p=0.0018) in type 2 DM s ubjects. During the follow-up, 23.4% of the men with type 2 DM developed CH D as compared to 13.4% of those without (p=0.008). Conclusions: During a 20-year follow-up, several cardiovascular risk factor s, including smoking, pulse pressure and the white-coat effect, predicted t he development of type 2 DM in initially healthy middle-aged men. However d espite the higher incidence of CHD, development of type 2 DM was associated with lowered LDL cholesterol. (C) 2000, Medikal Press.