Document Detail


Effects of ethnicity on diabetes incidence and prevention: results of the Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM) trial.
MedLine Citation:
PMID:  20950379     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Risk of Type 2 diabetes varies by ethnicity, but whether ethnicity remains important among those who have impaired glucose tolerance or impaired fasting glucose is uncertain. Whether the effect of thiazolidinedione treatment on diabetes prevention in persons with non-diabetic dysglycaemia varies by ethnicity is also not known. We addressed these questions using data collected in the DREAM trial.
METHODS: A 2-by-2 factorial double-blind randomized controlled trial to compare the effects of rosiglitazone and ramipril on the primary outcome of diabetes or death in persons meeting criteria for impaired glucose tolerance or impaired fasting glucose. The effect of these interventions by ethnicity was estimated using Cox regression analysis.
RESULTS: Of 5269 adults, 2365 were randomly assigned to rosiglitzone and 2634 to placebo. South Asians showed a higher hazard for the primary outcome compared with Europeans (hazard ratio, 95% confidence interval 2.21, 1.41-3.47) adjusted for age, gender, BMI, waist-hip ratio and geographic region. A lesser increase in risk was seen in Black people (1.37, 1.04-1.81). A significant reduction in risk of the primary outcome with rosiglitazone treatment assignment was seen in all ethnic groups, but the treatment effect significantly differed by ethnicity (P=0.0242), with South Asians experiencing a smaller, and Latinos a larger preventive effect.
CONCLUSIONS: Ethnicity is an important risk factor for Type 2 diabetes in dysglycaemic persons. All ethnic groups experienced a large significant reduction in diabetes risk because of rosiglitazone. The magnitude of this reduction differed by ethnicity. Given the post hoc nature of this analysis, further confirmation of these findings is needed.
Authors:
E J Boyko; H C Gerstein; V Mohan; S Yusuf; P Sheridan; S Anand; J E Shaw;
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diabetic medicine : a journal of the British Diabetic Association     Volume:  27     ISSN:  1464-5491     ISO Abbreviation:  Diabet. Med.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-18     Completed Date:  2011-01-07     Revised Date:  2011-02-25    
Medline Journal Info:
Nlm Unique ID:  8500858     Medline TA:  Diabet Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  1226-32     Citation Subset:  IM    
Copyright Information:
© 2010 The Authors. Diabetic Medicine © 2010 Diabetes UK.
Affiliation:
VA Puget Sound Health Care System, Seattle, WA, USA. eboyko@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Diabetes Mellitus, Type 2 / drug therapy,  epidemiology,  ethnology*,  prevention & control
Drug Therapy, Combination
Female
Glucose Intolerance / drug therapy,  epidemiology,  ethnology*
Humans
Hyperglycemia / drug therapy,  epidemiology,  ethnology*
Hypoglycemic Agents / therapeutic use*
Incidence
Male
Middle Aged
Ramipril / therapeutic use
Risk Assessment
Thiazolidinediones / therapeutic use
Grant Support
ID/Acronym/Agency:
MCT41548//Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
0/Hypoglycemic Agents; 0/Thiazolidinediones; 122320-73-4/rosiglitazone; 87333-19-5/Ramipril

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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