Diabet. Med. 28, 23–30 (2011)AbstractAim To develop strategies based on simple clinical assessment and blood markers to identify older individuals at high risk for Type 2 diabetes.Methods A prospective study of non‐diabetic men (n = 3523) and women (n = 3404) aged 60–79 years followed for 7 years, during which there were 297 incident cases of Type 2 diabetes. Logistic regression was used to develop scores to predict incident cases, starting with clinical predictors and adding blood markers that predicted the incidence of diabetes. Receiving operating characteristic analyses were used to assess improvement in prediction.Results The area under the curve for a simple clinical assessment score, which included age, sex, family history of diabetes, smoking status, BMI, waist circumference, hypertension and recall of doctor diagnosis of coronary heart disease was 0.765 (0.740, 0.791); sensitivity and specificity in the top quintile of the score were 50.3 and 81.4%, respectively. Addition of simple fasting blood markers HDL cholesterol, triglyceride and glucose improved prediction [area under the curve = 0.817 (0.793, 0.840), P < 0.0001; sensitivity 63.8%; specificity 82.0%]. An alternative model adding blood markers not dependent on fasting yielded similar results. Further addition of C‐reactive protein made no improvement. Blood measurements made small differences to reclassification of risk in those in the lowest three quintiles of the non‐laboratory score.Conclusion In large population settings, simple clinical assessments could be used in the first instance to identify older adults who would benefit from further testing with routine (non‐fasting) blood markers to identify those at most likely to be at elevated diabetes risk.

Aims: Secondhand smoke (SHS) exposure is associated with elevated CHD risks. Yet the pathways through which this may operate have not been investigated in epidemiologic studies with objective SHS exposure measures and a wide range of CHD risk factors associated with active smoking. Therefore we investigate associations between SHS exposure and CHD risk factors, to clarify how SHS exposure may raise risk of CHD.Methods: Cross-sectional population-based study of 5029 men and women aged 59-80 years from primary care practices in Great Britain. Smoking, behavioural and demographic information was reported in questionnaires; nurses made physical measurements and took blood samples for analysis of serum cotinine and markers of inflammation, hemostasis and endothelial dysfunction.Results: Active cigarette smokers had lower albumin and higher triglycerides, CRP, IL-6, white cell count, fibrinogen, blood viscosity, factor VIII, VWF and t-PA than non-smokers. Among non-smokers, serum cotinine levels were independently positively associated with CRP, fibrinogen, factor VIII, VWF and t-PA and inversely associated with albumin, after adjustment for age, gender, social and behavioural factors. The differences in CRP, fibrinogen and albumin between cotinine <= 0.05 and >0.7 ng/ml were one-third to one half the size of differences between cotinine <= 0.05 ng/ml and current smokers, but were of similar magnitude for VWF and t-PA.Conclusions: Endothelial, inflammatory and haemostatic markers related to CHD risk showed independent associations with SHS exposure in the same direction as those for active smoking. Results aid understanding of the associations between SHS exposure and elevated CHD risks. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

The aim of this study was to examine whether waist circumference (WC) or WHR improve diabetes prediction beyond body mass index in older men and women, and to define optimal cut-off points.

The greatest relative increase in type 2 diabetes (T2DM) prevalence in developed countries thought likely to occur over the next 25 years will be in the over 65 age group. The aim of this study was to examine the effectiveness of both simple strategies based on simple clinical parameters (suitable for use in primary care) and more complex scores involving blood markers to identify older individuals at high risk of developing T2DM.A …

OBJECTIVES:We examined whether area deprivation influenced risk of Type 2 diabetes, fasting blood glucose and insulin resistance over and above the effect of individual socio-economic position (SEP) measured across the life course. METHODS:A cross-sectional analysis of 4286 women aged 60 to 79 years from 457 British electoral wards in 23 towns. RESULTS:Area deprivation was positively associated with diagnosed [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.13, 1.53, per quintile of area deprivation, n = 2895], but not undiagnosed Type 2 diabetes after adjustment for individual life-course SEP. This association was robust to adjustment for adult health behaviours and physiological risk factors. Insulin resistance [homeostasis model assessment (HOMA) score] increased by 1.90% (95% CI 0.01, 3.82, n = 2526) per quintile of area deprivation after adjustment for individual SEP, while fasting blood glucose increased by 0.69% (95% CI 0.16, 1.22, n = 2875) after adjustment for individual SEP. CONCLUSIONS:Area level deprivation independently influences diagnosed Type 2 diabetes, insulin resistance and fasting blood glucose. Examination of more specific characteristics of places is needed to understand the mechanisms by which these effects arise.