PARENTS welcomed a new system that saves them having to visit their diabetic son’s school daily to inject him.

Brian Callanan doesn’t let cystic fibrosis slow him down. Diagnosed at birth with the genetic disease, the 34-year-old loves the outdoors, enjoys hiking and sailing, and is busy planning a snowboarding trip to Wyoming.

OBJECTIVE

We examined the association between high blood pressure and incident type 2 diabetes in African Americans and whites aged 35–54 years at baseline.

RESEARCH DESIGN AND METHODS

We combined data from the Atherosclerosis Risk in Communities (ARIC) study, the Coronary Artery Risk Development in Young Adults (CARDIA) study, and the Framingham Heart Study offspring cohort. Overall, 10,893 participants (57% women; 23% African American) were categorized by baseline blood pressure (normal, prehypertension, hypertension) and examined for incident diabetes (median follow-up 8.9 years).

RESULTS

Overall, 14.6% of African Americans and 7.9% of whites developed diabetes. Age-adjusted incidence was increasingly higher across increasing blood pressure groups (P values for trend: <0.05 for African American men; <0.001 for other race-sex groups). After adjustment for age, sex, BMI, fasting glucose, HDL cholesterol, and triglycerides, prehypertension or hypertension (compared with normal blood pressure) was associated with greater risks of diabetes in whites (hazard ratio [HR] for prehypertension: 1.32 [95% CI 1.09–1.61]; for hypertension: 1.25 [1.03–1.53]), but not African Americans (HR for prehypertension: 0.86 [0.63–1.17]; for hypertension: 0.92 [0.70–1.21]). HRs for developing diabetes among normotensive, prehypertensive, and hypertensive African Americans versus normotensive whites were: 2.75, 2.28, and 2.36, respectively (P values <0.001).

CONCLUSIONS

In African Americans, higher diabetes incidence among hypertensive individuals may be explained by BMI, fasting glucose, triglyceride, and HDL cholesterol. In whites, prehypertension and hypertension are associated with greater risk of diabetes, beyond that explained by other risk factors. African Americans, regardless of blood pressure, have greater risks of developing diabetes than whites.

OBJECTIVE

To compare incidences and risk factors for diabetes using seven definitions, with combinations of pharmacological treatment, fasting plasma glucose (FPG) ≥7.0 mmol/L, and HbA_1c ≥6.5%.

RESEARCH DESIGN AND METHODS

Participants aged 30–65 years from the Data from an Epidemiological Study on the Insulin Resistance Syndrome cohort were followed for 9 years.

RESULTS

More men had incident diabetes as defined by FPG ≥7.0 mmol/L and/or treatment than by HbA_1c ≥6.5% and/or treatment: 7.5% (140/1,867) and 5.3%, respectively (P < 0.009); for women incidences were similar: 3.2% (63/1,958) and 3.4%. Known risk factors predicted diabetes for almost all definitions. Among those with incident diabetes by FPG alone versus HbA_1c alone, there were more men (78 vs. 35%), case patients were 8 years younger, and fewer were alcohol abstainers (12 vs. 35%) (all P < 0.005). A diabetes risk score discriminated well between those with and without incident diabetes for all definitions.

CONCLUSIONS

In men, FPG definitions yielded more incident cases of diabetes than HbA_1c definitions, in contrast with women. An FPG-derived risk score remained relevant for HbA_1c-defined diabetes.

OBJECTIVE

To perform the first comprehensive psychometric evaluation of the Hypoglycemia Fear Survey-II (HFS-II), a measure of the behavioral and affective dimensions of fear of hypoglycemia, using modern test-theory methods, including item-response theory (IRT).

RESEARCH DESIGN AND METHODS

Surveys completed in four previous studies by 777 adults with type 1 diabetes were aggregated for analysis, with 289 subjects completing both subscales of the HFS-II and 488 subjects completing only the Worry subscale. The aggregated sample (53.3% female, 44.4% using insulin pumps) had a mean age of 41.9 years, diabetes duration of 23.8 years, HbA_1c value of 7.7%, and 1.4 severe hypoglycemic episodes in the past year. Data analysis included exploratory factor analysis using polychoric correlations and IRT. Factors were analyzed for fit, trait-level locations, point-measure correlations, and separation values.

RESULTS

Internal and test-retest reliability was good, as well as convergent validity, as demonstrated by significant correlations with other measures of psychological distress. Scores were significantly higher in subjects who had experienced severe hypoglycemia in the past year. Factor analyses validated the two subscales of the HFS-II. Item analyses showed that 12 of 15 items on the Behavior subscale, and all of the items on the Worry subscale had good-fit statistics.

CONCLUSIONS

The HFS-II is a reliable and valid measure of the fear of hypoglycemia in adults with type 1 diabetes, and factor analyses and IRT support the two separate subscales of the survey.

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