ATW1H%ASUACAD.BITNET@oac.ucla.edu (Dr David Dodell) (08/20/89)
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Services, Public Health Service, 1983; DHHS publication no. (ADM)83-1263.
Health InfoCom Network News Page 19
Volume 2, Number 30 August 19, 1989
5. National Institute on Drug Abuse. National trends in drug use and related
factors among American high school students and young adults, 1975-1986.
Rockville, Maryland: US Department of Health and Human Services, Public Health
Service, 1987; DHHS publication no. (ADM)87-1535.
6. National Institute on Drug Abuse. Trends in demographic characteristics
and patterns of drug use of clients admitted to drug abuse treatment programs
for cocaine abuse in selected states: cocaine client admissions 1979-1984.
Rockville, Maryland: US Department of Health and Human Services, Public Health
Service, 1987; DHHS publication no. (ADM)87-1528.
7. National Institute on Drug Abuse. National Household Survey on Drug Abuse:
population estimates, 1985. Rockville, Maryland: US Department of Health and
Human Services, Public Health Service, 1987; DHHS publication no. (ADM)87-
1539.
8. Silverman S. Scope, specifics of maternal drug use, effects on fetus are
beginning to emerge from studies. JAMA 1989;261:1688-9.
9. Chasnoff IJ, Griffith DR, MacGregor S, Dirkes K, Burns KA. Temporal
patterns of cocaine use in pregnancy: perinatal outcome. JAMA 1989;261:1741-4.
10. Zuckerman B, Frank DA, Hingson R, et al. Effects of maternal marijuana and
cocaine use on fetal growth. N Engl J Med 1989;320:762-8.
11. Mahalik MP, Gautieri RF, Mann DE Jr. Teratogenic potential of cocaine
hydrochloride in CF-1 mice. J Pharm Sci 1980;69:703-6.
12. Silverman S. Interaction of drug-abusing mother, fetus, types of drugs
examined in numerous studies. JAMA 1989;261:1689,1693.
*Include malformations of the kidney (such as renal agenesis) and
malformations of the collecting system.
Health InfoCom Network News Page 20
Volume 2, Number 30 August 19, 1989
Chronic Disease Reports: Deaths from Diabetes -- United States, 1986
In 1986, diabetes (International Classification of Diseases, Ninth Revision,
Clinical Modification (ICD-9-CM) 250) was listed as the underlying cause of
death for 37,178 persons in the United States. Diabetes mortality rates (age-
standardized to the 1986 U.S. population) were lowest in Nevada (11.6 per
100,000) and highest in Delaware (26.3 per 100,000) (Figure 1, Table 1).
Diabetes-related deaths accounted for 1.8% of U.S. mortality and for 1% of
years of potential life lost before age 65 (1). However, diabetes was
mentioned as a con tributory cause of death on 4.1 times as many death
certificates as it was selected as the underlying cause (Table 2). Moreover,
diabetes was not listed on approximately half of death certificates for
persons with noninsulin-dependent diabetes (2). Thus, diabetes may be
associated with approximately eight times as many deaths as indicated by
underlying cause alone.
Rates of diabetes mortality declined in the 1970s, but the decline has
slowed in recent years (3). Rates of diabetes mortality increase with age, are
6% higher in males than in females and 39% higher in nonwhites than in whites
(4). Smoking, hypertension, and overweight are modifiable risk factors for
death among diabetic persons (Table 2); estimates of deaths that could be
averted by eliminating these risk factors are substantial (Table 2). Diabetes
also contributes to end-stage renal disease, amputations, blindness, and other
serious complications; associated risk factors include higher levels of
glycemia, smoking, and hypertension. Assuming that risk-factor reduction among
diabetic persons would have the same benefit as in the general population,
more effective control of smoking, hypertension, and overweight should further
decrease morbidity and mortality rates among diabetic persons.
Reported by: Div of Surveillance and Epidemiologic Studies, Epidemiology
Program Office; Div of Diabetes Translation, Center for Chronic Disease
Prevention and Health Promotion, CDC.
References
1. CDC. Years of potential life lost before age 65--United States, 1987. MMWR
1989;38:27-9.
2. Herman WH, Teutsch SM, Geiss LS. Closing the gap: the problem of diabetes
mellitus in the United States. Diabetes Care 1985;8:391-406.
3. CDC. Trends in diabetes mellitus mortality. MMWR 1988;37:769-73.
4. NCHS. Vital statistics of the United States, 1986. Vol. II--Mortality, pt
A. Hyattsville, Maryland: US Department of Health and Human Services, Public
Health Service, 1988; DHHS publication no. (PHS)88-1122.
Health InfoCom Network News Page 21
Volume 2, Number 30 August 19, 1989
End-Stage Renal Disease Associated
with Diabetes -- United States, 1988
End-stage renal disease (ESRD) is a major complication of diabetes and
requires dialysis or transplantation for survival. The Medicare program
provides reim bursement* for greater than 90% of ESRD treatment in the United
States and maintains information that provides a basis for surveillance of
ESRD (1). In 1987, 33,393 new cases of ESRD were reported to Medicare, of
which 9482 (28.4%) were attributed to diabetes. Previous studies indicate
that the age-adjusted incidence of diabetes-attributable ESRD is three to
seven times higher among blacks, American Indians, and Mexican Americans than
among whites (2,3).
Of the 18,854 ESRD cases reported to Medicare in January-June 1988, 4535
(24.1%) were attributed to diabetes: 2577 (56.8%) to adult-onset** type, 1836
(40.5%) to juvenile type, and 122 (2.7%) unclassified. ESRD was more commonly
attributed to adult-onset diabetes among blacks (62.5%), Asians (67.7%), and
American Indians (78.7%) than among whites (55.8%).
ESRD cases attributed to adult-onset diabetes were most frequent in older
age groups (Figure 1). ESRD cases attributed to juvenile diabetes are
characterized by a bimodal distribution (Figure 1). However, because many
noninsulin-dependent diabetes mellitus (NIDDM) patients are treated with
insulin, they are often misclassified in surveys as insulin-dependent diabetes
mellitus (IDDM) patients. This may account for the apparent increase in
juvenile-diabetes-related ESRD cases in older age groups.
Reported by: Bur of Data Management and Strategy, Health Care Financing
Administration. Div of Diabetes Translation, Center for Chronic Disease
Prevention and Health Promotion, CDC.
Editorial Note: Adult-onset diabetes accounts for most diabetes-related ESRD
in the United States, especially among minority populations. The Medicare data
are consistent with findings from medical record reviews in Nebraska (4),
Michigan (5), and a large health-maintenance organization (6). Refinement of
the classification of type of diabetes and evaluation of its precision would
increase the value of the Medicare information system for surveillance of ESRD
associated with diabetes.
Control of hyperglycemia and hypertension are recommended for preventing
and slowing the progression of diabetes-associated renal disease (7). These
interventions are emphasized in state and territorial diabetes-control
programs and in public and professional education programs initiated by the
American Diabetes Association and the National Kidney Foundation. Close
monitoring for early markers of renal disease can identify persons at high
risk for ESRD and allow targeting of dietary and pharmacologic interventions.
Additional study of the application of these measures is being supported by
the National Institute of Diabetes and Digestive and Kidney Diseases (8).
Chronic disease control programs should consider prevention of NIDDM as an
additional approach to reduce ESRD and other complications of diabetes (9,10).
Effective dietary and physical activity approaches are urgently needed,
especially for families predisposed to NIDDM and for high-risk populations
(e.g., blacks, American Indians, and Mexican Americans).
References
1. Eggers PW, Connerton R, McMullan M. The Medicare experience with end-stage
renal disease: trends in incidence, prevalence, and survival. Health Care
Health InfoCom Network News Page 22
Volume 2, Number 30 August 19, 1989
Financ Rev 1984;5:69-88.
2. Teutsch S, Newman J, Eggers P. The problem of diabetic renal failure in
the United States: an overview. Am J Kidney Dis 1989;13:11-3.
3. Pugh JA, Stern MP, Haffner SM, Eifler CW, Zapata M. Excess incidence of
treatment of end-stage renal disease in Mexican Americans. Am J Epidemiol
1988;127:135-44.
4. Rettig B, Teutsch SM. The incidence of end-stage renal disease in type I
and type II diabetes mellitus. Diabetic Nephropathy 1984;3:26-7.
5. Cowie CC, Port FK, Wolfe RA, Savage PJ, Moll PP, Hawthorne VM. Racial
differences in diabetic end-stage renal disease incidence by diabetic type
(Abstract). Diabetes 1988; 37(suppl 1):52A.
6. Ordonez JD, Hiatt RA. Comparison of type II and type I diabetics treated
for end-stage renal disease in a large prepaid health plan population. Nephron
1989;51:524-9.
7. Herman W, Hawthorne V, Hamman R, et al. Consensus statement: preventing
the kidney disease of diabetes mellitus--public health perspectives. Am J
Kidney Dis 1989;13:2-6.
8. FitzSimmons SC, Agodoa L, Striker L, Conti F, Striker G. Kidney disease of
diabetes mellitus: NIDDK initiatives for the comprehensive study of its
natural history, pathogenesis, and prevention. Am J Kidney Dis 1989;13:7-10.
9. Tuomilehto J, Wolf E. Primary prevention of diabetes mellitus. Diabetes
Care 1987;10: 238-48.
10. CDC. Community-based exercise intervention--the Zuni Diabetes Project.
MMWR 1987;36: 661-4.
*More than $3 billion for the care of approximately 147,000 persons in 1987.
**In 1988, diabetes-attributable ESRD was subclassified by treatment providers
into "adult-onset" and "juvenile" types (the nomenclature of the International
Classification of Diseases, Ninth Revision (ICD-9)) without explicit criteria.
Although these categories cannot be directly translated into the preferred
categories of noninsulin-dependent diabetes mellitus and insulin-dependent
diabetes mellitus, respectively, they allow some assessment of the
contributions of the two major types of diabetes to ESRD.
Health InfoCom Network News Page 23
Volume 2, Number 30 August 19, 1989
===============================================================================
General Announcments
===============================================================================
NIH/FDA WORKSHOP - PROTECTION OF HUMAN SUBJECTS
National Institutes of Health
The Office for Protection from Research Risks, Office of Extramural Research,
National Institutes of Health, is sponsoring a Workshop on ethical issues
involved in behavioral and biomedical research.
The two-day program will convene at 8:30 am on September 18 with a
presentation on "The Role of NIH in Protection of Human Subjects."
The program is open to anyone with an interest in research as well as NIH and
other Federal personnel involved in the development of research protocols, the
review of research proposals and applications, the awarding of research funds,
and the performance and evaluation of research. Advance registration is
required.
DATES: September 18-19, 1989 - (8:30 am to 4:30 pm)
LOCATION:
The Auditorium
Uniformed Services University of the
Health Sciences
Building B, Room B2014
4301 Jones Bridge Road
Bethesda, Maryland 20814
TITLE OF WORKSHOP: Ethical Issues in Biomedical and Behavioral
Research
REGISTRATION CONTACT:
Agnes Richardson, Secretary to Director
Division of Program Development and
Evaluation, OPRR
National Institutes of Health
Building 31, Room 5B62
9000 Rockville Pike
Bethesda, Maryland 20892
Telephone: (301) 496-8101
REGISTRATION FEE: None
AGENDA TOPICS INCLUDE:
Overview of Research Protections
Ethical Principles and Research Protections
o Informed Consent
o Risks/Benefits Assessment
Health InfoCom Network News Page 24
Volume 2, Number 30 August 19, 1989
o Equitable Subject Selection
Ethics of Subject Selection and Research Design
in Controlled Clinical Trials
Ethical Issues in Biomedical Research
o Research During Pregnancy and AIDS Research
AIDS in the International Setting
Research Review and Funding
o Characteristics of Research Review
o Funding Mechanisms and Their Impact on Research
Research Ethics
o Characteristics of Research Review
o Funding Mechanisms and Their Impact on Research
Research Ethics
o The Future
Institutional Review Boards (IRBS) in the 1990'S: The Federal
Model Policy
PRESENTATIONS AND DISCUSSIONS WILL FOCUS ON TOPICS SUCH AS:
o Ethics of involving human subjects in biomedical and behavioral research.
o The importance of informed consent, risks/benefits assessment, and equitable
selection of subjects in research involving humans.
o The process of designing, approving, and funding research.
o Research during pregnancy and AIDS research, here and abroad.
o A look at the future of research ethics.
PARTIAL LIST OF SPEAKERS:
Lawrence S. Brown, Jr.,M.D., M.P.H.
Susan Conner, J.D.
Dale H. Cowan, M.D., J.D.
Sue Kier Hoppe, Ph.D.
Edmund G. Howe, M.D., J.D.
Herbert C. Kelman, Ph.D.
Mariam Kelty, Ph.D.
Mrs. Carol Levine
Robert J. Levine, M.D.
Alan Meisel, J.D.
John C. Petricciani, M.D.
Ernest D. Prentice, Ph.D.
M. Louis van de Beek, M.D., M.B.A.
Murry L. Wax, Ph.D.
Marvin Zelen, Ph.D.
Health InfoCom Network News Page 25
Volume 2, Number 30 August 19, 1989
The Division of Research Grants (DRG), National Institutes of Health,
(NIH) announces the development of "News from DRG," a telephone information
line that provides biweekly messages from the NIH Division of Research Grants
on items pertaining to the Division or to peer review at the NIH and the
Alcohol Drug and Mental Health Administration in general. Included are
extramural program or policy changes, statistics on extramural programs or
peer review, special events, new or revised publications, personnel changes,
and any other items of interest to the biomedical research community or
general public. The messages will change every other Monday.
To use this system, just dial (301) 496-3115. You will hear a
recorded message. At the end of the message, you will then have the
opportunity to make any comments or suggestions for future items. We welcome
your comments or suggestions, since this is the main way we can determine if
this information line is meeting the needs of our constituents.
For additional information on this system, contact
Dr. Samuel Joseloff, Chief of the DRG Office of
Grants Inquiries, (301) 496-7441.
Health InfoCom Network News Page 26
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