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Thesis. A dissertation based on material from Laxa containing 776 incident cases of diabetes patients up to 30 years follow-up (1972-2001) shows that the prevalence and incidence of diabetes has not changed over time, excess mortality for people acoustic neuroma with diabetes is very low. Cardiovascular disease and heart attack adversely affected by hypertension and hyperglycemia, and positive of drug treatment for diabetes. Drug therapy for diabetes did not reduce stroke incidence. Screening for diabetes did not affect total mortality or incidence of macrovascular disease.
From many countries published studies with variable follow-up showing increased prevalence of diabetes and associated acoustic neuroma increase in mortality. As for Sweden, it is unclear if the prevalence is increasing and cardiovascular mortality has decreased to the same extent in people with diabetes as it has done in non-diabetics. Pharmacological treatment of hypertension and hyperglycemia in people with diabetes has been much debated in recent years, and there is uncertainty about the target levels should be achieved. Worldwide acoustic neuroma authorities acoustic neuroma recommend screening for diabetes, but this leads to improved prognosis is unclear.
Thesis purpose was to study the incidence, prevalence and mortality trends over time in a Swedish cohort. The risk of cardiovascular complications and premature death at high glucose and blood pressure values as well as drug treatment of these conditions was also investigated. Another goal was to investigate whether the screening detection of diabetes involves less risk of complications acoustic neuroma than clinically detected disease.
During the study period were discovered 776 new cases of diabetes, 36 subjects with type 1 diabetes and 740 individuals with type 2 diabetes. Age-standardized incidence (3.18 cases / 1000 inhabitants) and prevalence (44 cases / 1000 inhabitants) did not increase over time. The age-standardized risk ratio (RR) of overall mortality in individuals with and without acoustic neuroma diabetes were all 1.17 (P <0.0021), for women 1.22 (P <0.007) and for men 1.13 (p = 0.095). The equivalent of cardiovascular disease (CVD) and death were 1.33, 1.41 and 1.27.
Cardiovascular-related mortality decreased over time in non-diabetic and diabetic men but not in women with diabetes. Cardiovascular onset increased with male gender (RR 1.48, 95 percent confidence interval [CI] 1.21 to 1.82), number of previous CVD (RR 1.13, 95 percent CI 1.08 to 1.18), age (RR 1.05, 95 percent CI 1.04 to 1.07), fasting glucose (RR 1.05, 95 percent CI 1.00 to 1.10), BMI (RR 1.04, 95 percent CI 1.01 to 1 , 06), mean arterial pressure (RR 1.02, 95 percent CI 1.01 to 1.03) and decreased with metformin and sulfonylureabehandling (RR 0.58, 95 percent CI 0.38 to 0.90 and RR 0.73 , 95 percent CI 0.55 to 0.97).
No statistically significant difference on mortality and cardiovascular disease incidence was noted for screened compared with clinically detected acoustic neuroma diabetics. In the screened group, however, a non-significant reduction of stroke incidence (24 percent, P = 0.15).
Jansson S. A longitudinal study of diabetes mellitus: with special reference to incidence and prevalence, acoustic neuroma and to determinants of macrovascular acoustic neuroma complications and mortality. Uppsala: Uppsala University; acoustic neuroma 2014.
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