Review from JAMA — Birth Weight and Risk of Type 2 Diabetes — A Systematic Review

Objective: To identify all cases of sudden unexpected death in epilepsy (SUDEP) among people in Sweden during 1 year and to determine the SUDEP incidence in relation to age, sex, and psychiatric comorbidity. Methods: We included all individuals with a hospital-based ambulatory care or hospital discharge diagnosis of epilepsy in the Swedish National Patient Registry during 1998–2005 who were alive on January 1, 2008. Deaths during 2008 were identified by linkage to the National Cause of Death Registry. Death certificates, medical charts, and police and autopsy reports were extensively reviewed to identify SUDEP cases. Results: Of 57,775 epilepsy patients alive on January 1, 2008, 1,890 died (3.3%) during 2008. Of these, 99 met the Annegers SUDEP criteria (49 definite, 19 probable, and 31 possible). SUDEP accounted for 5.2% of all deaths and 36% of deaths in the 0–15 years age group. The incidence of definite/probable SUDEP was 1.20/1,000 person-years, and higher in men (1.41) than in women (0.96). All SUDEP cases <16 years were in boys. SUDEP incidence at ages 50 years was 1.11, 1.13, and 1.29, respectively, per 1,000 person-years. The incidence was 5-fold increased among female patients with psychiatric comorbidities compared to those without. Epilepsy was mentioned on the death certificate in only 62 of the 99 (63%) SUDEP cases. Conclusions: Methods relying on death certificates underestimate SUDEP incidence. SUDEP risk has been underestimated especially in boys and in older people regardless of sex. Patients with psychiatric comorbidities, women in particular, are at increased SUDEP risk.

Persson P‐G, Carlsson S, Svanström L, Östenson C‐G, Efendic S, Grill V (Karolinska Hospital and Karolinska Institutet, Stockholm, Sweden). Cigarette smoking, oral moist snuff use and glucose intolerance. J Intern Med 2000; 248: 103–110.Objective. To investigate the association between cigarette smoking and use of oral moist snuff and impaired glucose tolerance and type 2 diabetes.Design. We performed a population‐based cross‐sectional study of glucose intolerance and tobacco use in Stockholm during 1992–94. The sample consisted of 3128 men, aged 35–56 years, of whom 52% had a family history of diabetes. In an oral glucose tolerance test, we detected 55 men with type 2 diabetes and 172 with impaired glucose tolerance. Information on cigarette smoking and oral moist snuff use was collected by a questionnaire.Results. The odds ratio of type 2 diabetes was increased for smokers of 25+ cigarettes day^–1 (odds ratio = 2.6, 95% confidence interval = 1.1–5.9) as well as for moist snuff dippers of 3+ boxes week^–1 (odds ratio = 2.7, 95% confidence interval = 1.3–5.5). The odds ratio of relatively high (highest tertile) fasting insulin levels in subjects with impaired glucose tolerance associated with cigarette smoking of 25+ cigarettes day^–1 was 1.5 (95% confidence interval = 0.7–3.6). The corresponding estimate of a relatively low (lowest tertile) 2 h insulin response was 2.5 (95% confidence interval = 0.9–7.1).Conclusions. These results indicate that heavy users of cigarettes or moist snuff have an increased risk of type 2 diabetes. The results could suggest that tobacco use is associated with a low insulin response.

Human insulin synthesized from A- and B-chains separately produced in Escherichia coli from cloned genes was characterized by examining its interaction biochemically and morphologically with IM-9 cultured human lymphocytes. Biosynthetic human insulin (BHI) behaves similarly to pork insulin with respect both to its binding properties and to the rate and magnitude at which it is internalized by the cells.

: Objectives.  The association between coffee consumption, type 2 diabetes and impaired glucose tolerance was examined. In addition, indicators of insulin sensitivity and β‐cell function according to homeostasis model assessment were studied in relation to coffee consumption.Design.  Population‐based cross‐sectional study.Setting and subjects.  The study comprised 7949 healthy Swedish subjects aged 35–56 years residing within five municipalities of Stockholm. An oral glucose tolerance test identified 55 men and 52 women with previously undiagnosed type 2 diabetes and 172 men and 167 women with impaired glucose tolerance. Information about coffee consumption and other factors was obtained by questionnaire.Results.  The relative risks (adjusted for potential confounders) of type 2 diabetes and impaired glucose tolerance when drinking ≥5 cups of coffee per day compared with ≤2 cups per day in men were 0.45 [95% confidence intervals (CI) 0.22–0.92] and 0.63 (CI: 0.41–0.97), respectively, and in women 0.27 (CI: 0.11–0.66) and 0.47 (CI: 0.29–0.76) respectively. In subjects with type 2 diabetes and impaired glucose tolerance, high coffee consumption (≥5 cups day⁻¹) was inversely associated with insulin resistance. In addition, in those with type 2 diabetes and in women (not in men) with impaired glucose tolerance high coffee consumption was inversely associated with low β‐cell function. In women, but not obviously in men, with normal glucose tolerance, coffee consumption was associated with a reduced risk of insulin resistance.Conclusions.  The results of this study indicated that high consumers of coffee have a reduced risk of type 2 diabetes and impaired glucose tolerance. The beneficial effects may involve both improved insulin sensitivity and enhanced insulin response.