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Diabetes diagnosis

German study finds under-reported diabetes in men

Is diabetes under-diagnosed among German men?
Study reinforces existing data regarding weight and comorbidity, but finds no significant relationship between obesity and diabetes in men
Study investigators cite under-reporting of diabetes among German men to explain discrepancy
Investigators hope study can be a baseline for comparison with new data

The first study examining the relationship between weight and comorbid conditions in the German population has been published, reinforcing findings from papers studying other populations, but finding evidence that diabetes is being under-diagnosed among German men.

The study, “Comorbidity of overweight and obesity in a nationally representative sample of German adults aged 18-79 years”, examined data from 7,124 men and women in the German National Health Interview and Examination Survey 1998.

The investigators found stepwise increases in the crude prevalence of cardio-metabolic risk factors, diabetes, cardiovascular disease, gall bladder disease, and osteoarthritis.

However, the relationship between overweight or obesity and diabetes and gallbladder disease was only significant among women.

The study found that only one-third of the men and less than half of the women in the study had normal weight. In the study, 48% of the men and 31% of the women were overweight; about 20% of both men and women were obese.

Dr Anja Schienkiewitz, lead investigator, said that the study, based on 1997-1999 data, represented an important baseline investigation for further longitudinal analyses of upcoming representative data, collected between 2008-2011.

Methodology

The German Health Interview and Examination Survey was conducted between October 1997 and March 1999, and involved 3,450 men and 3,674 women. Participants were randomly selected from non-institutionalised adults from local population registers, stratified by sex and 5-year age groups.

Participants’ weight, BMI, and abdominal obesity was measured, and physicians obtained a medical history using a computer-assisted personal interview.

To establish the presence of comorbidities, participants were asked whether a physician had ever told them they had a disease or health problem, and when the particular health problem had last been present.

Current medication use, smoking habits, education, household income, professional status group, and a composite socio-economic status index were also recorded.

A survey-specific weighting factor took into account differences in demographic characteristics from the official German population according to age, gender, community size, and residence in East or West Germany resulting from the sample design.

Findings

The crude prevalence of cardio-metabolic risk factors, diabetes, cardiovascular disease, or osteoarthritis increased with overweight and obesity in both sexes; the same was true for gall bladder disease among women.

The investigators did not find and significant association between overweight or obesity and lower respiratory disease, upper gastrointestinal tract disease, liver cirrhosis, thyroid disease, cancer, mental health problems, or musculoskeletal conditions other than osteoarthritis.

Both the overweight and obese were significantly more likely to have any cardio-metabolic risk factor: overweight men had a 84% higher chance (odds ratio 1.84, 95% confidence interval: 1.47-2.31) and obese men were four times more likely (OR = 4.07, 95% CI: 3.16-5.25). Women displayed similar, albeit slightly weaker, associations.

Overweight men were 1.4 times more likely (OR = 1.41, 95% CI: 1.12-1.78) to have osteoarhtiritis than normal weight men; obese men were 2.1 times more likely (OR = 2.14; 95% CI = 1.65-2.76).

In the study, the relationship between obesity or overweight and diabetes was only significant among women. The investigators noted, however, that a diabetes diagnosis in the study was based on the participant reporting being diagnosed with the condition by a physician, and that the prevalence of undiagnosed diabetes in Germany is higher among men than women, meaning that the association between overweight or obesity and diabetes in men could be underestimated.

Similarly, the association between obesity and cardiovascular disease was only significant in men; the investigators hypothesised that the missing significance could be due to gender disparities in the diagnosis of cardiovascular conditions, particularly coronary heart disease.

Acknowledging limitations in the trial, the investigators noted that the data in the study was restricted to the German population between 18 and 79 years, meaning that their results could not be generalised to the elderly. The reliance on self-reporting for chronic diseases meant that the study was subject to recall and misclassification errors.

The cross-sectional design of the study also meant that causality or causal direction could not be established between obesity and comorbidity.

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