There is a paucity of natural history information on the development of glucose intolerance, cardiovascular disease, and subsequent mortality among the Hispanic-American minority in the United States. This analytic proposal has four main components. First, we will determine the incidence of glucose intolerance (IGT and NIDDM), cardiovascular disease, and mortality by ethnicity and gender. Then we will explore risk factor effects on these outcomes and evaluate a model of the role of insulin sensitivity. Next, we will examine risk factors for diabetic complications, and finally determine clinically useful subgroups for intervention planning. We will use the previously collected data from the San Luis Valley Diabetes Study, a population-based prospective study with over 4 years of subject follow-up in rural southern Colorado. In order to plan preventive interventions in Hispanic or other populations, this natural history must be determined, and the possible differential role of risk factors in high risk subgroups (by ethnicity, gender, obesity, family history, etc.) must be identified. Environmental factors to be analyzed include dietary intake, physical activity, smoking, alcohol intake and social processes. Physiologic risk factors include obesity, fat patterning, weight change, lipids, blood pressure, microalbuminuria, uric acid, insulin and glucose tolerance. Outcomes include impaired glucose tolerance, non-insulin dependent diabetes mellitus, cardiovascular diseases (hypertension, stroke, myocardial infarction, peripheral vascular disease), mortality by cause, and among persons with diabetes, diabetic microvascular disease (retinopathy, neuropathy, nephropathy). This is one of only two such prospective data sets on Hispanics and NHWs and the only one that examines rural subjects. Thus, these analyses will add considerably to knowledge of the health and disease risk in the nation's second largest minority population.
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