This proposal is designed to extend prospective studies of the epidemiology of non-insulin dependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) and their comorbidities in the Rancho Bemardo cohort. This defined population of older adults was studied initially in 1972-74, and more extensively in 1984-87. The latter study included 2,859 participants aged 40+, 2480 of whom had a 75 gm oral glucose tolerance test (OGTT). Of the latter, 166 men and 158 women had NIDDM and 237 men and 348 women had IGT, based on World Health Organization criteria. This study included lifestyle and medical histories; anthropometry; blood pressure; lipid and lipoprotein measurements; visual acuity tests; retinal photographs; an electrocardiogram; dietary and psychosocial evaluations; renal functions tests; and (in a subset) hormone measurements. In this proposal we will use the surviving 1984-1987 participants who were characterized for carbohydrate tolerance by OGTT, cardiovascular disease (CVD), eye and renal disease and multiple attributes as the baseline cohort (n = 2480). Some earlier data will also be used to establish stability of attributes (e.g. blood pressure, obesity, lipids, fasting plasma glucose). We propose a repeat evaluation with regard to OGTT, CVD, eye and renal disease, and diverse behavioral, biochemical and endocrinological covariates. This will allow us to determine the incidence and determinants of NIDDM and IGT in older adults. We will also determine morbidity and mortality over time in the presence or absence of abnormal carbohydrate tolerance, and describe in greater detail the characteristics and clustering of complications in a population-based sample of older diabetics, and their relationship cross-sectionally and prospectively to multiple endogenous and exogenous characteristics. We will also extend the mortality follow-up of the cohort long enough to determine whether fasting and/or postchallenge hyperglycemia and/or hyperinsulinemia are risk factors for all cause and cardiovascular death in the elderly or are clinically important concommitants of aging.
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