This proposal is designed to extend prospective studies of the epidemiology of noninsulindependent diabetes mellitus (NIDDM) and impaired glucose tolerance (IGT) and their comorbidities in the Rancho Bernardo cohort. This defined population of older adults was studied initially in 1972-4, and more extensively in 1984. The latter study included 2,859 participants aged 40+, of whom 212 men and 185 women had NIDDM and 227 men and 333 women had IGT, based on a 75 gem oral glucose tolerance test and National Diabetes Data Group (NDDG) criteria. This study included lifestyle and medical histories, anthropometry, blood pressure, lipid and lipoprotein measurements, visual acuity tests, retinal photographs, and electrocardiogram, dietary and psychosocial evaluations, liver and renal functions tests, and sex hormones and insulin measurements (in a subset). By the end of current funding, detailed analyses of the prevalence, incidence and predictors of NIDDM and IGT will have been completed, but we will have barely tapped the potential of this rich database to elucidate the natural history and co-morbidity of NIDDM and IGT in a free-living population that includes the appropriate euglycemic comparison cohort. Continuation support is necessary 1) for further data collection in order to validate and characterize unconfirmed self-reported NIDDM and myocardial infarction and to extend morbidity and mortality follow-up of this cohort for another 5 years, and 2) for more detailed data analysis to determine prospectively the relationship of NDDG-defined NIDDM and IGT to subsequent morbidity and mortality, with a particular focus on cardiovascular disease, and to determine the relationship of NIDDM, IGT, euglycemia, and obesity to cardiovascular, renal and ocular disease (and other morbidity) in older adults
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