英文摘要
The epidemiologic transition of type 2 diabetes mellitus in Taiwan: Implications for A reversal of female preponderance from a national cohortC-H Tseng, Department of Internal Medicine, National Taiwan University College of Medicine;Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital; Department of Medical Research and Development, National Taiwan University Hospital Yun-Lin Branch, Taiwan.
The prevalence of diabetes mellitus is increasing with female preponderance in Taiwan. Whether a gender difference in mortality and/or incidence of diabetes can attribute to these epidemiologic phenomena is interesting and important.
The National Health Insurance (NHI) is a very unique health care system in Taiwan which covered more than 96% of the total population at its initial implementation. To answer a series of epidemiologic questions on diabetes in Taiwan, a national cohort of 256,036 diabetic patients (cohort I) using the NHIwas established during the year 1995 to 1998. Among them 93,484 cases (cohort II) were successfully interviewed by telephone from a subsample of cohort I. A further subsample of 16,994 cases (cohort III) was used for prospective long-term follow-upand a total of 1441 cases (cohort IV) participated in an extensive health examination with the collection of detailed personal information, biospecimens of urine and blood and complete laboratory examinations for diabetic chronic complications.
The prospective follow-up for the mortality of cohort I showed that the diabetic men consistently had a higher mortality rate than women in all age groups in Taiwan. This finding gives part of the explanation to the female preponderance in diabetes prevalence.
The incidence trends of type 2 diabetes from 1992 to 1996 for the different age groups in men and women calculated from cohort II disclosed an increasing trend of incidence, which is much more remarkable in the younger generation, especially in the male sex. Obesity could explain this increasing trend of diabetes incidence in the younger men in Taiwan. Therefore a possibility of reversal trend of sex preponderance in diabetes prevalence is expected in the years to come, which was evidenced from the recent national survey in 2002 showing male preponderance in diabetes prevalence in the population aged below 60 years in contrast to a female preponderance in the older population.
Analyzing the prevalence of lower extremity amputation (cohort II), stroke (cohort III) and coronary heart disease (cohort III) in the diabetic patients suggests significant age and sex differences in macrovascular complications with male preponderance. The analysis of incidence of hypertension in cohort II also revealed a higher risk in the diabetic men than the diabetic women. Because mortality in the diabetic patients is closely associated with the macrovascular complications, for which hypertension is the most important risk factor, the higher risk of hypertension and the higher prevalence of macrovascular complications in the diabetic men than women in our population gives good explanation for the higher mortality in the diabetic men.
In conclusions, increasing prevalence of diabetes with female preponderance had been observed for decades in Taiwan, which can be explained partly by the higher risk of morbidity and mortality in the diabetic men and an overall higher incidence in women of all ages. However, obesity-related diabetes has been increasing over the past decade, which is especially remarkable in the younger generation of the male sex. Therefore the sex preponderance in diabetes is expected to change from women to men in Taiwan rolling from the past decades to the future.
中文之題目、作者機關名
臺灣第2型糖尿病的流行病學變遷：由一個全國世代之系列追蹤研究顯示女性盛行率之優勢比例將趨消失曾慶孝
臺大醫學院內科、臺大醫院內科部內分泌暨新陳代謝科、臺大醫院雲林分院醫學研究發展部
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CLINICAL CHARACTERISTICS OF POORLY DIFFERENTIATED THYROID CARCINOMAS COMPARED WITH THOSE OF CLASSICAL PAPILLARY THYROID CARCINOMASJ-D Lin, 1T-C Chao,2C Hsueh, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, R.O.C.1Department of General Surgery, Chang Gung Memorial Hospital, Taiwan, R.O.C.2Department of Pathology, Chang Gung Memorial Hospital, Taiwan, R.O.C.
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OBJECTIVE This study compared clinical presentation and prognosis of poorly differentiated thyroid carcinoma (PDTC) with those of classical papillary thyroid carcinoma to identify the appropriate surgical modalities for use in conjunction with radioactive iodide (131I) therapy and external radiotherapy for treating PDTC.
中文之題目、作者機關名
分化不良甲狀腺癌與傳統乳突性甲狀腺癌之臨床特徵林仁德，1趙子傑，2薛純
林口長庚醫院內科部新陳代謝科，1一般外科，2病理科