P Zimmet

Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia

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Publications (206)968.32 Total impact

  • J.B. Dixon · P. Zimmet · K.G. Alberti · F. Rubino
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    ABSTRACT: De Taskforce Epidemiologie en Preventie van de International Diabetes Federation heeft een consensus-werkgroep bijeengebracht bestaande uit diabetologen, endocrinologen, chirurgen en epidemiologen om te beoordelen welke rol bariatrische chirurgie en andere gastrointestinale interventies horen te krijgen in de behandeling en preventie van type 2 diabetes.
    12/2015; 10(4):195-196. DOI:10.1007/s12467-012-0146-4
  • 35th Annual Scientific Meeting of the; 06/2014
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    ABSTRACT: AimTo assess factors influencing glycaemic control following gastric bypass surgery in patients with Type 2 diabetes and BMI 7%). Analysis was conducted using binary logistic regression, and cut-points obtained from receiver operator characteristics. ResultsExcellent glycaemic control was achieved in 31 (30%) at 1 year. Diabetes duration of 27 kg/m2 provided independent predictors and useful cut-points. Likelihood of excellent glycaemic control for an individual could be estimated using loge (Odds) = –6.7 + (0.26 × BMI) + (–1.2 × diabetes duration). Baseline BMI of 16%) were associated with excellent glycaemic control. Higher BMI was associated with greater percentage weight loss. Conclusion In patients with Type 2 diabetes and BMI
    Diabetic Medicine 04/2013; 30(4). · 3.06 Impact Factor
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    ABSTRACT: AimTo assess factors influencing glycaemic control following gastric bypass surgery in patients with Type 2 diabetes and BMI< 30 kg/m2.Methods Prospective longitudinal study of 103 patients with inadequate glycaemic control who underwent gastric bypass surgery at Soonchunhyang University, Seoul, Korea (n = 66) and Min-Sheng General Hospital, Taipei, Taiwan (n = 37). Procedures were performed August 2009 to January 2011. Key outcome measures were excellent glycaemic control of Type 2 diabetes defined as HbA1c < 42 mmol/mol (≤6%); inadequate response defined as HbA1c > 53 mmol/mol (> 7%). Analysis was conducted using binary logistic regression, and cut-points obtained from receiver operator characteristics.ResultsExcellent glycaemic control was achieved in 31 (30%) at 1 year. Diabetes duration of < 7 years and BMI > 27 kg/m2 provided independent predictors and useful cut-points. Likelihood of excellent glycaemic control for an individual could be estimated using loge (Odds) = -6.7 + (0.26 × BMI) + (-1.2 × diabetes duration). Baseline BMI of < 27 kg/m2 and baseline C-peptide of < 2.0ng/ml, best predicted a poor glycaemic response. In those with favourable baseline characteristics percentage weight loss (%WL) had a dominant influence on glycaemic outcomes. Baseline C-peptide (> 2.4 ng/ml) and subsequent percentage weight loss (> 16%) were associated with excellent glycaemic control. Higher BMI was associated with greater percentage weight loss.Conclusion In patients with Type 2 diabetes and BMI < 30 kg/m2, glycaemic response to gastric bypass is predicted by higher baseline BMI, shorter disease duration and higher fasting C-peptide. Post-surgery weight loss has a dominant effect. Baseline BMI and weight loss have a major influence on outcomes.
    Diabetic Medicine 12/2012; 30(4). DOI:10.1111/dme.12107 · 3.06 Impact Factor
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    J B Dixon · P Zimmet · K G Alberti · F Rubino
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    ABSTRACT: The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m(2) or more.
    Diabetic Medicine 06/2011; 28(6):628-42. DOI:10.1111/j.1464-5491.2011.03306.x · 3.06 Impact Factor
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  • Diabetes Care 06/2011; 34(6):1265-9. · 8.57 Impact Factor
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    ABSTRACT: The SH3-domain GRB2-like (endophilin)-interacting protein 1 (SGIP1) gene has been shown to be differentially expressed in the hypothalamus of lean versus obese Israeli sand rats (Psammomys obesus), and is suspected of having a role in regulating food intake. The purpose of this study was to assess the role of genetic variation in SGIP1 in human disease. We performed single-nucleotide polymorphism (SNP) genotyping in a large family pedigree cohort from the island of Mauritius. The Mauritius Family Study (MFS) consists of 400 individuals from 24 Indo-Mauritian families recruited from the genetically homogeneous population of Mauritius. We measured markers of the metabolic syndrome, including diabetes and obesity-related phenotypes such as fasting plasma glucose, waist:hip ratio, body mass index and fat mass. Statistical genetic analysis revealed associations between SGIP1 polymorphisms and fat mass (in kilograms) as measured by bioimpedance. SNP genotyping identified associations between several genetic variants and fat mass, with the strongest association for rs2146905 (P=4.7 × 10(-5)). A strong allelic effect was noted for several SNPs where fat mass was reduced by up to 9.4% for individuals homozygous for the minor allele. Our results show association between genetic variants in SGIP1 and fat mass. We provide evidence that variation in SGIP1 is a potentially important determinant of obesity-related traits in humans.
    International journal of obesity (2005) 03/2011; 36(2):201-6. DOI:10.1038/ijo.2011.67 · 5.39 Impact Factor
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    ABSTRACT: To investigate the association between change in daily step count and both adiposity and insulin sensitivity and the extent to which the association between change in daily step count and insulin sensitivity may be mediated by adiposity. Population based cohort study. Tasmania, Australia. 592 adults (men (n=267), mean age 51.4 (SD 12.2) years; women (n=325), mean age 50.3 (12.3) years) who participated in the Tasmanian component of the national AusDiab Study in 2000 and 2005. Body mass index, waist to hip ratio, and HOMA insulin sensitivity at follow-up in 2005. Over the five year period, the daily step count decreased for 65% (n=382) of participants. Having a higher daily step count in 2005 than in 2000 was independently associated with lower body mass index (0.08 (95% confidence interval 0.04 to 0.12) lower per 1000 steps), lower waist to hip ratio (0.15 (0.07 to 0.23) lower), and greater insulin sensitivity (1.38 (0.14 to 2.63) HOMA units higher) in 2005. The mean increase in HOMA units fell to 0.34 (-0.79 to 1.47) after adjustment for body mass index in 2005. Among community dwelling, middle aged adults, a higher daily step count at five year follow-up than at baseline was associated with better insulin sensitivity. This effect seems to be largely mediated through lower adiposity.
    BMJ (online) 01/2011; 342:c7249. DOI:10.1136/bmj.c7249 · 16.38 Impact Factor
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    E. Barr · A. Brown · J. Boffa · P. Zimmet
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    J W Y Yau · R Kawasaki · F M A Islam · J Shaw · P Zimmet · J J Wang · TY Wong
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    ABSTRACT: The fractal dimension (D(f)) of the retinal vasculature is a global measure of its branching pattern complexity. We examined the relationship of retinal D(f) with diabetes. We conducted a cross-sectional study of 1,577 participants with diabetes and impaired glucose metabolism and normal controls from the population-based Australian Diabetes, Obesity and Lifestyle (AusDiab) study. Retinal D(f) was quantified from fundus photographs using a computer-based programme and diabetes status was determined by oral glucose tolerance test based on the WHO criteria. After adjustment for age, sex and vascular risk factors, persons with higher retinal D(f) were more likely to have diabetes (OR 1.56; 95% CI 1.14-2.14, highest vs lowest fractal tertile). This relationship remained with further adjustment for retinal arteriolar calibre and presence of retinopathy (OR 1.64; 95% CI 1.19-2.27), and after excluding participants with retinopathy (OR 1.60; 95% CI 1.16-2.21). Retinal D (f) was not related to impaired glucose tolerance or impaired fasting glucose (OR 1.19; 95% CI 0.85-1.67). Individuals with diabetes, but not with impaired glucose metabolism, have greater retinal D(f), reflecting greater complexity of the retinal vasculature. Our findings suggest the presence of early microvascular changes in the retinal vasculature of persons with diabetes, even in the absence of overt retinopathy.
    Diabetologia 09/2010; 53(9):2042-5. DOI:10.1007/s00125-010-1811-z · 6.88 Impact Factor
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    ABSTRACT: To develop risk prediction models of future diabetes in Mauritian Indians. Three thousand and ninety-four Mauritian Indians (1141 men, aged 20-65 years) without diabetes in 1987 or 1992 were followed up to 1992 or 1998. Subjects underwent repeated oral glucose tolerance tests and diabetes was diagnosed according to 2006 World Health Organization/International Diabetes Federation criteria. Cox regression models for interval censored data were performed using data from 1544 randomly selected participants. Predicted probabilities for diabetes were calculated and validated in the remaining 1550 subjects. Over 11 years of follow-up, there were 511 cases of diabetes. Among variables tested, family history of diabetes, obesity (body mass index, waist circumference) and glucose were significant predictors of diabetes. Predicted probabilities derived from a simple model fitted with sex, family history of diabetes and obesity ranged from 0.05 to 0.64 in men and 0.03 to 0.49 in women. To predict the onset of diabetes, area under the receiver operating characteristic (ROC) curve (AROC) of predicted probabilities was 0.62 (95% confidence interval, 0.56-0.68) in men and 0.64 (0.59-0.69) in women. At a cut-off point of 0.12, the sensitivity and specificity were 0.72 (0.71-0.74) and 0.47 (0.45-0.49) in men and 0.77 (0.75-0.78) and 0.50 (0.48-0.52) in women, respectively. Addition of fasting plasma glucose (FPG) to the model improved the prediction slightly [AROC curve 0.70 (0.65-0.76) in men, 0.71 (0.67-0.76) in women]. A diabetes prediction model based on obesity and family history yielded moderate discrimination in Mauritian Indians, which was slightly inferior to the model with the FPG but may be useful in low-income countries to promote identification of people at high risk of diabetes.
    Diabetic Medicine 10/2009; 26(10):996-1002. DOI:10.1111/j.1464-5491.2009.02810.x · 3.06 Impact Factor
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    ABSTRACT: The prevalence of coronary heart disease (CHD) was determined in a population survey in Mauritius where the prevalence of non-insulin dependent diabetes and mortality from CHD are amongst the highest in the world. Men and women aged 35–74 years of all major ethnic groups were included: Asian Indians (Hindus and Muslims). Creoles and Chinese. ECG abnormalities suggesting either ‘probable CHD’ or ‘possible CHD’ were defined using standard criteria. The overall prevalence of probable CHD was 2.7% in men and 0.9% in women, and that of probable or possible CHD together 17.8% in men and 33.3% in women. The prevalence of CHD did not vary significantly between the four ethnic groups. In the multivariate analyses, age and high blood pressure were the most important independent predictors of ECG abnormalities. Neither diabetes nor serum insulin seemed to contribute independently to the prevalence of CHD.This survey confirmed the high ranking of Mauritius in international mortality statistics. The high rates of CHD seen in Asian Indians, African-origin Creoles and Chinese in the rapidly developing country of Mauritius may be a pointer to future problems in their regions of origin.
    Journal of Internal Medicine 08/2009; 233(2):187 - 194. DOI:10.1111/j.1365-2796.1993.tb00672.x · 5.79 Impact Factor
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    ABSTRACT: To compare (i) the prevalence and incidence of chronic complications and (ii) cardiac and all-cause mortality in community-based patients with latent autoimmune diabetes in adults (LADA) with those in Type 2 diabetic patients without antibodies to glutamic acid decarboxylase (GAD). Of the 1294 patients with clinically-defined Type 2 diabetes recruited to the longitudinal, observational Fremantle Diabetes Study between 1993 and 1996, 1255 (97%) had GAD antibodies measured at baseline. Complications were ascertained using standard criteria in patients returning for annual assessments until November 2001. Data on hospital admissions and mortality were available to the end of June 2006. Cox proportional hazards modelling was used to determine independent predictors of first occurrence of complications and cardiac and all-cause mortality. Forty-five (3.6%) subjects had LADA. Compared with the GAD antibody-negative patients, they had a similar prevalence and incidence of coronary heart (P = 0.48 and 0.80, respectively) and cerebrovascular (P = 0.64 and 0.29) disease and cardiac and all-cause mortality (P = 0.62 and 0.81, respectively). There was also a similar prevalence and incidence of retinopathy (P = 0.22 and 0.64, respectively) and neuropathy (P = 0.25 and 0.95), but microalbuminuria was less frequent both at baseline and during follow-up in the LADA subgroup in unadjusted models (P = 0.046) and after adjustment for other risk factors (P = 0.014 and 0.013). Except for a lower prevalence and incidence of nephropathy, LADA patients have a similar risk of complications and death to patients with clinically-diagnosed Type 2 diabetes without GAD antibodies. Cardiovascular risk factor management in LADA should, therefore, be as intensive as that for GAD antibody-negative patients.
    Diabetic Medicine 11/2008; 25(10):1245-50. DOI:10.1111/j.1464-5491.2008.02562.x · 3.06 Impact Factor
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    ABSTRACT: To characterize the expression of the small leucine-rich glycoprotein decorin in adipose tissue. Real-time PCR was used to measure decorin gene expression in adipose tissue from normal glucose tolerant (NGT), impaired glucose tolerant and type 2 diabetic (T2D) Psammomys obesus. Adipose tissue was fractionated to determine which cells were responsible for decorin expression. The location of decorin protein expression in adipose tissue was determined using immunohistochemistry. Real-time PCR was used to measure decorin mRNA levels in human adipose tissue from 16 insulin-sensitive, 16 insulin-resistant and 6 T2D human subjects. Circulating plasma decorin concentrations were measured by enzyme-linked immunosorbent assay in 145 NGT and 141 T2D human individuals from a large-scale epidemiological study in Mauritius. Decorin mRNA was found to be highly expressed in adipose tissue, and decorin gene expression was significantly higher in visceral than that in subcutaneous adipose tissue depots in both P. obesus and human subjects (P=0.002 and P=0.001, respectively). Decorin mRNA was predominantly expressed by stromal/vascular cells of adipose tissue, and decorin protein in adipose tissue was primarily detected adjacent to blood vessels. Circulating plasma decorin levels in humans were elevated by 12% in T2D (P=0.049) compared to NGT subjects. There was a significant independent correlation between plasma decorin levels and waist-to-hip ratio (WHR, P=0.024). In male subjects, plasma decorin levels were significantly correlated with WHR (P=0.006), and fasting and 2-h glucose levels in an oral glucose tolerance test (P=0.027 and P=0.001, respectively). Decorin expression in adipose tissue was markedly upregulated in the obese state and may therefore play a role in adipose tissue homeostasis or in pathophysiology associated with obesity.
    International journal of obesity (2005) 08/2008; 32(7):1113-21. DOI:10.1038/ijo.2008.41 · 5.39 Impact Factor
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    ABSTRACT: In this paper, the islet autoimmunity status and relation to clinical characteristics, beta cell function and cardio-metabolic risk factors in young-onset Asian diabetic patients are evaluated at baseline. The study population consisted of 912 patients (from China, India, Malaysia and Singapore) with age 12-40 years and diabetes duration <12 months. Autoantibodies to glutamic acid decarboxylase (GADA) and tyrosine phosphatase (IA-2A), beta cell function and cardio-metabolic risk parameters were assessed. Among our young patient cohort, 105 (11.5%) patients were GADA and/or IA-2A positives (Ab +ve). Ab +ve patients were younger, leaner, had more severe hyperglycaemia and lower beta cell function. The frequency of metabolic syndrome was significantly lower in Ab +ve patients (27%) compared to Ab -ve patients (54%). However, a substantial proportion of patients in both groups of patients had atherogenic dyslipidaemia, hypertension and albuminuria (micro or macro). In our study cohort, only one in 10 Asian youth with new-onset diabetes had evidence of islet autoimmunity. At least 60% of Ab +ve and 50% of Ab -ve patients demonstrated classical features of type 1 and type 2 diabetes respectively. Regardless of autoimmunity status, the cardio-metabolic risk factors, in particular atherogenic dyslipidaemia, hypertension and albuminuria were common in our patients with young-onset diabetes.
    Diabetes research and clinical practice 06/2008; 80(2):224-30. DOI:10.1016/j.diabres.2007.12.003 · 2.54 Impact Factor
  • M C Devers · S Campbell · J Shaw · P Zimmet · D Simmons
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    ABSTRACT: The definition of metabolic syndrome (MS) continues to be debated and does not include abnormal liver function tests (LFTs). This study aims to determine: (1) the association between the five ATP3 MS diagnostic components and different LFTs, and (2) the association between raised LFTs and prevalent cardiovascular disease (CVD). A total of 1357 patients, without alcoholism or known liver disease, from randomly selected households from rural Victoria, Australia, attended for biomedical assessment. Receiver operating characteristic (ROC) areas under the curve (AUC) were determined for associations between the ATP3 diagnostic components, and between LFTs and ATP3 diagnostic components. The range of ROC AUC for ATP3 diagnostic components was 0.60-0.77. Waist had the strongest association and blood pressure the weakest. The strength of association between ATP3 diagnostic components and gamma GT (GGT) was similar (0.63-0.72), but was less for alanine transaminase and aspartate transaminase. Using the ROC-derived GGT cut-off (men 27 IU, women 20 IU), those with MS and a high GGT had more CVD than those with MS and a low GGT, and those without MS (18% vs. 10% vs. 7%, respectively; P < 0.001). Among those with MS, after adjusting for covariates, the odds ratio of CVD was 2.66 (1.18-5.96) for a high GGT compared to a low GGT. CVD was not significantly more prevalent in MS patients with a low GGT compared to non-MS patients. We suggest that including a raised GGT in the criteria for MS could increase its predictive nature for CVD. Prospective studies are needed to confirm this finding.
    Diabetic Medicine 06/2008; 25(5):523-9. DOI:10.1111/j.1464-5491.2008.02408.x · 3.06 Impact Factor
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    Diabetes Care 05/2008; 31(5):1007-14. · 8.57 Impact Factor

Publication Stats

8k Citations
968.32 Total Impact Points

Institutions

  • 2009–2013
    • Baker IDI Heart and Diabetes Institute
      • Clinical Diabetes and Epidemiology Research Group
      Melbourne, Victoria, Australia
  • 1982–2008
    • Diabetes Australia, Victoria
      Melbourne, Victoria, Australia
  • 2006–2007
    • Imperial College Healthcare NHS Trust
      Londinium, England, United Kingdom
  • 2005
    • Mount Sinai Hospital
      New York City, New York, United States
  • 1989–2003
    • Monash University (Australia)
      • • Department of Epidemiology and Preventive Medicine
      • • Department of Biochemistry and Molecular Biology
      Melbourne, Victoria, Australia
    • Washington University in St. Louis
      • Department of Psychiatry
      San Luis, Missouri, United States
  • 1979–1999
    • Royal Melbourne Hospital
      Melbourne, Victoria, Australia
  • 1997
    • Deakin University
      • School of Exercise and Nutrition Sciences
      Geelong, Victoria, Australia
  • 1996
    • Hospital Clínico San Carlos
      Madrid, Madrid, Spain
  • 1986–1996
    • National Public Health Institute
      Helsinki, Southern Finland Province, Finland
  • 1995
    • Mahidol University
      Krung Thep, Bangkok, Thailand
  • 1992
    • University of Sydney
      • School of Public Health
      Sydney, New South Wales, Australia
  • 1984
    • University of Kuopio
      Kuopio, Eastern Finland Province, Finland
    • St. Vincent's Hospital Melbourne
      Melbourne, Victoria, Australia
  • 1983
    • Royal Victorian Eye and Ear Hospital
      Melbourne, Victoria, Australia
  • 1978–1981
    • Alfred Hospital
      Melbourne, Victoria, Australia