deployed near the Khamisiyah demolition site was not related to the prevalence of self-reported diabetes (OR 1.0, 95% CI 0.4-2.9). In this same report, being deployed (versus nondeployed) was not associated with the prevalence of diabetes (OR 1.0, 95% CI 0.5-2.4).

Updated and Supplemental Literature
Primary Studies

A study conducted in 1997 on 686 Danish Gulf War veterans and 231 nondeployed veterans found that mean insulin levels, which are predictive of diabetes risk, were similar in deployed (48 pmol/L) and nondeployed (52 pmol/L) (Ishoy et al., 1999b). It should be noted that Danish veterans served mostly as peacekeepers after the end of the conflict.

Finally, the Australian Gulf War veterans study (Sim et al., 2003) obtained random glucose levels in a sample of 1365 male and 30 female deployed veterans and 1365 male and 32 female controls. Levels of blood glucose were comparable in both groups: among deployed and nondeployed men, median plasma glucose was 4.7 mmol/L in both groups, while among deployed and nondeployed women, the average plasma glucose was 5.0 mmol/L and 4.5 mmol/L, respectively. In this study, response rates were higher among deployed (81% in men, 79% in women) than nondeployed veterans (57% in men, 44% in women), which could lead to selection bias. Also, blood glucose levels were not obtained from fasting blood, which limits their value to diagnose diabetes.

McDiarmid and colleagues measured levels of blood glucose in a cohort of deployed veterans exposed to depleted uranium (DU) from friendly-fire followed up with biennial exams. Though these veterans have been observed many times since 1991, levels of blood glucose have been only reported in publications corresponding to the 2005 and 2007 assessments (McDiarmid et al., 2007a, 2009). The authors did not observe any important difference in blood glucose levels between those exposed to low and high levels of DU, though these results are limited due to the small sample size of the cohort (n = 34 in the 2007 publication, corresponding to the 2005 exam; n = 35 in the 2009 publication, corresponding to the 2007 exam), and the lack of adjustment for potential confounders.

Secondary Studies

A number of large-scale epidemiologic studies included self-reported endocrine and metabolic disorders, including diabetes, with onset after the Gulf War. These studies were regarded as secondary studies for the purpose of this review.

Simmons et al. (2004) surveyed all 51,581 male UK veterans who served in the Gulf War and a demographically similar comparison cohort of 51,688 UK male veterans who were not deployed to the gulf. Among the 23,358 deployed men who responded, 0.2% reported having diabetes with onset after 1990, as did 0.4% of 17,730 nondeployed men who responded, for an OR of 0.7 (95% CI 0.5-1.0) adjusted for age at the time of the survey, service and rank at the time of the Gulf War, serving status at the time of the survey, alcohol consumption, and smoking.

A follow-up survey to the 1995 National Health Survey of Gulf War Era Veterans and Their Families conducted in 2004-2005 compared self-reported health status of deployed Gulf War veterans and nondeployed Gulf War veterans (Kang et al., 2009). This survey included 6111 deployed and 3859 nondeployed veterans, out of 15,000 in each group (response rates of 41% in deployed and 26% in nondeployed veterans). The prevalence of a self-reported diagnosis of diabetes was similar in deployed and nondeployed veterans (prevalence ratio 1.11, 95% CI 0.99-1.25), after adjustment for sociodemographic and lifestyle variables. The prevalence of “other

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