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Pennells L, Kaptoge S, Østergaard HB, Read SH, Carinci F, Franch-Nadal J, Petitjean C, Taylor O, Hageman SHJ, Xu Z, Shi F, Spackman S, Gualdi S, Holman N, Da Providencia E Costa RB, Bonnet F, Brenner H, Gillum RF, Kiechl S, Lawlor DA, Potier L, Schöttker B, Sofat R, Völzke H, Willeit J, Baltane Z, Fava S, Janos S, Lavens A, Pildava S, Poljicanin T, Pristas I, Rossing P, Sascha R, Scheidt-Nave C, Stotl I, Tibor G, Urbančič-Rovan V, Vanherwegen AS, Vistisen D, Du Y, Walker MR, Willeit P, Ference B, De Bacquer D, Halle M, Huculeci R, McEvoy JW, Timmis A, Vardas P, Dorresteijn JAN, Graham I, Wood A, Eliasson B, Herrington W, Danesh J, Mauricio D, Benedetti MM, Sattar N, Visseren FLJ, Wild S, Di Angelantonio E, Balkau B, Bonnet F, Fumeron F, Stocker H, Holleczek B, Schipf S, Schmidt CO, Dörr M, Tilg H, Leitner C, Notdurfter M, Taylor J, Dale C, Prieto-Merino D, Gillum RF, Lavens A, Vanherwegen AS, Poljicanin T, Pristas I, Buble T, Ivanko P, Rossing P, Carstensen B, Heidemann C, Du Y, Scheidt-Nave C, Gall T, Sandor J, Baltane Z, Pildava S, Lepiksone J, Magri CJ, Azzopardi J, Stotl I, Real J, Vlacho B, Mata-Cases M. SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe. Eur Heart J 2023; 44:2544-2556. [PMID: 37247330 PMCID: PMC10361012 DOI: 10.1093/eurheartj/ehad260] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 04/06/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
AIMS To develop and validate a recalibrated prediction model (SCORE2-Diabetes) to estimate the 10-year risk of cardiovascular disease (CVD) in individuals with type 2 diabetes in Europe. METHODS AND RESULTS SCORE2-Diabetes was developed by extending SCORE2 algorithms using individual-participant data from four large-scale datasets comprising 229 460 participants (43 706 CVD events) with type 2 diabetes and without previous CVD. Sex-specific competing risk-adjusted models were used including conventional risk factors (i.e. age, smoking, systolic blood pressure, total, and HDL-cholesterol), as well as diabetes-related variables (i.e. age at diabetes diagnosis, glycated haemoglobin [HbA1c] and creatinine-based estimated glomerular filtration rate [eGFR]). Models were recalibrated to CVD incidence in four European risk regions. External validation included 217 036 further individuals (38 602 CVD events), and showed good discrimination, and improvement over SCORE2 (C-index change from 0.009 to 0.031). Regional calibration was satisfactory. SCORE2-Diabetes risk predictions varied several-fold, depending on individuals' levels of diabetes-related factors. For example, in the moderate-risk region, the estimated 10-year CVD risk was 11% for a 60-year-old man, non-smoker, with type 2 diabetes, average conventional risk factors, HbA1c of 50 mmol/mol, eGFR of 90 mL/min/1.73 m2, and age at diabetes diagnosis of 60 years. By contrast, the estimated risk was 17% in a similar man, with HbA1c of 70 mmol/mol, eGFR of 60 mL/min/1.73 m2, and age at diabetes diagnosis of 50 years. For a woman with the same characteristics, the risk was 8% and 13%, respectively. CONCLUSION SCORE2-Diabetes, a new algorithm developed, calibrated, and validated to predict 10-year risk of CVD in individuals with type 2 diabetes, enhances identification of individuals at higher risk of developing CVD across Europe.
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Fava MC, Reiff S, Azzopardi J, Fava S. Time trajectories of key cardiometabolic parameters and of cardiovascular risk in subjects with diabetes in a real world setting. Diabetes Metab Syndr 2023; 17:102777. [PMID: 37216853 DOI: 10.1016/j.dsx.2023.102777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIMS Diabetes is associated with increased cardiovascular risk. Glycated haemoglobin (HbA1c), lipid parameters and blood pressure are known risk factors for adverse outcome. The aim of the study was to explore the time trajectories of these key parameters and of the associated cardiovascular risk. METHODS We linked the diabetes electronic health records to the laboratory information system so as to investigate the trajectories of key metabolic parameters from 3 years prior to the diagnosis of diabetes to 10 years after diagnosis. We calculated the cardiovascular risk at the different time points during this period using the United Kingdom Prospective Study (UKPDS) risk engine. RESULTS The study included 21,288 patients. The median age at diagnosis was 56 years and 55.3% were male. There was a sharp decrease in HbA1c after diagnosis of diabetes, but there was a progressive rise thereafter. All lipid parameters after diagnosis also improved in the year of diagnosis, and these improvements persisted even up to 10 years post-diagnosis. There was no discernible trend in mean systolic or diastolic blood pressures following diagnosis of diabetes. There was a slight decrease in the UKPDS-estimated cardiovascular risk after diagnosis of diabetes followed by a progressive increase. Estimated glomerular filtration rate declined at an average rate of 1.33 ml/min/1.73 m2/year. CONCLUSIONS Our data suggest that lipid control should be tightened with increasing duration of diabetes since this is more readily achievable than HbA1c lowering and since other factors such as age and duration of diabetes are unmodifiable.
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Affiliation(s)
| | | | | | - Stephen Fava
- Mater Dei Hospital, Malta; University of Malta Medical School, Malta.
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Carinci F, Štotl I, Cunningham SG, Poljicanin T, Pristas I, Traynor V, Olympios G, Scoutellas V, Azzopardi J, Doggen K, Sandor J, Adany R, Løvaas KF, Jarosz-Chobot P, Polanska J, Pruna S, de Lusignan S, Monesi M, Di Bartolo P, Scheidt-Nave C, Heidemann C, Zucker I, Maurina A, Lepiksone J, Rossing P, Arffman M, Keskimäki I, Gudbjornsdottir S, Di Iorio CT, Dupont E, de Sabata S, Klazinga N, Benedetti MM. Making Use of Comparable Health Data to Improve Quality of Care and Outcomes in Diabetes: The EUBIROD Review of Diabetes Registries and Data Sources in Europe. Front Clin Diabetes Healthc 2021; 2:744516. [PMID: 36994337 PMCID: PMC10012140 DOI: 10.3389/fcdhc.2021.744516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/08/2021] [Indexed: 12/16/2022]
Abstract
BackgroundRegistries and data sources contain information that can be used on an ongoing basis to improve quality of care and outcomes of people with diabetes. As a specific task of the EU Bridge Health project, we carried out a survey of diabetes-related data sources in Europe.ObjectivesWe aimed to report on the organization of different sources of diabetes information, including their governance, information infrastructure and dissemination strategies for quality control, service planning, public health, policy and research.MethodsSurvey using a structured questionnaire to collect targeted data from a network of collaborating institutions managing registries and data sources in 17 countries in the year 2017.ResultsThe 18 data sources participating in the study were most frequently academic centres (44.4%), national (72.2%), targeting all types of diabetes (61.1%) covering no more than 10% of the target population (44.4%). Although population-based in over a quarter of cases (27.8%), sources relied predominantly on provider-based datasets (38.5%), fewer using administrative data (16.6%). Data collection was continuous in the majority of cases (61.1%), but 50% could not perform data linkage. Public reports were more frequent (72.2%) as well as quality reports (77.8%), but one third did not provide feedback to policy and only half published ten or more peer reviewed papers during the last 5 years.ConclusionsThe heterogeneous implementation of diabetes registries and data sources hampers the comparability of quality and outcomes across Europe. Best practices exist but need to be shared more effectively to accelerate progress and deliver equitable results for people with diabetes.
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Affiliation(s)
- Fabrizio Carinci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
- *Correspondence: Fabrizio Carinci,
| | - Iztok Štotl
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Scott G. Cunningham
- Department of Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | - Tamara Poljicanin
- Division for Health Informatics and Biostatistics, Croatian Institute of Public Health, Zagreb, Croatia
| | - Ivan Pristas
- Division for Health Informatics and Biostatistics, Croatian Institute of Public Health, Zagreb, Croatia
| | - Vivie Traynor
- Diabetes Department, Larnaca Hospital Cyprus, Larnaca, Cyprus
| | - George Olympios
- Diabetes Department, Larnaca Hospital Cyprus, Larnaca, Cyprus
| | - Vasos Scoutellas
- Diabetes Department, Larnaca Hospital Cyprus, Larnaca, Cyprus
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | | | - Kris Doggen
- Health Services Research, Sciensano, Brussels, Belgium
| | - János Sandor
- Department of Public Health and Epidemiology, School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Roza Adany
- Department of Public Health and Epidemiology, School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Karianne F. Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Przemka Jarosz-Chobot
- Department of Children’s Diabetology, Medical University of Silesia, Katowice, Poland
| | - Joanna Polanska
- Department of Data Science and Engineering, The Silesian University of Technology, Gliwice, Poland
| | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marcello Monesi
- Diabetes Unit “Sant’Anna” Hospital Ferrara, Ferrara, Italy
- Associazione Medici Diabetologi (AMD), Rome, Italy
| | - Paolo Di Bartolo
- Associazione Medici Diabetologi (AMD), Rome, Italy
- Azienda Unità Sanitaria Locale (AUSL) Diabetes Unit Romagna, Ravenna, Italy
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christin Heidemann
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Inbar Zucker
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anita Maurina
- Research and Health Statistics Department, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Jana Lepiksone
- Research and Health Statistics Department, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | | | - Martti Arffman
- Welfare State Research and Reform Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Ilmo Keskimäki
- Welfare State Research and Reform Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Soffia Gudbjornsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska Hospital, Gothenburg, Sweden
| | | | - Elisabeth Dupont
- International Diabetes Federation European Region, Brussels, Belgium
| | - Stella de Sabata
- International Diabetes Federation European Region, Brussels, Belgium
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Massimo Massi Benedetti
- International Diabetes Federation European Region, Brussels, Belgium
- Hub for International Health Research, Perugia, Italy
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Brunetto Y, Farr-Wharton B, Farr-Wharton R, Shacklock K, Azzopardi J, Saccon C, Shriberg A. Comparing the impact of management support on police officers’ perceptions of discretionary power and engagement: Australia, USA and Malta. The International Journal of Human Resource Management 2017. [DOI: 10.1080/09585192.2017.1375964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yvonne Brunetto
- School of Business & Tourism, Southern Cross University , Bilinga, Australia
| | - Ben Farr-Wharton
- Management Discipline Group, University of Technology Sydney , Ultimo, Australia
| | - Rod Farr-Wharton
- School of Business, University of the Sunshine Coast , Maroochydore, Australia
| | - Kate Shacklock
- Griffith Business School, Griffith University , Southport, Australia
| | - Joseph Azzopardi
- Faculty of Economics, Management and Accountancy, Department of Management, University of Malta , Msida, Malta
| | - Chiara Saccon
- Department of Management, Ca’Forscari University , Venice, Italy
| | - Art Shriberg
- Management and Entrepreneurship, Xavier University , Cincinnati, OH, USA
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Abstract
Purpose
The purpose of this paper is to represent the findings from the first phase of an ongoing research project whose primary goal is to identify the most significant organizational internal and external cultural variables that leverage and enable a firm’s intellectual capital (IC) to make it more competitive in the marketplace.
Design/methodology/approach
The authors build on their earlier work in which Ulrich’s definition of IC as Competence × Commitment was expanded to include two additional dimensions, Creativity and Culture. The previous model explored the relationship between IC and the following five critical variables: Competence, Commitment, Control, Creativity and Culture. Here, the authors identify the most significant organizational internal and external cultural variables that leverage and enable a firm’s IC to make it more competitive in the marketplace.
Findings
This paper demonstrates the interplay between different cultural types and levels of business volatility on IC. The authors argue that the more volatile the industry is, the greater the need to secure and capitalize on IC, and the more critical it is for firms to adopt a flexible and adaptive organic culture that encourages the creation and leveraging of IC.
Originality/value
This framework is original and expands on Ulrich’s classical work on IC. It helps senior leaders and managers explore how to effectively and proactively capitalize on IC and leverage complex IC assets. The preliminary exploration into these convergent strands has provided a foundation to further develop and establish the interrelationships between organizational culture and IC.
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Cunningham SG, Carinci F, Brillante M, Leese GP, McAlpine RR, Azzopardi J, Beck P, Bratina N, Bocquet V, Doggen K, Jarosz-Chobot PK, Jecht M, Lindblad U, Moulton T, Metelko Ž, Nagy A, Olympios G, Pruna S, Skeie S, Storms F, Di Iorio CT, Massi Benedetti M. Core Standards of the EUBIROD Project. Defining a European Diabetes Data Dictionary for Clinical Audit and Healthcare Delivery. Methods Inf Med 2015; 55:166-76. [PMID: 26666452 DOI: 10.3414/me15-01-0016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND A set of core diabetes indicators were identified in a clinical review of current evidence for the EUBIROD project. In order to allow accurate comparisons of diabetes indicators, a standardised currency for data storage and aggregation was required. We aimed to define a robust European data dictionary with appropriate clinical definitions that can be used to analyse diabetes outcomes and provide the foundation for data collection from existing electronic health records for diabetes. METHODS Existing clinical datasets used by 15 partner institutions across Europe were collated and common data items analysed for consistency in terms of recording, data definition and units of measurement. Where necessary, data mappings and algorithms were specified in order to allow partners to meet the standard definitions. A series of descriptive elements were created to document metadata for each data item, including recording, consistency, completeness and quality. RESULTS While datasets varied in terms of consistency, it was possible to create a common standard that could be used by all. The minimum dataset defined 53 data items that were classified according to their feasibility and validity. Mappings and standardised definitions were used to create an electronic directory for diabetes care, providing the foundation for the EUBIROD data analysis repository, also used to implement the diabetes registry and model of care for Cyprus. CONCLUSIONS The development of data dictionaries and standards can be used to improve the quality and comparability of health information. A data dictionary has been developed to be compatible with other existing data sources for diabetes, within and beyond Europe.
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Affiliation(s)
- S G Cunningham
- Dr Scott G. Cunningham, Clinical Technology Centre, Level 7, Ninewells Hospital, Dundee, DD1 9SY, UK, E-mail:
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Azzopardi J, DeWitt DE. Quality and safety issues in procedural rural practice: a prospective evaluation of current quality and safety guidelines in 3000 colonoscopies. Rural Remote Health 2012; 12:1949. [PMID: 22985075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Colonoscopy remains the gold standard for the investigation and management of bowel pathology. A 2009 National Bowel Cancer Screening Program Quality Working Group report revealed that small rural towns in inner regional Victoria, Australia, for example Echuca (Rural and Remote Metropolitan Areas [RRMA] 4), registered 10.5 colonoscopies per 1000 population versus 18.5 per 1000 in the state capital Melbourne. Reasons for this discrepancy include lack of skilled practitioners in rural communities and travel time for patients to attend larger centres when the required bowel preparation or mobility issues limit access. Ideally, services are high quality, safe and local. This study assessed the quality and safety of a rural GP colonoscopy service. METHODS The indications, findings, caecal intubation rates, complications and completion time were recorded for 3000 serial colonoscopies performed by one rural procedural GP from 1995 to 2011 in Victorian Echuca. Quality was assessed using caecal intubation rate, polyp and colorectal carcinoma detection rates, and completion time. Safety was determined by complication rates. RESULTS The caecal intubation rate was 97% (excluding stenosing lesions), polypectomy detection rate was 39%, carcinoma detection rate was 2%, and the average time to completion was 17 min. Re-admission rates were 1.6/1000 for haemorrhage and 1.2/1000 for perforation. There were no deaths. CONCLUSIONS The results from this study compare favourably with published international standards, validate Australian general practice procedural training standards, and validate the additional quality measure of 'colonoscopy completion time'. Rural GPs can provide a safe and high quality service. Extending this service model to similar settings could improve reduced access to colonoscopy for rural Australians.
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Affiliation(s)
- J Azzopardi
- University of Melbourne Rural Health Academic Centre-Melbourne Medical School, Victoria, Australia.
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Di Iorio CT, Carinci F, Brillante M, Azzopardi J, Beck P, Bratina N, Cunningham SG, De Beaufort C, Debacker N, Jarosz-Chobot P, Jecht M, Lindblad U, Moulton T, Metelko Z, Nagy A, Olympios G, Pruna S, Roder M, Skeie S, Storms F, Massi Benedetti M. Cross-border flow of health information: is 'privacy by design' enough? Privacy performance assessment in EUBIROD. Eur J Public Health 2012; 23:247-53. [DOI: 10.1093/eurpub/cks043] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Di Iorio CT, Carinci F, Azzopardi J, Baglioni V, Beck P, Cunningham S, Evripidou A, Leese G, Loevaas KF, Olympios G, Federici MO, Pruna S, Palladino P, Skeie S, Taverner P, Traynor V, Benedetti MM. Privacy impact assessment in the design of transnational public health information systems: the BIRO project. J Med Ethics 2009; 35:753-761. [PMID: 19948932 DOI: 10.1136/jme.2009.029918] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To foster the development of a privacy-protective, sustainable cross-border information system in the framework of a European public health project. MATERIALS AND METHODS A targeted privacy impact assessment was implemented to identify the best architecture for a European information system for diabetes directly tapping into clinical registries. Four steps were used to provide input to software designers and developers: a structured literature search, analysis of data flow scenarios or options, creation of an ad hoc questionnaire and conduction of a Delphi procedure. RESULTS The literature search identified a core set of relevant papers on privacy (n = 11). Technicians envisaged three candidate system architectures, with associated data flows, to source an information flow questionnaire that was submitted to the Delphi panel for the selection of the best architecture. A detailed scheme envisaging an "aggregation by group of patients" was finally chosen, based upon the exchange of finely tuned summary tables. CONCLUSIONS Public health information systems should be carefully engineered only after a clear strategy for privacy protection has been planned, to avoid breaching current regulations and future concerns and to optimise the development of statistical routines. The BIRO (Best Information Through Regional Outcomes) project delivers a specific method of privacy impact assessment that can be conveniently used in similar situations across Europe.
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Abstract
Each of ten adult patients consecutively admitted in DKA (diabetic ketoacidosis) was infused with either 0.15 or 0.12 mol/l saline as part of the treatment regimen. Computerized tomography (CT) scans of the brain were performed before treatment, and at 6-12 and 24 h together with a number of blood variables. The CT scans of a group of ten patients with no history of diabetes were studied as controls. The CT scans of all diabetic patients in DKA showed a definite increase in brain tissue density when compared with those of non-diabetic subjects (mean 36.2 vs. 28.9 Hounsfield units (HU), P<0.001). This did not change with either fluid regimen over the first 24 h. There was a statistically significant difference in brain tissue density between the CT scans of patients in DKA compared with CT scans taken >6 months after the last episode of DKA (32.6 vs. 25.4 HU, P<0.001). The CT scans taken >6 months after the last episode of DKA showed normal brain tissue density with no statistically significant differences from those of control scans. The density of diabetic brains on CT scanning during ketoacidosis is increased; this may be due to cerebral dehydration. This paper does not provide any evidence of cerebral oedema in adults during the treatment of ketoacidosis with isotonic and hypotonic fluids.
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12
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Abstract
OBJECTIVE To investigate whether the DD genotype is a predictor of mortality and of the decline in renal function in patients with type 2 diabetes and established nephropathy. RESEARCH DESIGN AND METHODS A total of 56 such patients of Maltese Caucasian descent were recruited, and their ACE genotype was determined. Serum creatinine was estimated approximately every 4 months. The glomerular filtration rate (GFR) was calculated according to the Cockroft-Gault formula, and rate of change was determined by regression analysis. RESULTS The rate of change in calculated GFR was -7.76 ml.min(-1).year(-1) in those with the DD genotype (n = 31) and -1.17 ml. min(-1). h(-1) in those with the ID or II genotype (n = 25) (P < 0.01). The 3-year mortality was 45.2% in the DD group compared with 20.0% in the ID/II group (P < 0.05). CONCLUSIONS The DD genotype of the ACE gene polymorphism is associated with a more rapid decline in renal function and higher mortality in type 2 diabetic patients with established nephropathy.
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Affiliation(s)
- S Fava
- Diabetes Clinic, St. Luke's Hospital, Guardamangia, Malta.
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13
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Abstract
BACKGROUND Short stature has been shown to be associated with proteinuria in type 1 diabetes, but no data exist with respect to type 2 diabetes. The objective of the study was to investigate the relationship between final adult height and macroproteinuria in type 2 diabetic patients. METHODS One hundred and forty-four consecutive type 2 diabetic patients (84 males, 60 females) with macroproteinuria were recruited into the study. For every patient, three diabetic controls matched for age, gender, and duration of diabetes were randomly selected. Height was measured in patients and controls to the nearest 0.5 cm. RESULTS The mean height in men with macroproteinuria (n = 84) was 164.4 cm (SD 6.74) compared to 166.6 cm (SD 6.64) in controls (n = 252) (P < 0.01). The mean height in women with macroproteinuria (n = 60) was 150.6 cm (SD 5.20) compared to 152.5 cm (SD 5.78) in controls (n = 180) (P < 0.02). CONCLUSION Short stature is associated with an increased risk of macroproteinuria in type 2 diabetic patients. We postulate that common genetic or environmental factors that affect final adult height might also predispose to the development of nephropathy.
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Affiliation(s)
- S Fava
- Diabetes Clinic, St Luke's Hospital, Malta. University of Exeter, Exeter, UK. University of Malta, King's College Hospital, London, UK
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Abstract
There is strong evidence for clustering of renal disease in type 1 diabetes, but few data exist with respect to type 2 diabetes. The objective of this case-control study is to determine whether there is a familial predisposition to the development of proteinuria in patients with type 2 diabetes. Fifty patients with type 2 diabetes with macroproteinuria (protein > or = 500 mg/24 h) with no evidence of causes other than diabetic nephropathy on investigation were identified through routine screening. These patients had 25 living sibs with diabetes, of whom 24 sibs agreed to participate on the study. For each of these sibs, two controls with non-insulin-dependent diabetes were randomly selected, individually matched for age, sex, and duration of diabetes. Twelve of 24 sibs (50%) and 9 of 48 controls (18.8%) had proteinuria (P < 0.01). Systolic and diastolic blood pressure and the proportion on antihypertensive treatment were similar in the two groups. Our data suggest there is increased prevalence of macroproteinuria in diabetic sibs of macroproteinuric patients with type 2 diabetes in a population of white, Caucasian, European descent.
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Affiliation(s)
- S Fava
- St Luke's Hospital, Guardamangia, Malta
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Abstract
It is known that most acute cardiovascular events exhibit a circadian rhythm in their onset. The authors describe differences in the circadian rhythm of onset of acute pulmonary edema and associated acute myocardial infarction in diabetic and nondiabetic patients.
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Affiliation(s)
- S Fava
- Diabetes Clinic, Department of Medicine, St. Luke's Hospital, Malta
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Fava S, Azzopardi J. Thrombolysis in diabetic patients with myocardial infarction. Diabetes Care 1997; 20:906-7. [PMID: 9135965 DOI: 10.2337/diacare.20.5.906a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
This prospective hospital-based, case-control study compares the outcome of unstable angina in non-insulin dependent diabetic patients and non-diabetic control subjects. One hundred and sixty-two diabetic patients and 162 non-diabetic control patients with unstable angina were entered into the study. The 3-month mortality was 8.6% (95% confidence interval, CI = 4.4-12.9%) in diabetic patients and 2.5% (CI = 0.1-4.9%) in control patients (p = 0.014). The 1-year mortality was 16.7% (CI = 10.9%-22.4%) in diabetic patients and 8.6% (CI = 4.4%-12.9%) in non-diabetic patients (p = 0.029). Diabetic patients received beta-blockade and underwent coronary angiography and angioplasty less frequently than controls; the frequency of unstable angina, of acute myocardial infarction, and coronary artery bypass grafting was similar in both groups at 1 year of follow-up. It is concluded that diabetic patients with unstable angina have a higher mortality than non-diabetic patients and that this difference is largely accounted for by early (first 3 months) mortality.
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Affiliation(s)
- S Fava
- St Luke's Hospital, Malta
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Abstract
The aim of the study was to investigate prospectively the prognostic value of blood glucose on admission in diabetic and non-diabetic patients with an acute myocardial infarction. Three hundred and thirty-three diabetic and 565 non-diabetic patients were admitted with acute myocardial infarction during the study period of 3.5 years. There was a significant association between mortality and blood glucose on admission in diabetic patients (regression coefficient, r = 0.92, 0.5 < p < 0.02) but not in non-diabetic individuals (r = 0.69, 0.2 < p < 0.5). Age- and sex-standardized mortality was higher in the diabetic group (12.2% vs 7.4%, p < 0.03), but was identical if standardized also for blood glucose on admission. We conclude that a high blood glucose on admission is a bad prognostic indicator in a diabetic patient with an acute myocardial infarction. The excess mortality in diabetic patients with acute myocardial infarction can be attributed to the higher proportion with hyperglycaemia.
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Affiliation(s)
- S Fava
- Department of Medicine, St Luke's Hospital, Malta
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Abstract
OBJECTIVES To investigate the circadian pattern of acute myocardial infarction in non-insulin-dependent diabetic patients and to compare it with that of controls. BACKGROUND Previous studies have shown that there is a circadian variation in the incidence of acute myocardial infarction, but there are few data on diabetic subjects. METHODS A hospital based prospective case-control study. RESULTS 196 diabetic patients and 196 age and sex matched controls were admitted with a diagnosis of acute myocardial infarction during the study period. IN 32 diabetic patients and 38 controls, the time of onset of myocardial infarction was unknown; in 34, 44, 42, and 44 diabetic patients the onset was in the first to fourth quarters respectively (chi 2 = 1.66, NS). The corresponding figures for the controls were 30, 56, 45, and 27 (chi 2 = 13.9, P < 0.005). The difference between the two groups was highly significant (chi 2 = 10.3, P < 0.025). CONCLUSIONS Diabetic subjects do not show a significant circadian variation in the onset of acute myocardial infarction.
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Affiliation(s)
- S Fava
- Department of Medicine, St Luke's Hospital, Malta
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20
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Fava S, Azzopardi J, Muscat HA, Fenech FF. Thrombolysis in patients with diabetes. Risk of intraocular haemorrhage remains unknown. BMJ 1995; 310:1009. [PMID: 7728010 PMCID: PMC2549407 DOI: 10.1136/bmj.310.6985.1009a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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21
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Abstract
A computerized population health problem targeting program for diabetes mellitus and other common non-communicable disease was tested at St Luke's Hospital, Malta. The program utilizes a patient questionnaire by dialogue with a computer lasting about 20 min. The system evaluates and targets health problems that are followed up through the database. During a period of 10 months, two groups of people were screened using the system, consisting of 128 recently diagnosed diabetic patients presenting consecutively and 320 people from the general population. The age distributions of the two groups were similar. The system indicated 27% of the control group as being within the Diabetes Risk Group; 5% of this control group were confirmed to have diabetes. Eighty-two percent of newly referred diabetic patients were detected, giving false positive results in 23% and a false negative result in 18% of cases. The classification rules in the system were tuned to the population of Moscow, Russia. We have since adjusted these to better suit the Maltese population. The adjusted rules now indicate 20% of the general population as being within the risk group and have correctly detected 84% of the diabetic people, giving a false positive result in 15% and a false negative result in 16% of cases.
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22
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Abstract
OBJECTIVE To compare the outcome of acute myocardial infarction in NIDDM patients and nondiabetic control subjects. The relation of glycemic control, duration of diabetes, and major diabetic complications to the outcome of acute myocardial infarction in diabetic subjects was investigated. RESEARCH DESIGN AND METHODS This was a prospective, hospital-based, case-control study. RESULTS One hundred and ninety-six NIDDM patients and 196 nondiabetic control subjects with acute myocardial infarction were entered into the study. 23.5% of diabetic subjects and 34.2% of control subjects received thrombolytic therapy (P < 0.05). Diabetic subjects showed signs of reperfusion less often than control subjects (P < 0.05). Mortality was higher in the diabetic group (17.3 vs. 10.2%, P < 0.05). Pump failure (38.3 vs. 16.8%, P < 0.01) and cardiogenic shock (9.7 vs. 3.6%, P < 0.05) also occurred more frequently in diabetic subjects. Loss of heart rate variability was correlated with both pump failure and mortality; proliferative retinopathy was correlated with pump failure. Glycemic control and other diabetic complications did not correlate with outcome. CONCLUSIONS Our findings confirm the higher mortality and incidence of pump failure in acute myocardial infarction with co-morbid diabetes. They suggest that the less frequent use of thrombolytic therapy, lower reperfusion rates, and more advanced coronary artery disease might be contributory. The presence of autonomic neuropathy and microvascular disease probably also contribute to poor outcome; other major diabetic complications and diabetic control did not influence outcome.
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Affiliation(s)
- S Fava
- Diabetes Clinic, St. Luke's Hospital, Malta, Europe
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23
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Azzopardi J, Campbell IW, Clarke BF, Duncan LJ. [Duration of effective hypoglycaemic action of glipizide given once daily (author's transl)]. Med Klin 1975; 70:1214-8. [PMID: 809650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The clinically effective duration of blood glucose lowering action of a new hypoglycaemic sulphonylurea, glipizide, given in single before breakfast dosage (up to 20 mg) has been studied in 20 apparently insulin-independent diabetics. All, on diet only, had persistent overnight 1-2% glycosuria, fasting glycaemia in excess of 150 mg/100ml, random mid-morning glycaemia of at least 250 mg/100ml and associated clinical symptoms. Eighteen were satisfactorily controlled over the observation period of six months by single daily dosage (mean 10 mg daily); in addition considerable improvement in glucose tolerance occurred. Complementary in-patients indicated that, within the range of dosage studied, there was no therapeutic advantage in taking glipizide twice daily.
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Burn JI, Davey J, Sellwood RA, Deeley TJ, Azzopardi J, Li J. A prospective comparative clinical trial in early carcinoma of the female breast. Br J Surg 1968; 55:869. [PMID: 5687021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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