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Woldring JM, Gans ROB, Paans W, Luttik ML. Physicians and nurses view on their roles in communication and collaboration with families: A qualitative study. Scand J Caring Sci 2023; 37:1109-1122. [PMID: 37248644 DOI: 10.1111/scs.13185] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Families are introduced as new partners in interprofessional communication and collaboration during hospitalisation of an adult patient. Their introduction into the healthcare team has consequences for the roles and responsibilities of all healthcare professionals. Role clarification is thus needed to create optimal communication and collaboration with families. AIM To gain insight into how physicians and nurses view their own roles and each other's roles in communication and collaboration with families in the care of adult patients. METHODS A qualitative interpretive interview design was used. Fourteen semi-structured interviews, with seven physicians and seven nurses, were conducted. Data were analysed according to the steps of thematic analysis. For the study design and analysis of the results, the guidelines of the consolidated criteria for reporting qualitative studies (COREQ) were followed. The ethical committee of the University Medical Center Groningen approved the study protocol (research number 202100640). FINDINGS Thematic analysis resulted in three themes, each consisting of two or three code groups. Two themes "building a relationship" and "sharing information" were described as roles that both nurses and physicians share regarding communication and collaboration with families. The role expectations differed between physicians and nurses, but these differences were not discussed with each other. The theme "providing support to family" was regarded a nurse-specific role by both professions. CONCLUSION Physicians and nurses see a role for themselves and each other in communication and collaboration with families. However, the division of roles and expectations thereof are different, overlapping, and unclear. To optimise the role and position of family during hospital care, clarification and division of the roles between physicians and nurses in this partnership is necessary.
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Affiliation(s)
- Josien M Woldring
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolter Paans
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marie Louise Luttik
- Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
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Rosien L, van Dijk PR, Oskam J, Pierie MEN, Groenier KH, Gans ROB, Bilo HJG. Lower Extremity Amputation Rates in People With Diabetes Mellitus: A Retrospective Population Based Cohort Study in Zwolle Region, The Netherlands. Eur J Vasc Endovasc Surg 2023; 66:229-236. [PMID: 37220802 DOI: 10.1016/j.ejvs.2023.05.030] [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] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/21/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Lower extremity amputations are a major complication of diabetes mellitus (DM). In a previous Dutch study, the incident rate of major amputations was 89.2 per 100 000 person years. The primary aim of this study was to describe the lower extremity amputation rates in people with DM in the Zwolle region, where preventive and curative footcare is organised according to the guidelines of the International Working Group of the Diabetic Foot (IWGDF). The secondary aim was to evaluate outcomes and underlying characteristics of these people. METHODS This was a retrospective regional population based cohort study. Data from all people with DM treated in primary and secondary care, living in the region Zwolle were collected. All amputations in the period 2017 to 2019 were analysed. Comparisons were made between those with and without an amputation. RESULTS In the analysis 5 915 people with DM were included, with a mean age of 67.8 (IQR 57.9, 75.9) years. Of those people, 47% were women and the median HbA1c was 53 (IQR 47, 62) mmol/mol. Over the three year study period 68 amputations were performed in 59 people: 46 minor, 22 major. This translated into an average annual crude amputation incidence rate of non-traumatic major and minor amputations of 41.5 and 86.9 per 100 000 person years among people with diabetes. Compared with those not undergoing amputations, those who underwent an amputation were more often men, older, mainly had T2DM, were treated in secondary care, had higher diastolic blood pressure, worse diabetic footcare profile, longer DM duration and higher HbA1c. At the end of the follow up, 111 people died: 96 (1.6%) without and 15 (25.4%) with amputations (p < .001). CONCLUSIONS This retrospective study provides detailed insight into the rate of amputations in Dutch people with diabetes in the region Zwolle. Compared with previous Dutch estimates, these data suggest a considerable decrease in the major amputation incidence rate.
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Affiliation(s)
- Leonie Rosien
- Diabetes Centre, Isala, 8025 BP Zwolle, The Netherlands; Innofeet, 8013 PH Zwolle, The Netherlands; Department of Internal Medicine, University Medical Centre Groningen, 9700 RB Groningen, and Groningen University, The Netherlands.
| | - Peter R van Dijk
- Diabetes Centre, Isala, 8025 BP Zwolle, The Netherlands; Department of Endocrinology, University Medical Centre Groningen, 9700 AB Groningen, The Netherlands; Department of Internal Medicine, University Medical Centre Groningen, 9700 RB Groningen, and Groningen University, The Netherlands
| | - Jacques Oskam
- Department of Surgery, Isala, 8025 AB Zwolle, The Netherlands
| | | | | | - Rijk O B Gans
- Department of Internal Medicine, University Medical Centre Groningen, 9700 RB Groningen, and Groningen University, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University Medical Centre Groningen, 9700 RB Groningen, and Groningen University, The Netherlands
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3
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Lameijer A, Bakker JJ, Kao K, Xu Y, Gans ROB, Bilo HJG, Dunn TC, van Dijk PR. Real-life 24-week changes in glycemic parameters among European users of flash glucose monitoring with type 1 and 2 diabetes and different levels of glycemic control. Diabetes Res Clin Pract 2023:110735. [PMID: 37276981 DOI: 10.1016/j.diabres.2023.110735] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/05/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
AIM To evaluate real-life changes of glycemic parameters among flash glucose monitoring (FLASH) users who do not meet glycemic targets. METHODS De-identified data were obtained between 2014 and 2021 from patients using FLASH uninterrupted for a 24-week period. Glycemic parameters during first and last sensor use were examined in four identifiable groups: type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM) on basal-bolus insulin, T2DM on basal insulin, and T2DM without insulin treatment. Within each group, subgroup analyses were performed in persons with initial suboptimal glycemic regulation (time in range (TIR; 3.9-10 mmol/L) <70%, time above range (TAR; >10 mmol/L) >25%, or time below range (TBR; <3.9 mmol/L) >4%). RESULTS Data were obtained from 1,909 persons with T1DM and 1,813 persons with T2DM (1,499 basal-bolus insulin, 189 basal insulin, and 125 non-insulin users). In most of the performed analyses, both overall and in the various subgroups, significant improvements were observed in virtually all predefined primary (TIR) and secondary endpoints (eHbA1c, TAR, TBR and glucose variability). CONCLUSIONS 24-weeks FLASH use in real life by persons with T1DM and T2DM with suboptimal glycemic regulation is associated with improvement of glycemic parameters, irrespective of pre-use regulation or treatment modality.
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Affiliation(s)
- Annel Lameijer
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Julia J Bakker
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | | | | | - Rijk O B Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - Henk J G Bilo
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands; Isala, Diabetes Research Center, Zwolle, The Netherlands
| | | | - Peter R van Dijk
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands; Isala, Diabetes Research Center, Zwolle, The Netherlands.
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Been RA, van Beek AP, Gans ROB, van Dijk PR. The Elderly Lag Behind in the Use of Intermittent Scanning Continuous Glucose Monitoring. J Diabetes Sci Technol 2023; 17:262-263. [PMID: 36128711 PMCID: PMC9846404 DOI: 10.1177/19322968221126691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Riemer A. Been
- Department of Endocrinology, University of
Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - André P. van Beek
- Department of Endocrinology, University of
Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Rijk O. B. Gans
- Department of Internal Medicine, University
of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Peter R. van Dijk
- Department of Endocrinology, University of
Groningen and University Medical Center Groningen, Groningen, The Netherlands
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Schnog JJB, Samson MJ, Gans ROB, Duits AJ. An urgent call to raise the bar in oncology. Br J Cancer 2021; 125:1477-1485. [PMID: 34400802 PMCID: PMC8365561 DOI: 10.1038/s41416-021-01495-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/09/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023] Open
Abstract
Important breakthroughs in medical treatments have improved outcomes for patients suffering from several types of cancer. However, many oncological treatments approved by regulatory agencies are of low value and do not contribute significantly to cancer mortality reduction, but lead to unrealistic patient expectations and push even affluent societies to unsustainable health care costs. Several factors that contribute to approvals of low-value oncology treatments are addressed, including issues with clinical trials, bias in reporting, regulatory agency shortcomings and drug pricing. With the COVID-19 pandemic enforcing the elimination of low-value interventions in all fields of medicine, efforts should urgently be made by all involved in cancer care to select only high-value and sustainable interventions. Transformation of medical education, improvement in clinical trial design, quality, conduct and reporting, strict adherence to scientific norms by regulatory agencies and use of value-based scales can all contribute to raising the bar for oncology drug approvals and influence drug pricing and availability.
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Affiliation(s)
- John-John B. Schnog
- Department of Hematology-Medical Oncology, Curaçao Medical Center, Willemstad, Curaçao ,Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao
| | - Michael J. Samson
- Department of Radiation Oncology, Curaçao Medical Center, Willemstad, Curaçao
| | - Rijk O. B. Gans
- grid.4494.d0000 0000 9558 4598Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ashley J. Duits
- Curaçao Biomedical and Health Research Institute, Willemstad, Curaçao ,grid.4494.d0000 0000 9558 4598Institute for Medical Education, University Medical Center Groningen, Groningen, The Netherlands ,Red Cross Blood Bank Foundation, Willemstad, Curaçao
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van der Goot WE, Duvivier RJ, Van Yperen NW, de Carvalho-Filho MA, Noot KE, Ikink R, Gans ROB, Kloeze E, Tulleken JE, Lammers AJJ, Jaarsma ADC, Bierman WFW. Psychological distress among frontline workers during the COVID-19 pandemic: A mixed-methods study. PLoS One 2021; 16:e0255510. [PMID: 34351970 PMCID: PMC8341539 DOI: 10.1371/journal.pone.0255510] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Novel virus outbreaks, such as the COVID-19 pandemic, may increase psychological distress among frontline workers. Psychological distress may lead to reduced performance, reduced employability or even burnout. In the present study, we assessed experienced psychological distress during the COVID-19 pandemic from a self-determination theory perspective. Methods This mixed-methods study, with repeated measures, used surveys (quantitative data) combined with audio diaries (qualitative data) to assess work-related COVID-19 experiences, psychological need satisfaction and frustration, and psychological distress over time. Forty-six participants (nurses, junior doctors, and consultants) completed 259 surveys and shared 60 audio diaries. Surveys and audio diaries were analysed separately. Results Quantitative results indicated that perceived psychological distress during COVID-19 was higher than pre-COVID-19 and fluctuated over time. Need frustration, specifically autonomy and competence, was positively associated with psychological distress, while need satisfaction, especially relatedness, was negatively associated with psychological distress. In the qualitative, thematic analysis, we observed that especially organisational logistics (rostering, work-life balance, and internal communication) frustrated autonomy, and unfamiliarity with COVID-19 frustrated competence. Despite many need frustrating experiences, a strong connection with colleagues and patients were important sources of relatedness support (i.e. need satisfaction) that seemed to mitigate psychological distress. Conclusion The COVID-19 pandemic resulted in an increase of psychological distress among frontline workers. Both need frustration and need satisfaction explained unique variance of psychological distress, but seemed to originate from different sources. Challenging times require healthcare organisations to better support their professionals by tailored formal and informal support. We propose to address both indirect (e.g. organisation) and direct (e.g. colleagues) elements of the clinical and social environment in order to reduce need frustration and enhance need satisfaction.
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Affiliation(s)
- Wieke E. van der Goot
- Martini Academy, Martini Hospital, Groningen, The Netherlands
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Robbert J. Duvivier
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Nico W. Van Yperen
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Marco A. de Carvalho-Filho
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- ICVS Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - Kirsten E. Noot
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Renee Ikink
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk O. B. Gans
- Department of Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eveline Kloeze
- Department of Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jaap E. Tulleken
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A. J. Jolanda Lammers
- Department of Internal Medicine / Infectious Diseases, Isala, Zwolle, The Netherlands
| | - A. Debbie C. Jaarsma
- Center for Educational Development and Research in Health Sciences (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Wouter F. W. Bierman
- Department of Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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7
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Lameijer A, Lommerde N, Dunn TC, Fokkert MJ, Edens MA, Kao K, Xu Y, Gans ROB, Bilo HJG, van Dijk PR. Flash Glucose Monitoring in the Netherlands: Increased monitoring frequency is associated with improvement of glycemic parameters. Diabetes Res Clin Pract 2021; 177:108897. [PMID: 34098059 DOI: 10.1016/j.diabres.2021.108897] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/07/2021] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 12/17/2022]
Abstract
AIMS To evaluate the association between Flash Glucose Monitoring (FLASH) frequency and glycemic parameters during real-life circumstances in the Netherlands. METHODS Obtained glucose readings were de-identified and uploaded to a dedicated database when FLASH reading devices were connected to internet. Data between September 2014 and March 2020, comprising 16,331 analyzable readers (163,762 sensors) were analyzed. Scan rate per reader was determined and each reader was sorted into 20 equally sized rank ordered groups (n = 817 each). RESULTS Users performed a median of 11.5 [IQR 7.7-16.7] scans per day. Those in the lowest and highest ventiles scanned on average 3.7 and 40.0 times per day and had an eHbA1c of 8.6% (71 mmol/mol) and 6.9% (52 mmol/mol), respectively. Increasing scan rates were associated with more time in target range (3.9-10 mmol/L), less time in hyperglycemia (>10 mmol/L), and a lower standard deviation of glucose. An eHbA1c of 7.0% (53 mmol/mol) translated in approximately 65% time in target range, 30% time in hyperglycemia and 5% time in hypoglycemia (<3.9 mmol/L). CONCLUSIONS These outcomes among Dutch FLASH users suggest that with higher scan rate glycemic control improves.
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Affiliation(s)
- Annel Lameijer
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, the Netherlands
| | - Nicole Lommerde
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | | | - Marion J Fokkert
- Isala, Department of Clinical Chemistry, Zwolle, the Netherlands
| | - Mireille A Edens
- Isala, Department of Innovation and Science, Zwolle, the Netherlands
| | | | | | - R O B Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Henk J G Bilo
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands; Isala, Diabetes Research Center, Zwolle, the Netherlands
| | - Peter R van Dijk
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, the Netherlands; Isala, Diabetes Research Center, Zwolle, the Netherlands.
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8
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Yepes‐Calderón M, Sotomayor CG, Pena M, Eisenga MF, Gans ROB, Berger SP, Moers C, Sugaya T, Doekharan D, Navis GJ, van den Born J, Bakker SJL. Urinary liver-type fatty acid-binding protein is independently associated with graft failure in outpatient kidney transplant recipients. Am J Transplant 2021; 21:1535-1544. [PMID: 32946659 PMCID: PMC8048636 DOI: 10.1111/ajt.16312] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/16/2020] [Accepted: 09/07/2020] [Indexed: 01/25/2023]
Abstract
Urinary liver-type fatty acid-binding protein (uL-FABP) is a biomarker of kidney hypoxia and ischemia, and thus offers a novel approach to identify early kidney insults associated with increased risk of graft failure in outpatient kidney transplant recipients (KTR). We investigated whether uL-FABP is associated with graft failure and whether it improves risk prediction. We studied a cohort of 638 outpatient KTR with a functional graft ≥1-year. During a median follow-up of 5.3 years, 80 KTR developed graft failure. uL-FABP (median 2.11, interquartile range 0.93-7.37 µg/24"/>h) was prospectively associated with the risk of graft failure (hazard ratio 1.75; 95% confidence interval 1.27-2.41 per 1-SD increment; P = .001), independent of potential confounders including estimated glomerular filtration rate and proteinuria. uL-FABP showed excellent discrimination ability for graft failure (c-statistic of 0.83) and its addition to a prediction model composed by established clinical predictors of graft failure significantly improved the c-statistic to 0.89 (P for F-test <.001). These results were robust to several sensitivity analyses. Further validation studies are warranted to evaluate the potential use of a risk-prediction model including uL-FABP to improve identification of outpatient KTR at high risk of graft failure in clinical care.
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Affiliation(s)
- Manuela Yepes‐Calderón
- Division of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Camilo G. Sotomayor
- Division of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Michelle Pena
- Departmant of Clinical Pharmacy and PharmacologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Michele F. Eisenga
- Division of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Rijk O. B. Gans
- Department of Internal MedicineUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Stefan P. Berger
- Division of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Cyril Moers
- Division of Transplantation SurgeryUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Takeshi Sugaya
- Department of MedicineSt. Marianna University School of MedicineKawasakiJapan
| | | | - Gerjan J. Navis
- Division of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Jaap van den Born
- Division of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Stephan J. L. Bakker
- Division of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
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Fokkert MJ, van Dijk PR, Edens MA, Díez A, Slingerland RJ, Gans ROB, Delgado E, Bilo HJG. Performance of continuous glucose monitoring devices during intensive exercise conditions in people with diabetes: the Mont Blanc experience. Diabet Med 2020; 37:1204-1205. [PMID: 32003876 DOI: 10.1111/dme.14259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M J Fokkert
- Department of Clinical Chemistry, Zwolle, The Netherlands
| | - P R van Dijk
- Diabetes Research Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, Groningen, The Netherlands
- Department of Endocrinology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M A Edens
- Department of Innovation and Science, Zwolle, The Netherlands
| | - A Díez
- Hospital del Bierzo, Sección de Endocrinología, Ponferrada, Spain
| | | | - R O B Gans
- Department of Internal Medicine, Groningen, The Netherlands
| | - E Delgado
- Department of Endocrinology and Nutrition, University of Oviedo, Oviedo, Spain
- Central University Hospital of Asturias, Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
| | - H J G Bilo
- Department of Innovation and Science, Zwolle, The Netherlands
- Department of Internal Medicine, Groningen, The Netherlands
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Douwes RM, Gomes-Neto AW, Eisenga MF, Van Loon E, Schutten JC, Gans ROB, Naesens M, van den Berg E, Sprangers B, Berger SP, Navis G, Blokzijl H, Meijers B, Bakker SJL, Kuypers D. The association between use of proton-pump inhibitors and excess mortality after kidney transplantation: A cohort study. PLoS Med 2020; 17:e1003140. [PMID: 32542023 PMCID: PMC7295199 DOI: 10.1371/journal.pmed.1003140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic use of proton-pump inhibitors (PPIs) is common in kidney transplant recipients (KTRs). However, concerns are emerging about the potential long-term complications of PPI therapy. We aimed to investigate whether PPI use is associated with excess mortality risk in KTRs. METHODS AND FINDINGS We investigated the association of PPI use with mortality risk using multivariable Cox proportional hazard regression analyses in a single-center prospective cohort of 703 stable outpatient KTRs, who visited the outpatient clinic of the University Medical Center Groningen (UMCG) between November 2008 and March 2011 (ClinicalTrials.gov Identifier NCT02811835). Independent replication of the results was performed in a prospective cohort of 656 KTRs from the University Hospitals Leuven (NCT01331668). Mean age was 53 ± 13 years, 57% were male, and 56.6% used PPIs. During median follow-up of 8.2 (4.7-9.0) years, 194 KTRs died. In univariable Cox regression analyses, PPI use was associated with an almost 2 times higher mortality risk (hazard ratio [HR] 1.86, 95% CI 1.38-2.52, P < 0.001) compared with no use. After adjustment for potential confounders, PPI use remained independently associated with mortality (HR 1.68, 95% CI 1.21-2.33, P = 0.002). Moreover, the HR for mortality risk in KTRs taking a high PPI dose (>20 mg omeprazole equivalents/day) compared with patients taking no PPIs (HR 2.14, 95% CI 1.48-3.09, P < 0.001) was higher than in KTRs taking a low PPI dose (HR 1.72, 95% CI 1.23-2.39, P = 0.001). These findings were replicated in the Leuven Renal Transplant Cohort. The main limitation of this study is its observational design, which precludes conclusions about causation. CONCLUSIONS We demonstrated that PPI use is associated with an increased mortality risk in KTRs, independent of potential confounders. Moreover, our data suggest that this risk is highest among KTRs taking high PPI dosages. Because of the observational nature of our data, our results require further corroboration before it can be recommended to avoid the long-term use of PPIs in KTRs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02811835, NCT01331668.
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Affiliation(s)
- Rianne M. Douwes
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - António W. Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F. Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabet Van Loon
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Nephrology & Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Joëlle C. Schutten
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk O. B. Gans
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten Naesens
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Nephrology & Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Else van den Berg
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ben Sprangers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Nephrology & Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Stefan P. Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hans Blokzijl
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Björn Meijers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Nephrology & Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Nephrology & Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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11
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Gol JM, Rosmalen JGM, Gans ROB, Voshaar RCO. The importance of contextual aspects in the care for patients with functional somatic symptoms. Med Hypotheses 2020; 142:109731. [PMID: 32335457 DOI: 10.1016/j.mehy.2020.109731] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 12/30/2022]
Abstract
Functional somatic symptoms refer to physical symptoms that cannot be (bio) medically explained. The pattern or clustering of such symptoms may lead to functional syndromes like chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, among many others. Since the underlying pathophysiology remains unknown, several explanatory models have been proposed, nearly all including social and psychological parameters. These models have stimulated effectiveness studies of several psychological and psychopharmacological therapies. While the evidence for their effectiveness is steadily growing, effect-sizes are at most moderate and many patients do not benefit. We hypothesize that the context in which interventions for functional somatic symptoms are delivered substantially influences their effectiveness. Although this hypothesis is in line with explanatory models of functional somatic symptoms, to our knowledge, studies primarily focusing on the influence of contextual aspects on treatment outcome are scarce. Contextual research in the field of somatic symptoms has (irrespective whether these symptoms can be medically explained or not), however, just begun and already yielded some valuable results. These findings can be organized according to Duranti's and Goodwin's theoretical approach to context in order to substantiate our hypothesis. Based on this approach, we categorized empirical findings in three contextual aspects, i.e. 1) the setting, 2) the behavioural environment, and 3) the language environment. Collectively, some support is found for the fact that early identification of patients with functional somatic symptoms, starting treatment as soon as possible, having a neat appearance and an organized office interior, a warm and friendly nonverbal approach and a language use without defensiveness are contextual parameters which enhance the assessment by the patient of the physician's competence to help. Nonetheless, in vivo studies addressing the most aspects, i.e. nonverbal behaviour and language, are needed for better understanding of these contextual aspect. Moreover, future research should address to what extent optimizing contextual aspects improve care for functional somatic symptoms.
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Affiliation(s)
- J M Gol
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands.
| | - J G M Rosmalen
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands
| | - R O B Gans
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands
| | - R C Oude Voshaar
- University of Groningen & University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion Regulation (ICPE), PO Box 30.001 (CC72), 9700 RB Groningen, the Netherlands
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12
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Yepes-Calderón M, Sotomayor CG, Gans ROB, Berger SP, Leuvenink HGD, Tsikas D, Rodrigo R, Navis GJ, Bakker SJL. Post-transplantation plasma malondialdehyde is associated with cardiovascular mortality in renal transplant recipients: a prospective cohort study. Nephrol Dial Transplant 2020; 35:512-519. [PMID: 32133530 PMCID: PMC7056950 DOI: 10.1093/ndt/gfz288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In renal transplant recipients (RTRs), cardiovascular mortality is the most common cause of long-term renal graft loss. Oxidative stress (OS) has been associated with cardiovascular disease and is known to be enhanced in RTRs. We aimed to prospectively investigate whether the concentration of the OS biomarker malondialdehyde (MDA) is associated with long-term risk of cardiovascular mortality in a large cohort of RTRs. METHODS The plasma MDA concentration was measured using the thiobarbituric acid reaction assay in 604 extensively phenotyped RTRs with a functioning allograft for ≥1 year. The association between MDA and cardiovascular mortality was assessed using Cox proportional hazard regression analyses in the overall cohort and within subgroups according to significant effect modifiers. RESULTS Median circulating MDA concentration at baseline was 5.38 [interquartile range (IQR) 4.31-6.45] μmol/L. During a follow-up period of 6.4 (IQR 5.6-6.8) years, 110 (18%) RTRs died, with 40% of deaths due to cardiovascular causes. MDA concentration was significantly associated with the risk for cardiovascular mortality {hazard ratio [HR] 1.31 [95% confidence interval (CI) 1.03-1.67] per 1-SD increment}, independent of adjustment for potential confounders, including renal function, immunosuppressive therapy, smoking status and blood pressure. The association between MDA concentration and the risk for cardiovascular mortality was stronger in RTRs with relatively lower plasma ascorbic acid concentrations [≤42.5 µmol/L; HR 1.79 (95% CI 1.30-2.48) per 1-SD increment] or relatively lower estimated glomerular filtration rates [≤45 mL/min/1.73 m2; HR 2.09 (95% CI 1.45-3.00) per 1-SD increment]. CONCLUSIONS Circulating MDA concentration is independently associated with long-term risk for cardiovascular mortality, particularly in RTRs with relatively lower ascorbic acid concentrations or renal function. Further studies are warranted to elucidate whether OS-targeted interventions could decrease cardiovascular mortality in RTRs.
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Affiliation(s)
- Manuela Yepes-Calderón
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Camilo G Sotomayor
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henri G D Leuvenink
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dimitrios Tsikas
- Institute of Toxicology, Core Unit Proteomics, Hannover Medical School, Hannover, Germany
| | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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13
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van Dijk PR, Waanders F, Pasch A, Logtenberg SJJ, Vriesendorp T, Groenier KH, Hillebrands JL, Kleefstra N, Gans ROB, van Goor H, Bilo HJ. Favourable serum calcification propensity with intraperitoneal as compared with subcutaneous insulin administration in type 1 diabetes. Ther Adv Endocrinol Metab 2020; 11:2042018820908456. [PMID: 32166012 PMCID: PMC7054733 DOI: 10.1177/2042018820908456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/31/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Serum calcification propensity can be monitored using the maturation time of calciprotein particles in serum (T50 test). A shorter T50 indicates greater propensity to calcify; this is an independent determinant of cardiovascular disease. As the intraperitoneal (IP) route of insulin administration mimics the physiology more than the subcutaneous (SC) route in persons with type 1 diabetes (T1DM), we hypothesized that IP insulin influences determinants of calcium propensity and therefore result in a longer T50 than SC insulin administration. METHODS Prospective, observational case-control study. Measurements were performed at baseline and at 26 weeks in age and gender matched persons with T1DM. RESULTS A total of 181 persons, 39 (21.5%) of which used IP and 142 (78.5%) SC insulin were analysed. Baseline T50 was 356 (45) minutes. The geometric mean T50 significantly differed between both treatment groups: 367 [95% confidence interval (CI) 357, 376] for the IP group and 352 (95% CI 347, 357) for the SC group with a difference of -15 (95% CI -25, -4) minutes, in favour of IP treatment. In multivariable analyses, the IP route of insulin administration had a positive relation on T50 concentrations while higher age, triglycerides and phosphate concentrations had an inverse relation. CONCLUSION Among persons with T1DM, IP insulin administration results in a more favourable calcification propensity time then SC insulin. It has yet to be shown if this observation translates into improved cardiovascular outcomes.
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Affiliation(s)
| | - Femke Waanders
- Department of Internal Medicine, Isala, Zwolle,
The Netherlands
| | | | | | | | | | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology,
Pathology division, University Medical Center Groningen, University of
Groningen, Groningen, the Netherlands
| | - Nanno Kleefstra
- Department of Internal Medicine, University
Medical Center Groningen, University of Groningen, Groningen, The
Netherlands
- Langerhans Medical Research Group, Ommen, the
Netherlands
- GGZ Drenthe Mental Health Institute, Assen, the
Netherlands
| | - Rijk O. B. Gans
- Department of Internal Medicine, University
Medical Center Groningen, University of Groningen, Groningen, The
Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology,
Pathology division, University Medical Center Groningen, University of
Groningen, Groningen, the Netherlands
| | - Henk J.G. Bilo
- Department of Internal Medicine, University
Medical Center Groningen, University of Groningen, Groningen, The
Netherlands
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14
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Sotomayor CG, Gomes-Neto AW, van Londen M, Gans ROB, Nolte IM, Berger SP, Navis GJ, Rodrigo R, Leuvenink HGD, Schalkwijk CG, Bakker SJL. Circulating Advanced Glycation Endproducts and Long-Term Risk of Cardiovascular Mortality in Kidney Transplant Recipients. Clin J Am Soc Nephrol 2019; 14:1512-1520. [PMID: 31530552 PMCID: PMC6777589 DOI: 10.2215/cjn.00540119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/13/2019] [Accepted: 07/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES In kidney transplant recipients, elevated circulating advanced glycation endproducts (AGEs) are the result of increased formation and decreased kidney clearance. AGEs trigger several intracellular mechanisms that ultimately yield excess cardiovascular disease. We hypothesized that, in stable kidney transplant recipients, circulating AGEs are associated with long-term risk of cardiovascular mortality, and that such a relationship is mediated by inflammatory, oxidative stress, and endothelial dysfunction biomarkers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Prospective cohort study of stable kidney transplant recipients recruited between 2001 and 2003 in a university setting. We performed multivariable-adjusted Cox regression analyses to assess the association of AGEs (i.e., Nε -[Carboxymethyl]lysine (CML) and Nε -[Carboxyethyl]lysine (CEL), measured by tandem mass spectrometry) with cardiovascular mortality. Mediation analyses were performed according to Preacher and Hayes's procedure. RESULTS We included 555 kidney transplant recipients (age 51±12 years, 56% men). During a median follow-up of 6.9 years, 122 kidney transplant recipients died (52% deaths were due to cardiovascular causes). CML and CEL concentrations were directly associated with cardiovascular mortality (respectively, hazard ratio, 1.55; 95% confidence interval, 1.24 to 1.95; P<0.001; and hazard ratio, 1.53; 95% confidence interval 1.18 to 1.98; P=0.002), independent of age, diabetes, smoking status, body mass index, eGFR and proteinuria. Further adjustments, including cardiovascular history, did not materially change these findings. In mediation analyses, free thiol groups and soluble vascular cell adhesion molecule-1 consistently explained approximately 35% of the association of CML and CEL with cardiovascular mortality. CONCLUSIONS In stable kidney transplant recipients, circulating levels of AGEs are independently associated with long-term risk of cardiovascular mortality. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_09_17_CJN00540119.mp3.
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Affiliation(s)
| | | | | | | | | | | | | | - Ramón Rodrigo
- Faculty of Medicine, Institute of Biomedical Sciences, University of Chile, Santiago, Chile; and
| | - Henri G D Leuvenink
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine and.,Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
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15
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Abbasi A, Corpeleijn E, Meijer E, Postmus D, Gansevoort RT, Gans ROB, Struck J, Hillege HL, Stolk RP, Navis G, Bakker SJL. Correction to: Sex differences in the association between plasma copeptin and incident type 2 diabetes: the Prevention of Renal and Vascular Endstage Disease (PREVEND) study. Diabetologia 2019; 62:1518-1519. [PMID: 31190157 DOI: 10.1007/s00125-019-4917-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The values given for copeptin levels in men in quartiles 1 and 2 (Table 1) were incorrect, and should have read.
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Affiliation(s)
- A Abbasi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - E Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - E Meijer
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - D Postmus
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - R T Gansevoort
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R O B Gans
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Struck
- Department of Research, BRAHMS GmbH/Thermo Fisher Scientific, Hennigsdorf, Germany
| | - H L Hillege
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - R P Stolk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands
| | - G Navis
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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16
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Olgers TJ, Azizi N, Blans MJ, Bosch FH, Gans ROB, Ter Maaten JC. Point-of-care Ultrasound (PoCUS) for the internist in Acute Medicine: a uniform curriculum. Neth J Med 2019; 77:168-176. [PMID: 31264587] [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: 06/09/2023]
Abstract
The use of Point-of-care Ultrasound (PoCUS) is rapidly increasing in internal medicine as it is useful in the primary assessment of acutely ill internal medicine patients for enhanced diagnostics and resuscitation. PoCUS can be taught in a modular fashion including basic core applications and advanced applications which can be combined for a symptom-based approach. Several PoCUS curriculum guidelines, especially for emergency medicine, exist throughout the world but a clear Dutch guideline for internists has not been developed. In this review we propose 'core' ultrasound competencies for internists that may also be incorporated into the European Training Requirements Internal Medicine. We suggest the use of an Entrustable Professional Activities (EPA) competencybased training system with EPAs specifically designed for ultrasound.
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Affiliation(s)
- T J Olgers
- Department of Internal Medicine, University Medical Center Groningen, the Netherlands
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17
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Gans ROB. [Can diagnostic errors be avoided?]. Ned Tijdschr Geneeskd 2018; 162:D3212. [PMID: 30570928] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Errors in the diagnostic process contribute substantially to medical errors and adverse events in the health care system. Research into ways to reduce diagnostic errors is still in its infancy. In this article, it is argued that checklists and time-outs for a brief moment of diagnostic reflection may be advisable.
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Affiliation(s)
- Rijk O B Gans
- Universitair Medisch Centrum Groningen, afd. Interne Geneeskunde
- Contact: R.O.B. Gans
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18
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Sotomayor CG, Gomes-Neto AW, Gans ROB, de Borst MH, Berger SP, Rodrigo R, Navis GJ, Touw DJ, Bakker SJL. Fish Intake, Circulating Mercury and Mortality in Renal Transplant Recipients. Nutrients 2018; 10:nu10101419. [PMID: 30282924 PMCID: PMC6212909 DOI: 10.3390/nu10101419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 12/15/2022] Open
Abstract
Marine-derived omega-3 polyunsaturated fatty acids (n-3 PUFAs) are inversely associated with cardiovascular and all-cause mortality in renal transplant recipients (RTRs). Recommendations to increase marine-derived n-3 PUFAs by increasing fish intake may have a drawback in concomitant stimulation of mercury intake, which could lead to higher circulating mercury concentrations and mitigation of otherwise beneficial effects of n-3 PUFAs. We aimed to monitor circulating mercury concentrations, and to prospectively evaluate whether it counteracts the potential association between fish intake and cardiovascular and all-cause mortality in a cohort of RTRs (n = 604, 53 ± 13 years-old, 57% men) with long-term follow-up (median of 5.4 years; 121 deaths). Circulating mercury concentration (median 0.30 (IQR 0.14–0.63) µg/L) positively associated with fish intake (std. β = 0.21, p < 0.001). Multivariable-adjusted Cox-proportional hazards regression analyses showed that prior to, and after additional adjustment for circulating mercury concentrations, fish intake was inversely associated with both cardiovascular (HR 0.75, 95% CI 0.58–0.96; and, HR 0.75, 95% CI 0.58–0.97, respectively) and all-cause mortality (HR 0.84, 95% CI 0.72–0.97; and, HR 0.86, 95% CI 0.74–0.99, respectively). Secondary analyses accounting for marine-derived n-3 PUFAs intake revealed associations of similar magnitude. In conclusion, we found no evidence of a counteracting effect conferred by circulating mercury concentrations on the associations between fish and marine-derived n-3 PUFAs intake and the risks of cardiovascular and all-cause mortality in RTRs.
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Affiliation(s)
- Camilo G Sotomayor
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
| | - António W Gomes-Neto
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
| | - Martin H de Borst
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
| | - Stefan P Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
| | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile.
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
| | - Daan J Touw
- Department of Pharmacy and Clinical Pharmacology, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.
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19
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Osté MCJ, Gomes‐Neto AW, Corpeleijn E, Gans ROB, de Borst MH, van den Berg E, Soedamah‐Muthu SS, Kromhout D, Navis GJ, Bakker SJL. Dietary Approach to Stop Hypertension (DASH) diet and risk of renal function decline and all-cause mortality in renal transplant recipients. Am J Transplant 2018; 18:2523-2533. [PMID: 29464830 PMCID: PMC6175360 DOI: 10.1111/ajt.14707] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/31/2018] [Accepted: 02/15/2018] [Indexed: 01/25/2023]
Abstract
Renal transplant recipients (RTR) are at risk of decline of graft function and premature mortality, with high blood pressure as an important risk factor for both. To study the association of the Dietary Approach to Stop Hypertension (DASH) diet with these adverse events, we conducted a prospective cohort study of adult RTR. Dietary data were collected using a validated 177-item food frequency questionnaire and an overall DASH-score was obtained. We included 632 stable RTR (mean ± standard deviation age 53.0 ± 12.7 years, 57% men). Mean DASH score was 23.8 ± 4.7. During median follow-up of 5.3 (interquartile range, 4.1-6.0) years, 119 (18.8%) RTR had renal function decline, defined as a combined endpoint of doubling of serum creatinine and death-censored graft failure, and 128 (20.3%) died. In Cox-regression analyses, RTR in the highest tertile of the DASH score had lower risk of both renal function decline (hazard ratio [HR] = 0.57; 95% confidence interval [CI], 0.33-0.96, P = .03) and all-cause mortality (HR = 0.52; 95%CI, 0.32-0.83, P = .006) compared to the lowest tertile, independent of potential confounders. Adherence to a DASH-style diet is associated with lower risk of both renal function decline and all-cause mortality. These results suggest that a healthful diet might benefit long-term outcome in RTR.
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Affiliation(s)
- Maryse C. J. Osté
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - António W. Gomes‐Neto
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Eva Corpeleijn
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Rijk O. B. Gans
- Department of Internal MedicineUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Martin H. de Borst
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Else van den Berg
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Sabita S. Soedamah‐Muthu
- Department of Medical and Clinical PsychologyCenter of Research on Psychology in Somatic DiseasesTilburg UniversityTilburgThe Netherlands
| | - Daan Kromhout
- Department of EpidemiologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands,Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | - Gerjan J. Navis
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Stephan J. L. Bakker
- Department of NephrologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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20
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Sotomayor CG, Gomes-Neto AW, Eisenga MF, Nolte IM, Anderson JLC, de Borst MH, Osté MCJ, Rodrigo R, Gans ROB, Berger SP, Navis GJ, Bakker SJL. Consumption of fruits and vegetables and cardiovascular mortality in renal transplant recipients: a prospective cohort study. Nephrol Dial Transplant 2018; 35:357-365. [DOI: 10.1093/ndt/gfy248] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 06/27/2018] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
It currently remains understudied whether low consumption of fruits and vegetables after kidney transplantation may be a modifiable cardiovascular risk factor. We aimed to investigate the associations between consumption of fruits and vegetables and cardiovascular mortality in renal transplant recipients (RTRs).
Methods
Consumption of fruits and vegetables was assessed in an extensively phenotyping cohort of RTRs. Multivariable-adjusted Cox proportional hazards regression analyses were performed to assess the risk of cardiovascular mortality.
Results
We included 400 RTRs (age 52 ± 12 years, 54% males). At a median follow-up of 7.2 years, 23% of RTRs died (53% were due to cardiovascular causes). Overall, fruit consumption was not associated with cardiovascular mortality {hazard ratio [HR] 0.82 [95% confidence interval (CI) 0.60–1.14]; P = 0.24}, whereas vegetable consumption was inversely associated with cardiovascular mortality [HR 0.49 (95% CI 0.34–0.71); P < 0.001]. This association remained independent of adjustment for several potential confounders. The association of fruit consumption with cardiovascular mortality was significantly modified by estimated glomerular filtration rate (eGFR; Pinteraction = 0.01) and proteinuria (Pinteraction = 0.01), with significant inverse associations in patients with eGFR > 45 mL/min/1.73 m2 [HR 0.56 (95% CI 0.35–0.92); P = 0.02] or the absence of proteinuria [HR 0.62 (95% CI 0.41–0.92); P = 0.02].
Conclusions
In RTRs, a relatively higher vegetable consumption is independently and strongly associated with lower cardiovascular mortality. A relatively higher fruit consumption is also associated with lower cardiovascular mortality, although particularly in RTRs with eGFR > 45 mL/min/1.73 m2 or an absence of proteinuria. Further studies seem warranted to investigate whether increasing consumption of fruits and vegetables may open opportunities for potential interventional pathways to decrease the burden of cardiovascular mortality in RTRs.
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Affiliation(s)
- Camilo G Sotomayor
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - António W Gomes-Neto
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michele F Eisenga
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josephine L C Anderson
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maryse C J Osté
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ramón Rodrigo
- Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Rijk O B Gans
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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van Tienhoven-Wind LJN, Gruppen EG, James RW, Bakker SJL, Gans ROB, Dullaart RPF. Serum paraoxonase-1 activity is inversely related to free thyroxine in euthyroid subjects: The PREVEND Cohort Study. Eur J Clin Invest 2018; 48. [PMID: 29171874 DOI: 10.1111/eci.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 11/18/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Low-normal thyroid function within the euthyroid range has been suggested to enhance atherosclerosis susceptibility. Paraoxonase-1 (PON-1) may protect against atherosclerotic cardiovascular disease development by attenuating oxidative stress. We evaluated relationships of PON-1 with thyroid stimulating hormone (TSH), free T4 , free T3 , lipids and apolipoprotein (apo)A-I in euthyroid subjects, and assessed whether such relationships are modified in the context of the metabolic syndrome (MetS). MATERIALS AND METHODS Serum PON-1 activity (arylesterase activity), TSH, free T4 , free T3 , lipids and apoA-I was measured in 2206 euthyroid subjects (aged 28-75 years; 1138 men (age 49 ± 13 years) and 1068 women (age 46 ± 12 years), recruited from the general population (PREVEND cohort). RESULTS In age- and sex-adjusted analysis, PON-1 activity (divided into tertiles) was positively related to TSH (β = -0.045, P = .036) and inversely to free T4 (β = -0.042, P = .050) but not to free T3 (β = -0.027, P = .20). PON-1 activity was positively related to total cholesterol, non-HDL cholesterol and triglycerides, as well as to HDL cholesterol and apoA-I (P < .01 to <.001). The inverse relationship of PON-1 activity with free T4 remained present after adjustment for lipids and other potential confounders (β = -0.066, P = .002), but the positive relationship with TSH lost significance (β = 0.034, P = .11). The inverse relationship of PON-1 activity with free T4 was not different in subjects with vs without MetS (P = .94), nor modified by the presence of its individual components (P ≥ .22 for each). CONCLUSIONS Serum PON-1 activity is inversely associated with free T4 in euthyroid subjects, suggesting that low-normal thyroid function may affect PON-1 regulation.
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Affiliation(s)
- Lynnda J N van Tienhoven-Wind
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Eke G Gruppen
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Richard W James
- Department of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
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22
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Renting N, Raat ANJ, Dornan T, Wenger-Trayner E, van der Wal MA, Borleffs JCC, Gans ROB, Jaarsma ADC. Integrated and implicit: how residents learn CanMEDS roles by participating in practice. Med Educ 2017; 51:942-952. [PMID: 28485074 DOI: 10.1111/medu.13335] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 09/14/2016] [Accepted: 03/06/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Learning outcomes for residency training are defined in competency frameworks such as the CanMEDS framework, which ultimately aim to better prepare residents for their future tasks. Although residents' training relies heavily on learning through participation in the workplace under the supervision of a specialist, it remains unclear how the CanMEDS framework informs practice-based learning and daily interactions between residents and supervisors. OBJECTIVES This study aimed to explore how the CanMEDS framework informs residents' practice-based training and interactions with supervisors. METHODS Constructivist grounded theory guided iterative data collection and analyses. Data were collected by direct observations of residents and supervisors, combined with formal and field interviews. We progressively arrived at an explanatory theory by coding and interpreting the data, building provisional theories and through continuous conversations. Data analysis drew on sensitising insights from communities of practice theory, which provided this study with a social learning perspective. RESULTS CanMEDS roles occurred in an integrated fashion and usually remained implicit during interactions. The language of CanMEDS was not adopted in clinical practice, which seemed to impede explicit learning interactions. The CanMEDS framework seemed only one of many factors of influence in practice-based training: patient records and other documents were highly influential in daily activities and did not always correspond with CanMEDS roles. Additionally, the position of residents seemed too peripheral to allow them to learn certain aspects of the Health Advocate and Leader roles. CONCLUSIONS The CanMEDS framework did not really guide supervisors' and residents' practice or interactions. It was not explicitly used as a common language in which to talk about resident performance and roles. Therefore, the extent to which CanMEDS actually helps improve residents' learning trajectories and conversations between residents and supervisors about residents' progress remains questionable. This study highlights the fact that the reification of competency frameworks into the complexity of practice-based learning is not a straightforward exercise.
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Affiliation(s)
- Nienke Renting
- Centre for Education Development and Research in Health Professions (CEDAR), University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - A N Janet Raat
- Research Centre for Talent Development in Higher Education and Society, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | | | - Martha A van der Wal
- Centre for Education Development and Research in Health Professions (CEDAR), University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan C C Borleffs
- Centre for Education Development and Research in Health Professions (CEDAR), University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - A Debbie C Jaarsma
- Centre for Education Development and Research in Health Professions (CEDAR), University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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23
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Sotomayor CG, Eisenga MF, Gomes Neto AW, Ozyilmaz A, Gans ROB, Jong WHAD, Zelle DM, Berger SP, Gaillard CAJM, Navis GJ, Bakker SJL. Vitamin C Depletion and All-Cause Mortality in Renal Transplant Recipients. Nutrients 2017; 9:nu9060568. [PMID: 28574431 PMCID: PMC5490547 DOI: 10.3390/nu9060568] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 02/05/2023] Open
Abstract
Vitamin C may reduce inflammation and is inversely associated with mortality in the general population. We investigated the association of plasma vitamin C with all-cause mortality in renal transplant recipients (RTR); and whether this association would be mediated by inflammatory biomarkers. Vitamin C, high sensitive C-reactive protein (hs-CRP), soluble intercellular cell adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured in a cohort of 598 RTR. Cox regression analyses were used to analyze the association between vitamin C depletion (≤28 µmol/L; 22% of RTR) and mortality. Mediation analyses were performed according to Preacher and Hayes's procedure. At a median follow-up of 7.0 (6.2-7.5) years, 131 (21%) patients died. Vitamin C depletion was univariately associated with almost two-fold higher risk of mortality (Hazard ratio (HR) 1.95; 95% confidence interval (95%CI) 1.35-2.81, p < 0.001). This association remained independent of potential confounders (HR 1.74; 95%CI 1.18-2.57, p = 0.005). Hs-CRP, sICAM-1, sVCAM-1 and a composite score of inflammatory biomarkers mediated 16, 17, 15, and 32% of the association, respectively. Vitamin C depletion is frequent and independently associated with almost two-fold higher risk of mortality in RTR. It may be hypothesized that the beneficial effect of vitamin C at least partly occurs through decreasing inflammation.
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Affiliation(s)
- Camilo G Sotomayor
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Michele F Eisenga
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Antonio W Gomes Neto
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Akin Ozyilmaz
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Wilhelmina H A de Jong
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Dorien M Zelle
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Stefan P Berger
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Carlo A J M Gaillard
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Gerjan J Navis
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
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Gomes Neto AW, Sotomayor CG, Pranger IG, van den Berg E, Gans ROB, Soedamah-Muthu SS, Navis GJ, Bakker SJL. Intake of Marine-Derived Omega-3 Polyunsaturated Fatty Acids and Mortality in Renal Transplant Recipients. Nutrients 2017; 9:nu9040363. [PMID: 28379169 PMCID: PMC5409702 DOI: 10.3390/nu9040363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 12/13/2022] Open
Abstract
The effect of marine-derived omega-3 polyunsaturated fatty acids (n-3 PUFA) on long-term outcome in renal transplant recipients (RTR) remains unclear. We investigated whether marine-derived n-3 PUFA intake is associated with all-cause and cardiovascular (CV) mortality in RTR. Intake of eicosapentaenoic acid plus docosahexaenoic acid (EPA-DHA) was assessed using a validated Food Frequency Questionnaire. Cox regression analyses were performed to evaluate the associations of EPA-DHA intake with all-cause and CV mortality. We included 627 RTR (age 53 ± 13 years). EPA-DHA intake was 102 (42–215) mg/day. During median follow-up of 5.4 years, 130 (21%) RTR died, with 52 (8.3%) due to CV causes. EPA-DHA intake was associated with lower risk of all-cause mortality (Hazard Ratio (HR) 0.85; 95% confidence interval (95% CI) 0.75–0.97). Age (p= 0.03) and smoking status (p = 0.01) significantly modified this association, with lower risk of all-cause and CV mortality particularly in older (HR 0.75, 95% CI 0.61–0.92; HR 0.68, 95% CI 0.48–0.95) and non-smoking RTR (HR 0.80, 95% CI 0.68–0.93; HR 0.74, 95% CI 0.56–0.98). In conclusion, marine-derived n-3 PUFA intake is inversely associated with risk of all-cause and CV mortality in RTR. The strongest associations were present in subgroups of patients, which adds further evidence to the plea for EPA-DHA supplementation, particularly in elderly and non-smoking RTR.
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Affiliation(s)
- António W Gomes Neto
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Camilo G Sotomayor
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Ilse G Pranger
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Else van den Berg
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Sabita S Soedamah-Muthu
- Division of Human Nutrition, Wageningen University & Research, Droevendaalsesteeg 4, Wageningen 6708 PB, The Netherlands.
| | - Gerjan J Navis
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
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Abbasi A, Kieneker LM, Corpeleijn E, Gansevoort RT, Gans ROB, Struck J, de Boer RA, Hillege HL, Stolk RP, Navis G, Bakker SJL. Plasma N-terminal Prosomatostatin and Risk of Incident Cardiovascular Disease and All-Cause Mortality in a Prospective Observational Cohort: the PREVEND Study. Clin Chem 2016; 63:278-287. [PMID: 28062624 DOI: 10.1373/clinchem.2016.259275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/20/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Somatostatin is a component of the well-known insulin-like growth factor-1/growth hormone (GH) longevity axis. There is observational evidence that increased GH is associated with an increased risk of cardiovascular disease (CVD). We aimed to investigate the potential association of plasma N-terminal fragment prosomatostatin (NT-proSST) with incident CVD and all-cause mortality in apparently healthy adults. METHODS We studied 8134 participants without history of CVD (aged 28-75 years; women, 52.6%) from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study in Groningen, the Netherlands. Plasma NT-proSST was measured in baseline samples. Outcomes were incidence of CVD and all-cause mortality. RESULTS In cross-sectional analyses, NT-proSST [mean (SD), 384.0 (169.3) pmol/L] was positively associated with male sex and age (both P < 0.001). During a median follow-up of 10.5 (Q1-Q3: 9.9-10.8) years, 708 (8.7%) participants developed CVD and 517 (6.4%) participants died. In univariable analyses, NT-proSST was associated with an increased risk of incident CVD and all-cause mortality (both P < 0.001). In multivariable analyses, these associations were independent of the Framingham risk factors, with hazard ratios (95% CI) per doubling of NT-proSST of 1.17 (1.03-1.34; P = 0.02) for incident CVD and of 1.28 (1.09-1.49; P = 0.002) for all-cause mortality. Addition of NT-proSST to the updated Framingham Risk Score improved reclassification (integrated discrimination improvement (P < 0.001); net reclassification improvement was 2.5% (P = 0.04)). CONCLUSIONS Plasma NT-proSST is positively associated with increased risk of future CVD and all-cause mortality, partly independent of traditional CVD risk factors. Further research is needed to address the nature of associations.
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Affiliation(s)
- Ali Abbasi
- Department of Epidemiology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands; .,Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands.,MRC Epidemiology Unit, University of Cambridge School of Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, the United Kingdom.,Department of Primary Care & Public Health Sciences, King's College London, London, UK
| | - Lyanne M Kieneker
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Hans L Hillege
- Department of Epidemiology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands.,Department of Cardiology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Ronald P Stolk
- Department of Epidemiology, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
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Renting N, Gans ROB, Borleffs JCC, Van Der Wal MA, Jaarsma ADC, Cohen-Schotanus J. A feedback system in residency to evaluate CanMEDS roles and provide high-quality feedback: Exploring its application. Med Teach 2016; 38:738-45. [PMID: 26473377 DOI: 10.3109/0142159x.2015.1075649] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Residents benefit from regular, high quality feedback on all CanMEDS roles during their training. However, feedback mostly concerns Medical Expert, leaving the other roles behind. A feedback system was developed to guide supervisors in providing feedback on CanMEDS roles. We analyzed whether feedback was provided on the intended roles and explored differences in quality of written feedback. METHODS In the feedback system, CanMEDS roles were assigned to five authentic situations: Patient Encounter, Morning Report, On-call, CAT, and Oral Presentation. Quality of feedback was operationalized as specificity and inclusion of strengths and improvement points. Differences in specificity between roles were tested with Mann-Whitney U tests with a Bonferroni correction (α = 0.003). RESULTS Supervisors (n = 126) provided residents (n = 120) with feedback (591 times). Feedback was provided on the intended roles, most frequently on Scholar (78%) and Communicator (71%); least on Manager (47%), and Collaborator (56%). Strengths (78%) were mentioned more frequently than improvement points (52%), which were lacking in 40% of the feedback on Manager, Professional, and Collaborator. Feedback on Scholar was more frequently (p = 0.000) and on Reflective Professional was less frequently (p = 0.003) specific. DISCUSSION AND CONCLUSION Assigning roles to authentic situations guides supervisors in providing feedback on different CanMEDS roles. We recommend additional supervisor training on how to observe and evaluate the roles.
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Affiliation(s)
- Nienke Renting
- a University of Groningen and University Medical Center Groningen , The Netherlands
| | - Rijk O B Gans
- a University of Groningen and University Medical Center Groningen , The Netherlands
| | - Jan C C Borleffs
- a University of Groningen and University Medical Center Groningen , The Netherlands
| | - Martha A Van Der Wal
- a University of Groningen and University Medical Center Groningen , The Netherlands
| | - A Debbie C Jaarsma
- a University of Groningen and University Medical Center Groningen , The Netherlands
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27
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Boering M, van Dijk PR, Logtenberg SJJ, Groenier KH, Wolffenbuttel BHR, Gans ROB, Kleefstra N, Bilo HJG. Effects of intraperitoneal insulin versus subcutaneous insulin administration on sex hormone-binding globulin concentrations in patients with type 1 diabetes mellitus. Endocr Connect 2016; 5:136-42. [PMID: 27287189 PMCID: PMC5002961 DOI: 10.1530/ec-16-0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/28/2016] [Indexed: 02/05/2023]
Abstract
AIMS Elevated sex hormone-binding globulin (SHBG) concentrations have been described in patients with type 1 diabetes mellitus (T1DM), probably due to low portal insulin concentrations. We aimed to investigate whether the route of insulin administration, continuous intraperitoneal insulin infusion (CIPII), or subcutaneous (SC), influences SHBG concentrations among T1DM patients. METHODS Post hoc analysis of SHBG in samples derived from a randomized, open-labeled crossover trial was carried out in 20 T1DM patients: 50% males, mean age 43 (±13) years, diabetes duration 23 (±11) years, and hemoglobin A1c (HbA1c) 8.7 (±1.1) (72 (±12) mmol/mol). As secondary outcomes, testosterone, 17-β-estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were analyzed. RESULTS Estimated mean change in SHBG was -10.3nmol/L (95% CI: -17.4, -3.2) during CIPII and 3.7nmol/L (95% CI: -12.0, 4.6) during SC insulin treatment. Taking the effect of treatment order into account, the difference in SHBG between therapies was -6.6nmol/L (95% CI: -17.5, 4.3); -12.7nmol/L (95% CI: -25.1, -0.4) for males and -1.7nmol/L (95% CI: -24.6, 21.1) for females, respectively. Among males, SHBG and testosterone concentrations changed significantly during CIPII; -15.8nmol/L (95% CI: -24.2, -7.5) and -8.3nmol/L (95% CI: -14.4, -2.2), respectively. The difference between CIPII and SC insulin treatment was also significant for change in FSH 1.2U/L (95% CI: 0.1, 2.2) among males. CONCLUSIONS SHBG concentrations decreased significantly during CIPII treatment. Moreover, the difference in change between CIPII and SC insulin therapy was significant for SHBG and FSH among males. These findings support the hypothesis that portal insulin administration influences circulating SHBG and sex steroids.
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Affiliation(s)
- M Boering
- IsalaDiabetes Centre, Zwolle, The Netherlands
| | - P R van Dijk
- IsalaDiabetes Centre, Zwolle, The Netherlands IsalaDepartment of Internal Medicine, Zwolle, The Netherlands
| | - S J J Logtenberg
- DiakonessenhuisDepartment of Internal Medicine, Utrecht, The Netherlands Langerhans Medical Research groupZwolle, The Netherlands
| | - K H Groenier
- IsalaDiabetes Centre, Zwolle, The Netherlands Department of General PracticeUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B H R Wolffenbuttel
- Department of Internal MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R O B Gans
- Department of Internal MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - N Kleefstra
- IsalaDiabetes Centre, Zwolle, The Netherlands Langerhans Medical Research groupZwolle, The Netherlands Department of Internal MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H J G Bilo
- IsalaDiabetes Centre, Zwolle, The Netherlands IsalaDepartment of Internal Medicine, Zwolle, The Netherlands Department of Internal MedicineUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Renting N, Dornan T, Gans ROB, Borleffs JCC, Cohen-Schotanus J, Jaarsma ADC. What supervisors say in their feedback: construction of CanMEDS roles in workplace settings. Adv Health Sci Educ Theory Pract 2016; 21:375-87. [PMID: 26342599 PMCID: PMC4801985 DOI: 10.1007/s10459-015-9634-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/22/2015] [Indexed: 05/10/2023]
Abstract
The CanMEDS framework has been widely adopted in residency education and feedback processes are guided by it. It is, however, only one of many influences on what is actually discussed in feedback. The sociohistorical culture of medicine and individual supervisors' contexts, experiences and beliefs are also influential. Our aim was to find how CanMEDS roles are constructed in feedback in a postgraduate curriculum-in-action. We applied a set of discourse analytic tools to written feedback from 591 feedback forms from 7 hospitals, including 3150 feedback comments in which 126 supervisors provided feedback to 120 residents after observing their performance in authentic settings. The role of Collaborator was constructed in two different ways: a cooperative discourse of equality with other workers and patients; and a discourse, which gave residents positions of power-delegating, asserting and 'taking a firm stance'. Efficiency-being fast and to the point emerged as an important attribute of physicians. Patients were seldom part of the discourses and, when they were, they were constructed as objects of communication and collaboration rather than partners. Although some of the discourses are in line with what might be expected, others were in striking contrast to the spirit of CanMEDS. This study's findings suggest that it takes more than a competency framework, evaluation instruments, and supervisor training to change the culture of workplaces. The impact on residents of training in such demanding, efficiency-focused clinical environments is an important topic for future research.
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Affiliation(s)
- Nienke Renting
- Center for Educational Development and Research in Health Professions, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- Department of Education Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Jan C C Borleffs
- Center for Educational Development and Research in Health Professions, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Janke Cohen-Schotanus
- Center for Educational Development and Research in Health Professions, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - A Debbie C Jaarsma
- Center for Educational Development and Research in Health Professions, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
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Deshpande DD, Fleming TH, Gans ROB, Nawroth PP. Impaired Pro-opiomelanocortin (Pomc) – Mu Opioid Receptor (MOR) axis contributes to painful diabetic neuropathy in Streptozotocin induced mice. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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van Dijk PR, Logtenberg SJJ, Hendriks SH, Groenier KH, Feenstra J, Pouwer F, Gans ROB, Kleefstra N, Bilo HJG. Intraperitoneal versus subcutaneous insulin therapy in the treatment of type 1 diabetes mellitus. Neth J Med 2015; 73:399-409. [PMID: 26582805] [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: 06/05/2023]
Abstract
BACKGROUND Continuous intraperitoneal insulin infusion (CIPII), a last-resort type 1 diabetes mellitus (T1DM) treatment, has only been investigated in small or controlled studies. We aimed to investigate glycaemia and quality of life (QoL) with CIPII versus subcutaneous (SC) insulin therapy during usual T1DM care. METHODS A prospective, observational case-control study. CIPII-treated cases were matched to SC controls. The primary endpoint was a non-inferiority assessment (pre-defined margin of -5.5 mmol÷mol) of the baseline adjusted difference in HbA1c between groups during a 26-week follow-up. Secondary outcomes included QoL, clinical and biochemical measurements. RESULTS In total, 183 patients were analysed (CIPII n = 39 and SC n = 144). The HbA1c difference between treatment groups was -3.0 mmol÷mol (95% CI -5.0, -1.0), being lower in the SC group. Patients using SC insulin therapy spent less percentage of time in hyperglycaemia (-9.3% (95% CI -15.8, -2.8)) and more in euglycaemia (6.9% (95% CI 1.2, 12.5) as compared with CIPII-treated patients. Besides a 3.6 U÷l (95% CI 1.2, 6.0) lower concentration of alanine aminotransferase with CIPII, no biochemical and clinical differences were present. Most QoL scores were lower at baseline among CIPII-treated patients. However, besides lower health status, there were no differences in the baseline-adjusted general and diabetes-specific QoL and treatment satisfaction. CONCLUSION Although patients using CIPII had a higher glycaemic profile compared with patients using SC insulin therapy, the HbA1c difference was non-inferior. Overall, health status was lower among CIPII-treated patients, although diabetes-specific QoL and treatment satisfaction was similar to subcutaneously treated patients.
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Affiliation(s)
- P R van Dijk
- Departments of Diabetes Centre and Internal Medicine, Isala, Zwolle, the Netherlands
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van Ockenburg SL, Bos EH, de Jonge P, van der Harst P, Gans ROB, Rosmalen JGM. Stressful life events and leukocyte telomere attrition in adulthood: a prospective population-based cohort study. Psychol Med 2015; 45:2975-2984. [PMID: 26219269 DOI: 10.1017/s0033291715000914] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Telomere attrition might be one of the mechanisms through which psychosocial stress leads to somatic disease. To date it is unknown if exposure to adverse life events in adulthood is associated with telomere shortening prospectively. In the current study we investigated whether life events are associated with shortening of telomere length (TL). METHOD Participants were 1094 adults (mean age 53.1, range 33-79 years) from the PREVEND cohort. Data were collected at baseline (T1) and at two follow-up visits after 4 years (T2) and 6 years (T3). Life events were assessed with an adjusted version of the List of Threatening Events (LTE). TL was measured by monochrome multiplex quantitative PCR at T1, T2, and T3. A linear mixed model was used to assess the effect of recent life events on TL prospectively. Multivariable regression analyses were performed to assess whether the lifetime life events score or the score of life events experienced before the age of 12 predicted TL cross-sectionally. All final models were adjusted for age, sex, body mass index, presence of chronic diseases, frequency of sports, smoking status, and level of education. RESULTS Recent life events significantly predicted telomere attrition prospectively (B = -0.031, p = 0.007). We were not able to demonstrate a significant cross-sectional relationship between the lifetime LTE score and TL. Nor did we find exposure to adverse life events before the age of 12 to be associated with TL in adulthood. CONCLUSIONS Exposure to recent adverse life events in adulthood is associated with telomere attrition prospectively.
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Affiliation(s)
- S L van Ockenburg
- Interdisciplinary Center Psychopathology and Emotion regulation,University of Groningen,University Medical Center Groningen,The Netherlands
| | - E H Bos
- Interdisciplinary Center Psychopathology and Emotion regulation,University of Groningen,University Medical Center Groningen,The Netherlands
| | - P de Jonge
- Interdisciplinary Center Psychopathology and Emotion regulation,University of Groningen,University Medical Center Groningen,The Netherlands
| | - P van der Harst
- Department of Cardiology,University of Groningen,University Medical Center Groningen,The Netherlands
| | - R O B Gans
- Department of Internal Medicine,University of Groningen,University Medical Center Groningen,The Netherlands
| | - J G M Rosmalen
- Interdisciplinary Center Psychopathology and Emotion regulation,University of Groningen,University Medical Center Groningen,The Netherlands
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Klooster A, Larkin JR, Adaikalakoteswari A, Gans ROB, van Goor H, Thornalley PJ, Rabbani N, Navis G, Leuvenink HGD, Bakker SJL. Severe thiamine deficiency complicated by weight loss protects against renal ischaemia-reperfusion injury in rats. NDT Plus 2015; 2:182-3. [PMID: 25949326 PMCID: PMC4421349 DOI: 10.1093/ndtplus/sfn194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - James R Larkin
- Protein Damage and Systems Biology Research Group, Clinical Sciences Research Institute University of Warwick Medical School , Coventry , UK
| | - Antonysunil Adaikalakoteswari
- Protein Damage and Systems Biology Research Group, Clinical Sciences Research Institute University of Warwick Medical School , Coventry , UK
| | - Rijk O B Gans
- Department of Medicine University Medical Center of Groningen and University of Groningen , The Netherlands
| | - Harry van Goor
- Department of Pathology and Laboratory Medicine , University Medical Center Groningen and University of Groningen The Netherlands
| | - Paul J Thornalley
- Protein Damage and Systems Biology Research Group, Clinical Sciences Research Institute University of Warwick Medical School , Coventry , UK
| | - Naila Rabbani
- Protein Damage and Systems Biology Research Group, Clinical Sciences Research Institute University of Warwick Medical School , Coventry , UK
| | - Gerjan Navis
- Department of Medicine University Medical Center of Groningen and University of Groningen , The Netherlands
| | - Henri G D Leuvenink
- Department of Surgery, Surgical Research Laboratory , University Medical Center of Groningen and University of Groningen The Netherlands
| | - Stephan J L Bakker
- Department of Medicine University Medical Center of Groningen and University of Groningen , The Netherlands
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Said MY, Deetman PE, de Vries APJ, Zelle DM, Gans ROB, Navis G, Joosten MM, Bakker SJL. Causal path analyses of the association of protein intake with risk of mortality and graft failure in renal transplant recipients. Clin Transplant 2015; 29:447-57. [PMID: 25739949 DOI: 10.1111/ctr.12536] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/27/2022]
Abstract
The effect of a low protein intake on survival in renal transplant recipients (RTR) is unknown. A low protein intake may increase risks of malnutrition, low muscle mass, and death. We aimed to study associations of protein intake with mortality and graft failure and to identify potential intermediate factors. Protein intake was estimated from 24-h urinary urea excretion (24-h UUE). Graft failure was defined as return to dialysis or retransplantation. We used Cox regression analyses to analyze associations with outcome and potential intermediate factors in the causal path. In 604 RTR, mean ± SD 24-h UUE was 380 ± 114 mmol/24-h. During median follow-up for 7.0 yr (interquartile range: 6.2-7.5 yr), 133 RTR died and 53 developed graft failure. In univariate analyses, 24-h UUE was associated with lower risk of mortality (HR [95% CI] = 0.80 [0.69-0.94]) and graft failure (HR [95% CI] = 0.72 [0.56-0.92]). These associations were independent of potential confounders. In causal path analyses, the association of 24-h UUE with mortality disappeared after adjustment for muscle mass. Low protein intake is associated with increased risk of mortality and graft failure in RTR. Causal path analyses reveal that the association with mortality is explained by low muscle mass. These findings suggest that protein intake restriction should not be advised to RTR.
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Affiliation(s)
- M Yusof Said
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands
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Abbasi A, Deetman PE, Corpeleijn E, Gansevoort RT, Gans ROB, Hillege HL, van der Harst P, Stolk RP, Navis G, Alizadeh BZ, Bakker SJL. Bilirubin as a potential causal factor in type 2 diabetes risk: a Mendelian randomization study. Diabetes 2015; 64:1459-69. [PMID: 25368098 PMCID: PMC4346199 DOI: 10.2337/db14-0228] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Circulating bilirubin, a natural antioxidant, is associated with decreased risk of type 2 diabetes (T2D), but the nature of the relationship remains unknown. We performed Mendelian randomization in a prospective cohort of 3,381 participants free of diabetes at baseline (age 28-75 years; women 52.6%). We used rs6742078 located in the uridine diphosphate-glucuronosyltransferase locus as an instrumental variable (IV) to study a potential causal effect of serum total bilirubin level on T2D risk. T2D developed in a total of 210 participants (6.2%) during a median follow-up period of 7.8 years. In adjusted analyses, rs6742078, which explained 19.5% of bilirubin variation, was strongly associated with total bilirubin (a 0.68-SD increase in bilirubin levels per T allele; P < 1 × 10(-122)) and was also associated with T2D risk (odds ratio [OR] 0.69 [95% CI 0.54-0.90]; P = 0.006). Per 1-SD increase in log-transformed bilirubin levels, we observed a 25% (OR 0.75 [95% CI 0.62-0.92]; P = 0.004) lower risk of T2D. In Mendelian randomization analysis, the causal risk reduction for T2D was estimated to be 42% (causal OR for IV estimation per 1-SD increase in log-transformed bilirubin 0.58 [95% CI 0.39-0.84]; P = 0.005), which was comparable to the observational estimate (Durbin-Wu-Hausman χ(2) test, P for difference = 0.19). These novel results provide evidence that an elevated bilirubin level is causally associated with the risk of T2D and support its role as a protective determinant.
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Affiliation(s)
- Ali Abbasi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, U.K.
| | - Petronella E Deetman
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ron T Gansevoort
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rijk O B Gans
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans L Hillege
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, the Netherlands
| | - Ronald P Stolk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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van Ockenburg SL, Tak LM, Bakker SJL, Gans ROB, de Jonge P, Rosmalen JGM. Effects of adverse life events on heart rate variability, cortisol, and C-reactive protein. Acta Psychiatr Scand 2015; 131:40-50. [PMID: 24833194 DOI: 10.1111/acps.12286] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Our objective was to assess whether self-reported adverse life events during childhood or over the lifespan are associated with altered activity of the autonomic nervous system (ANS), the hypothalamic-pituitary-adrenal axis (HPA axis), and the immune system. METHOD This study was performed in a population-based cohort of 1094 adults aged 33-79 years, 46.3% male, average age 53 (SD 11.4). Two waves of data were collected at a 2-year interval, enabling replication of the analyses. Cumulative exposure to adverse life events was assessed by means of the List of Threatening Experiences. ANS function was assessed by spectral analysis of heart rate variability in the high-frequency band (HRV-HF). HPA axis function was assessed by 24-h urinary free cortisol (24-h UFC) excretion. Inflammation was assessed by high-sensitive C-reactive protein (hsCRP). RESULTS Multiple linear regression analyses did not reveal any significant associations, with the exception of one significant negative association between the lifetime score of adverse life events and HRV-HF β = -0.028; P = 0.037 at baseline, but not at follow up 2 years later. CONCLUSION In a large population-based cohort, adverse life events were not consistently associated with HRV-HF, 24-h UFC or (hsCRP).
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Affiliation(s)
- S L van Ockenburg
- Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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van Dijk PR, Logtenberg SJJ, Groenier KH, Gans ROB, Bilo HJG, Kleefstra N. Report of a 7 year case-control study of continuous intraperitoneal insulin infusion and subcutaneous insulin therapy among patients with poorly controlled type 1 diabetes mellitus: favourable effects on hypoglycaemic episodes. Diabetes Res Clin Pract 2014; 106:256-63. [PMID: 25305134 DOI: 10.1016/j.diabres.2014.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 06/17/2014] [Revised: 07/18/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
AIMS Continuous intraperitoneal insulin infusion (CIPII) is a last-resort treatment option for patients with type 1 diabetes mellitus (T1DM) who fail to reach adequate glycaemic control with subcutaneous (SC) insulin therapy. Aim was to compare the long-term effects of CIPII and SC insulin therapy among patients with T1DM in poor glycaemic control. METHODS Patients in which CIPII was initiated in 2006 were compared with a control group of T1DM patients who continued SC therapy. Linear mixed models were used to calculate differences between the baseline (2006) and final (2013) measurements within and between groups. RESULTS A total of 95 patients of which 21 were using CIPII and 74 using SC insulin were included. Within the CIPII group, the number of hypoglycaemic episodes decreased with -5 (95% CI -8 to -3) per 2 weeks while it remained stable among SC patients. Over time, only the number of hypoglycaemic episodes decreased more with CIPII as compared to SC insulin treatment (difference: -6 (95% CI -9 to -4)). There were no differences between treatment groups regarding clinical parameters and quality of life scores over time. Pump or catheter dysfunction led to ketoacidosis in 6 patients: 2 using CIPII and 4 SC insulin. CONCLUSIONS After 7 years of follow-up, there is a persistent decline of hypoglycaemic events among CIPII treated T1DM patients. Besides less hypoglycaemic episodes with CIPII therapy, there are no differences between long-term CIPII and SC insulin therapy.
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Affiliation(s)
- P R van Dijk
- Isala, Diabetes Centre, Zwolle, The Netherlands.
| | - S J J Logtenberg
- Isala, Diabetes Centre, Zwolle, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - K H Groenier
- Isala, Diabetes Centre, Zwolle, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - R O B Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - H J G Bilo
- Isala, Diabetes Centre, Zwolle, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands; Isala, Department of Internal Medicine, Zwolle, The Netherlands
| | - N Kleefstra
- Isala, Diabetes Centre, Zwolle, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands; Langerhans Medical Research Group, Zwolle, The Netherlands
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van Dijk PR, Logtenberg SJJ, Gans ROB, Bilo HJG, Kleefstra N. Intraperitoneal insulin infusion: treatment option for type 1 diabetes resulting in beneficial endocrine effects beyond glycaemia. Clin Endocrinol (Oxf) 2014; 81:488-97. [PMID: 25041605 DOI: 10.1111/cen.12546] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/11/2014] [Accepted: 07/03/2014] [Indexed: 11/28/2022]
Abstract
Continuous intraperitoneal insulin infusion (CIPII) is a treatment option for patients with type 1 diabetes mellitus who fail to reach adequate glycaemic control despite intensive subcutaneous (SC) insulin therapy. CIPII has clear advantages over SC insulin administration in terms of pharmacokinetic and pharmacodynamic properties and has been shown to improve glycaemic regulation. Due to the delivery of insulin predominantly in the portal vein, as opposed to systemically, CIPII offers a unique research model to investigate the effects of insulin on endocrine and metabolic parameters in vivo. The aim of the present article is to provide an overview of the literature with respect to the effects of CIPII on glucose management, quality of life, complications and costs, with additional focus on metabolic and endocrine aspects. Finally, future use and research objectives are discussed.
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Abbasi A, Corpeleijn E, Gansevoort RT, Gans ROB, Struck J, Schulte J, Hillege HL, van der Harst P, Stolk RP, Navis G, Bakker SJL. Circulating peroxiredoxin 4 and type 2 diabetes risk: the Prevention of Renal and Vascular Endstage Disease (PREVEND) study. Diabetologia 2014; 57:1842-9. [PMID: 24893865 PMCID: PMC4119240 DOI: 10.1007/s00125-014-3278-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/08/2014] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS Oxidative stress plays a key role in the development of type 2 diabetes mellitus. We previously showed that the circulating antioxidant peroxiredoxin 4 (Prx4) is associated with cardiometabolic risk factors. We aimed to evaluate the association of Prx4 with type 2 diabetes risk in the general population. METHODS We analysed data on 7,972 individuals from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study (49% men, aged 28-75 years) with no diabetes at baseline. Logistic regression models adjusted for age, sex, smoking, waist circumference, hypertension and family history of diabetes were used to estimate the ORs for type 2 diabetes. RESULTS During a median follow up of 7.7 years, 496 individuals (288 men; 58%) developed type 2 diabetes. The median (Q1-Q3) Prx4 level was 0.84 (0.53-1.40) U/l in individuals who developed type 2 diabetes and 0.68 (0.43-1.08) U/l in individuals who did not develop type 2 diabetes. For every doubling of Prx4 levels, the adjusted OR (95% CI) for type 2 diabetes was 1.16 (1.05-1.29) in the whole population; by sex, it was 1.31 (1.14-1.50) for men and 1.03 (0.87-1.21) for women. Further adjustment for other clinical measures did not materially change the results. The addition of Prx4 to a validated diabetes risk score significantly improved the prediction of type 2 diabetes in men (p = 0.002 for reclassification improvement). CONCLUSIONS/INTERPRETATION Our findings suggest that elevated serum Prx4 levels are associated with a higher risk of incident type 2 diabetes. For men, taking Prx4 into consideration can improve type 2 diabetes prediction over a validated diabetes risk score; in contrast, there is no improvement in risk prediction for women.
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Affiliation(s)
- Ali Abbasi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,
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Alkhalaf A, Landman GWD, van Hateren KJJ, Groenier KH, Mooyaart AL, De Heer E, Gans ROB, Navis GJ, Bakker SJL, Kleefstra N, Bilo HJG. Sex specific association between carnosinase gene CNDP1 and cardiovascular mortality in patients with type 2 diabetes (ZODIAC-22). J Nephrol 2014; 28:201-7. [PMID: 24756973 DOI: 10.1007/s40620-014-0096-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/07/2014] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Homozygosity for a 5-leucine repeat (5L-5L) in the carnosinase gene (CNDP1) has been associated with a reduced prevalence of diabetic nephropathy in cross-sectional studies in patients with type 2 diabetes, particularly in women. Prospective studies on mortality are not available. This study investigated whether 5L-5L was associated with mortality and progression of renal function loss and to what extent this effect is modified by sex. METHODS In a prospective cohort of patients with type 2 diabetes, a Cox proportional hazard model was used to compare 5L-5L with other genotypes regarding (cardiovascular) mortality. Renal function slopes were obtained by within-individual linear regression of the estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation, and were compared between 5L-5L and other genotypes. RESULTS 871 patients were included (38% with 5L-5L). After 9.5 years of follow-up, hazards ratios (HR) for all-cause and cardiovascular mortality in 5L-5L versus other genotypes were 1.09 [95% confidence interval (CI) 0.88-1.36] and 1.12 (95% CI 0.79-1.58), respectively. There was a significant interaction between CNDP1 and sex for the association with cardiovascular mortality (p = 0.01), not for all-cause mortality (p = 0.32). Adjusted HR in 5L-5L for cardiovascular mortality was 0.69 (95% CI 0.39-1.23) in men and 1.77 (95% CI 1.12-2.81) in women. The slopes of eGFR-MDRD did not significantly differ between 5L-5L and other genotypes. CONCLUSIONS The association between CNDP1 and cardiovascular mortality was sex-specific, with a higher risk in women with 5L-5L genotype. CNDP1 was not associated with all-cause mortality or change in eGFR.
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Affiliation(s)
- A Alkhalaf
- Diabetes Centre, Isala Clinics, Dr. Spanjaardweg 11, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
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Landman GWD, de Bock GH, van Hateren KJJ, van Dijk PR, Groenier KH, Gans ROB, Houweling ST, Bilo HJG, Kleefstra N. Safety and efficacy of gliclazide as treatment for type 2 diabetes: a systematic review and meta-analysis of randomized trials. PLoS One 2014; 9:e82880. [PMID: 24533045 PMCID: PMC3922704 DOI: 10.1371/journal.pone.0082880] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/28/2013] [Indexed: 11/23/2022] Open
Abstract
Objective and Design Gliclazide has been associated with a low risk of hypoglycemic episodes and beneficial long-term cardiovascular safety in observational cohorts. The aim of this study was to assess in a systematic review and meta-analysis of randomized controlled trials the safety and efficacy of gliclazide compared to other oral glucose-lowering agents (PROSPERO2013:CRD42013004156) Data Sources Medline, EMBASE, Clinicaltrials.gov, Trialregister.nl, Clinicaltrialsregister.eu and the Cochrane database. Selection Included were randomized studies of at least 12 weeks duration with the following outcomes: HbA1c change, incidence of severe hypoglycemia, weight change, cardiovascular events and/or mortality when comparing gliclazide with other oral blood glucose lowering drugs. Bias was assessed with the Cochrane risk of bias tool. The inverse variance random effects model was used. Results Nineteen trials were included; 3,083 patients treated with gliclazide and 3,155 patients treated with other oral blood glucose lowering drugs. There was a considerable amount of heterogeneity between and bias in studies. Compared to other glucose lowering agents except metformin, gliclazide was slightly more effective (−0.13% (95%CI: −0.25, −0.02, I2 55%)). One out of 2,387 gliclazide users experienced a severe hypoglycemic event, whilst also using insulin. There were 25 confirmed non-severe hypoglycemic events (2.2%) in 1,152 gliclazide users and 22 events (1.8%) in 1,163 patients in the comparator group (risk ratio 1.09 (95% CI: 0.20, 5.78, I2 77%)). Few studies reported differences in weight and none were designed to evaluate cardiovascular outcomes. Conclusions The methodological quality of randomized trials comparing gliclazide to other oral glucose lowering agents was poor and effect estimates on weight were limited by publication bias. The number of severe hypoglycemic episodes was extremely low, and gliclazide appears at least equally effective compared to other glucose lowering agents. None of the trials were designed for evaluating cardiovascular outcomes, which warrants attention in future randomized trials.
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Affiliation(s)
| | - Geertruide H. de Bock
- Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Klaas H. Groenier
- Department of General Practice, University Medical Centre Groningen, Groningen, The Netherlands
| | - Rijk O. B. Gans
- Department Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Henk J. G. Bilo
- Diabetes Centre Zwolle, Zwolle, The Netherlands
- Department Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands
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Landman GWD, van Dijk PR, Drion I, van Hateren KJJ, Struck J, Groenier KH, Gans ROB, Bilo HJG, Bakker SJL, Kleefstra N. Midregional fragment of proadrenomedullin, new-onset albuminuria, and cardiovascular and all-cause mortality in patients with type 2 diabetes (ZODIAC-30). Diabetes Care 2014; 37:839-45. [PMID: 24170764 DOI: 10.2337/dc13-1852] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The midregional fragment of proadrenomedullin (MR-proADM) is a marker of endothelial dysfunction and has been associated with a variety of diseases. Our aim was to investigate whether MR-proADM is associated with new-onset albuminuria and cardiovascular (CV) and all-cause mortality in patients with type 2 diabetes treated in primary care. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes participating in the observational Zwolle Outpatient Diabetes Project Integrating Available Care (ZODIAC) study were included. Cox regression analyses were used to assess the relation of baseline MR-proADM with new-onset albuminuria and CV and all-cause mortality. Risk prediction capabilities of MR-proADM for new-onset albuminuria and CV and all-cause mortality were assessed with Harrell's C and the integrated discrimination improvement. RESULTS In 1,243 patients (mean age 67 [±12] years), the median follow-up was 5.6 years (interquartile range 3.1-10.1); 388 (31%) patients died, with 168 (12%) CV deaths. Log2 MR-proADM was associated with CV (hazard ratio 1.96 [95% CI 1.27-3.01]) and all-cause mortality (1.78 [1.34-2.36]) after adjusting for age, sex, BMI, smoking, systolic blood pressure, cholesterol-to-HDL ratio, duration of diabetes, HbA1c, ACE inhibitor/angiotensin receptor blocker, history of CV diseases, log serum creatinine, and log albumin-to-creatinine ratio. MR-proADM slightly improved mortality risk prediction. The age- and sex-adjusted, but not multivariate-adjusted, MR-proADM levels were associated with new-onset albuminuria. CONCLUSIONS MR-proADM was associated with CV and all-cause mortality in patients with type 2 diabetes after a median follow-up of 5.6 years. There was no independent relationship with new-onset albuminuria. In the availability of an extensive set of risk factors, there was little added effect of MR-proADM in risk prediction of CV and all-cause mortality.
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Jonker JT, de Mol P, de Vries ST, Widya RL, Hammer S, van Schinkel LD, van der Meer RW, Gans ROB, Webb AG, Kan HE, de Koning EJP, Bilo HJG, Lamb HJ. Exercise and Type 2 Diabetes Mellitus: Changes in Tissue-specific Fat Distribution and Cardiac Function. Radiology 2013; 269:434-42. [DOI: 10.1148/radiol.13121631] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Waanders F, Visser FW, Gans ROB. Current concepts in the management of diabetic nephropathy. Neth J Med 2013; 71:448-458. [PMID: 24218418] [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: 06/02/2023]
Abstract
Although much progress has been made in slowing the progression of diabetic nephropathy, renal dysfunction and development of end-stage renal disease (ESRD) remain major concerns in diabetes. In addition, diabetic patients with microalbuminuria have an increased cardiovascular mortality. Therefore, new treatment modalities or strategies are needed to prevent or slow the progression of diabetic nephropathy and prevent cardiovascular disease in diabetes. In this review we describe current concepts in pathophysiology, treatment goals and we discuss future developments in the treatment of diabetic nephropathy. Common risk factors for diabetic nephropathy and its progression are longer duration, poor glycaemic control, hypertension and the presence of albuminuria. Available treatment options, especially renin-angiotensin aldosterone system (RAAS) blockade, but also better blood pressure and blood glucose control, decrease the incidence of cardiovascular disease and renal disease in diabetes. It is important that treatment goals are tailored to the individual patient with individual treatment goals of glycaemic control and blood pressure, depending on age, type of diabetes and diabetes duration. Aggressive treatment of glucose control and blood pressure might not always be best practice for every patient. Since the proportion of ESRD due to diabetic nephropathy remains high, optimisation of RAAS blockade is advocated and can be achieved by adequate sodium restriction and/or diuretic treatment. Moreover, aldosterone blockade might be a valuable strategy, which has potency to slow the progression of diabetic renal disease. Other possible future interventions are under investigation, but large clinical trials have to be awaited to confirm the safety and efficacy of these drugs.
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Affiliation(s)
- F Waanders
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Abbasi A, Corpeleijn E, Gansevoort RT, Gans ROB, Hillege HL, Stolk RP, Navis G, Bakker SJL, Dullaart RPF. Role of HDL cholesterol and estimates of HDL particle composition in future development of type 2 diabetes in the general population: the PREVEND study. J Clin Endocrinol Metab 2013; 98:E1352-9. [PMID: 23690306 DOI: 10.1210/jc.2013-1680] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS High-density lipoproteins (HDLs) may directly stimulate β-cell function and glucose metabolism. We determined the relationships of fasting high-density lipoprotein cholesterol (HDL-C), plasma apolipoprotein (apo) A-I and apoA-II, and HDL-C-to-apoA-I and HDL-C-to-apoA-II ratios, as estimates of HDL particle composition, with incident type 2 diabetes mellitus. METHODS A prospective study was carried out in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) cohort after exclusion of subjects with diabetes at baseline (n = 6820; age, 28-75 years). The association of HDL-related variables with incident type 2 diabetes was determined by multivariate logistic regression analyses. RESULTS After a median follow-up of 7.7 years, 394 incident cases of type 2 diabetes mellitus were ascertained (5.8%). After adjustment for age, sex, family history of diabetes, body mass index, hypertension, alcohol, and smoking, odd ratios (ORs) for diabetes were 0.55 (95% confidence interval [CI], 0.47-0.64; P < .001), 0.81 (0.71-0.93; P = .002), 0.02 (0.01-0.06; P < .001), and 0.03 (0.01-0.060; P < .001) per 1-SD increase in HDL-C and apoA-I and in the HDL-C-to-apoA-I and the HDL-C-to-apoA-II ratios, respectively. In contrast, apoA-II was not related to incident diabetes (OR = 1.02; 95% CI, 0.90-1.16; P=0.71). The relationships of HDL-C and the ratios of HDL-C to apoA-I and HDL-C to apoA-II remained significant after further adjustment for baseline glucose and triglycerides (OR(HDL) = 0.74 [95% CI, 0.61-0.88], OR(HDL/APO A-I) = 0.14 [0.04-0.44], and OR(HDL/APOA-II) = 0.12 [0.04-0.36]; all P ≤ .001). CONCLUSIONS Higher HDL-C, as well as higher HDL-C-to-apoA-I and HDL-C-to-apoA-II ratios are strongly and independently related to a lower risk of future type 2 diabetes.
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Affiliation(s)
- Ali Abbasi
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen 9700 RB, The Netherlands
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Zelle DM, Corpeleijn E, Deinum J, Stolk RP, Gans ROB, Navis G, Bakker SJL. Pancreatic β-cell dysfunction and risk of new-onset diabetes after kidney transplantation. Diabetes Care 2013; 36:1926-32. [PMID: 23378624 PMCID: PMC3687295 DOI: 10.2337/dc12-1894] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Chronic exposure to calcineurin inhibitors and corticosteroids poses renal transplant recipients (RTR) at high risk for development of new-onset diabetes after transplantation (NODAT). Pancreatic β-cell dysfunction may be crucial to the pathophysiology of NODAT and specific markers for β-cell dysfunction may have additive value for predicting NODAT in this population. Therefore, we prospectively investigated whether proinsulin, as a marker of pancreatic β-cell dysfunction, is associated with future development of NODAT and improves prediction of it. RESEARCH DESIGN AND METHODS All RTR between 2001 and 2003 with a functioning graft for ≥1 year were considered eligible for inclusion, except for subjects with diabetes at baseline who were excluded. We recorded incidence of NODAT until April 2012. RESULTS A total of 487 RTR (age 50 ± 12 years, 55% men) participated at a median time of 6.0 (interquartile range [IQR], 2.6-11.5) years after transplantation. Median fasting proinsulin levels were 16.6 (IQR, 11.0-24.2) pmol/L. During median follow-up for 10.1 (IQR, 9.1-10.4) years, 42 (35%) RTR had development of NODAT in the highest quartile of the distribution of proinsulin versus 34 (9%) in the lowest three quartiles (P < 0.001). In Cox regression analyses, proinsulin (hazard ratio, 2.29; 95% CI, 1.85-2.83; P < 0.001) was strongly associated with NODAT development. This was independent of age, sex, calcineurine inhibitors, prednisolone use, components of the metabolic syndrome, or homeostasis model assessment. CONCLUSIONS In conclusion, fasting proinsulin is strongly associated with NODAT development in RTR. Our results highlight the role of β-cell dysfunction in the pathophysiology of NODAT and indicate the potential value of proinsulin for identification of RTR at increased risk for NODAT.
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Affiliation(s)
- Dorien M Zelle
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.
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Jonker JT, de Mol P, de Vries ST, Widya RL, Hammer S, van Schinkel LD, van der Meer RW, Gans ROB, Webb AG, Kan HE, de Koning EJP, Bilo HJG, Lamb HJ. Exercise and type 2 diabetes mellitus: changes in tissue-specific fat distribution and cardiac function. Radiology 2013. [PMID: 23801768 DOI: 10.1148/radiology.13121631] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively assess the effects of an exercise intervention on organ-specific fat accumulation and cardiac function in type 2 diabetes mellitus. MATERIALS AND METHODS Written informed consent was obtained from all participants, and the study protocol was approved by the medical ethics committee. The study followed 12 patients with type 2 diabetes mellitus (seven men; mean age, 46 years ± 2 [standard error]) before and after 6 months of moderate-intensity exercise, followed by a high-altitude trekking expedition with exercise of long duration. Abdominal, epicardial, and paracardial fat volume were measured by using magnetic resonance (MR) imaging. Cardiac function was quantified with cardiac MR, and images were analyzed by a researcher who was supervised by a senior researcher (4 and 21 years of respective experience in cardiac MR). Hepatic, myocardial, and intramyocellular triglyceride (TG) content relative to water were measured with proton MR spectroscopy at 1.5 and 7 T. Two-tailed paired t tests were used for statistical analysis. RESULTS Exercise reduced visceral abdominal fat volume from 348 mL ± 57 to 219 mL ± 33 (P < .01), and subcutaneous abdominal fat volume remained unchanged (P = .9). Exercise decreased hepatic TG content from 6.8% ± 2.3 to 4.6% ± 1.6 (P < .01) and paracardial fat volume from 4.6 mL ± 0.9 to 3.7 mL ± 0.8 (P = .02). Exercise did not change epicardial fat volume (P = .9), myocardial TG content (P = .9), intramyocellular lipid content (P = .3), or cardiac function (P = .5). CONCLUSION A 6-month exercise intervention in type 2 diabetes mellitus decreased hepatic TG content and visceral abdominal and paracardial fat volume, which are associated with increased cardiovascular risk, but cardiac function was unaffected. Tissue-specific exercise-induced changes in body fat distribution in type 2 diabetes mellitus were demonstrated in this study.
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Affiliation(s)
- Jacqueline T Jonker
- Departments of Endocrinology and Metabolism, Radiology, and Nephrology, Leiden University Medical Center, C3-R, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands; Department of Cardiology, Tjongerschans Hospital, Heerenveen, the Netherlands; Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
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Landman GWD, Kleefstra N, van Hateren KJJ, Gans ROB, Bilo HJG, Groenier KH. Educational disparities in mortality among patients with type 2 diabetes in The Netherlands (ZODIAC-23). Neth J Med 2013; 71:76-80. [PMID: 23462055] [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]
Abstract
BACKGROUND Relative mortality differences between educational level in mortality have been reported among diabetic as well as among non-diabetic subjects in Europe, but data on absolute differences are lacking. We studied the effect of educational disparities on mortality in a Dutch prospective cohort of type 2 diabetes mellitus (T2DM) patients. METHODS This study was part of the ZODIAC study, a prospective observational study of patients with T2DM. Data on educational level were first collected on 19 May 1998, and from this date on, 858 patients were included in 1998; educational level was known for 656 patients. Vital status was assessed in 2009. The relationship between mortality and educational level was studied using a Cox proportional hazard model, the relative index of inequality (RII), slope index of inequality (SII) and the population attributable risk (PAR). Educational level was divided into four categories; the highest educational level was used as reference. RESULTS After a median follow-up time of 9.7 years, 365 out of 858 patients had died. The hazard ratio of primary education for total mortality was 3.02 (95% CI 1.44-6.34). The RII was 2.85 (95% CI 1.21-6.67), the absolute difference in the risk for mortality (SII) was 384 deaths (95% CI 49-719) per 10,000 follow-up years. PAR for patients with the lowest level of education was 51.4%. CONCLUSIONS A low educational level had a higher impact on mortality than having a macrovascular complication. Given the substantial differences in mortality between educational levels in T2DM, more understanding of underlying (modifiable) mechanisms is necessary.
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Affiliation(s)
- G W D Landman
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
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Abbasi A, Bakker SJL, Corpeleijn E, van der A DL, Gansevoort RT, Gans ROB, Peelen LM, van der Schouw YT, Stolk RP, Navis G, Spijkerman AMW, Beulens JWJ. Liver function tests and risk prediction of incident type 2 diabetes: evaluation in two independent cohorts. PLoS One 2012; 7:e51496. [PMID: 23284703 PMCID: PMC3524238 DOI: 10.1371/journal.pone.0051496] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 11/01/2012] [Indexed: 12/14/2022] Open
Abstract
Background Liver function tests might predict the risk of type 2 diabetes. An independent study evaluating utility of these markers compared with an existing prediction model is yet lacking. Methods and Findings We performed a case-cohort study, including random subcohort (6.5%) from 38,379 participants with 924 incident diabetes cases (the Dutch contribution to the European Prospective Investigation Into Cancer and Nutrition, EPIC-NL, the Netherlands), and another population-based cohort study including 7,952 participants with 503 incident cases (the Prevention of Renal and Vascular End-stage Disease, PREVEND, Groningen, the Netherlands). We examined predictive value of combination of the Liver function tests (gamma-glutamyltransferase, alanine aminotransferase, aspartate aminotransferase and albumin) above validated models for 7.5-year risk of diabetes (the Cooperative Health Research in the Region of Augsburg, the KORA study). Basic model includes age, sex, BMI, smoking, hypertension and parental diabetes. Clinical models additionally include glucose and uric acid (model1) and HbA1c (model2). In both studies, addition of Liver function tests to the basic model improved the prediction (C-statistic by∼0.020; NRI by∼9.0%; P<0.001). In the EPIC-NL case-cohort study, addition to clinical model1 resulted in statistically significant improvement in the overall population (C-statistic = +0.009; P<0.001; NRI = 8.8%; P<0.001), while addition to clinical model 2 yielded marginal improvement limited to men (C-statistic = +0.007; P = 0.06; NRI = 3.3%; P = 0.04). In the PREVEND cohort study, addition to clinical model 1 resulted in significant improvement in the overall population (C-statistic change = 0.008; P = 0.003; NRI = 3.6%; P = 0.03), with largest improvement in men (C-statistic change = 0.013; P = 0.01; NRI = 5.4%; P = 0.04). In PREVEND, improvement compared to clinical model 2 could not be tested because of lack of HbA1c data. Conclusions Liver function tests modestly improve prediction for medium-term risk of incident diabetes above basic and extended clinical prediction models, only if no HbA1c is incorporated. If data on HbA1c are available, Liver function tests have little incremental predictive value, although a small benefit may be present in men.
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Affiliation(s)
- Ali Abbasi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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