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de Haan-Du J, Groenier KH, Wauben-Spaetgens B, Jalving M, Kleefstra N, Landman GWD, de Bock GH. The Value of Glycemic Control Prior to Cancer Diagnosis on All-Cause Mortality among Patients with Type 2 Diabetes in Dutch Primary Care. Cancer Epidemiol Biomarkers Prev 2023; 32:252-259. [PMID: 36442479 PMCID: PMC9900319 DOI: 10.1158/1055-9965.epi-22-0766] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/19/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Poor glycemic control prior to cancer diagnosis for patients with preexisting type 2 diabetes (T2DM) may predict a worse cancer diagnosis. We investigated the association between pre-diagnosis glycemic control and all-cause mortality in patients with T2DM who develop cancer. METHODS This prospective cohort study linked data from three sources covering 1989 to 2019: a T2DM benchmarking database, the Netherlands Cancer Registry, and the Personal Records Database. We included patients with T2DM and incident primary breast, colorectal, or prostate cancer (stage 0-III), with target glycemic control defined according to Dutch guidelines. Analysis involved estimating the association between glycemic control and all-cause mortality with Cox proportional hazard models, accounting for individual expected survival relative to the general population and relevant disease (e.g., diabetes duration and medications) and individual (e.g., age and gender) characteristics. RESULTS Of the 71,648 linked cases, 620 had breast cancer, 774 had colorectal cancer, and 438 had prostate cancer, with follow-up data available for 6.4 (4.2-8.4), 5.6 (2.7-7.6), and 6.3 (4.5-8.2) years, respectively. Compared with patients with pre-diagnosis glycemic control at target, the HRs and 95% confidence intervals for mortality among those with pre-diagnosis glycemic control not at target were 1.40 (1.00-1.96) for breast cancer, 1.45 (1.12-1.88) for colorectal cancer, and 1.39 (0.98-1.98) for prostate cancer. CONCLUSIONS Among patients with T2DM in Dutch primary care, poor glycemic control before diagnosis with breast and colorectal cancer can increase mortality compared with good control. IMPACT Glycemic control prior to cancer diagnosis is of prognostic value.
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Affiliation(s)
- Jing de Haan-Du
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | | | - Brendy Wauben-Spaetgens
- Department of Research and Development, Netherlands Comprehensive Cancer organization (IKNL), Utrecht, the Netherlands
| | - Mathilde Jalving
- Department of Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nanne Kleefstra
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands.,GGZ Drenthe Mental Health Institute, Department of Forensic Psychiatry, Assen, the Netherlands
| | - Gijs W D Landman
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
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Zhang F, de Haan-Du J, Sidorenkov G, Landman GWD, Jalving M, Zhang Q, de Bock GH. Type 2 Diabetes Mellitus and Clinicopathological Tumor Characteristics in Women Diagnosed with Breast Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13194992. [PMID: 34638475 PMCID: PMC8508341 DOI: 10.3390/cancers13194992] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/31/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 02/05/2023] Open
Abstract
Poor prognosis caused by type 2 diabetes mellitus (T2DM) in women with breast cancer is conferred, while the association between T2DM and breast tumor aggressiveness is still a matter of debate. This study aimed to clarify the differences in breast cancer characteristics, including stage, size, lymph node status, grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (Her2), between patients with and without pre-existing T2DM. PubMed, Embase, and Web of Science were searched for studies from 1 January 2010 to 2 July 2021. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were pooled by using a random effects model. T2DM was significantly associated with tumor stages III/IV versus cancers in situ and stages I/II (pooled ORs (pOR), 95% CI: 1.19; 1.04-1.36, p = 0.012), tumor size >20 versus ≤20 mm (pOR, 95% CI: 1.18; 1.04-1.35, p = 0.013), and lymph node invasion versus no involvement (pOR, 95% CI: 1.26; 1.05-1.51, p = 0.013). These findings suggest that women with T2DM are at a higher risk of late-stage tumors, large tumor sizes, and invasive lymph nodes at breast cancer diagnosis.
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Affiliation(s)
- Fan Zhang
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.Z.); (J.d.H.-D.); (G.H.d.B.)
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China;
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou 515041, China
| | - Jing de Haan-Du
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.Z.); (J.d.H.-D.); (G.H.d.B.)
| | - Grigory Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.Z.); (J.d.H.-D.); (G.H.d.B.)
- Correspondence:
| | - Gijs W. D. Landman
- Department of Internal Medicine, Gelre Hospital, 7334 DZ Apeldoorn, The Netherlands;
| | - Mathilde Jalving
- Department of Oncology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Qingying Zhang
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China;
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou 515041, China
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.Z.); (J.d.H.-D.); (G.H.d.B.)
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de Haan-Du J, Landman GWD, Groenier KH, Vissers PAJ, Louwman MWJ, Kleefstra N, de Bock GH. The Risk of Cutaneous Squamous Cell Carcinoma Among Patients with Type 2 Diabetes Receiving Hydrochlorothiazide: A Cohort Study. Cancer Epidemiol Biomarkers Prev 2021; 30:2114-2121. [PMID: 34493493 DOI: 10.1158/1055-9965.epi-21-0620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/05/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Because of continuous hyperglycemia and hyperinsulinemia and the use of photosensitizing drug, hydrochlorothiazide (HCTZ), the risk of cutaneous squamous cell carcinoma (cSCC) might be increased among patients with diabetes. This study aimed to estimate the risk of cSCC among HCTZ users with type 2 diabetes, and to determine whether thiazide-like diuretics, another drug in the same class with HCTZ, would be safer. METHODS We linked the benchmarking database in Dutch primary care, the Netherlands Cancer Registry, and the Dutch Personal Records Database (1998-2019). All 71,648 patients were included, except for those who had a history of skin cancer prior to cohort entry. We used Cox modeling to estimate the HRs and 95% confidence intervals for cSCC. The model was adjusted by cumulative exposure to each antihypertensive, age, sex, smoking, body mass index, blood pressure, serum creatinine, other confounding drug use at cohort entry, and cohort entry year. RESULTS There were 1,409 cSCC events (23 among thiazide-like diuretics users), during a follow-up of 679,789 person-years. Compared with no HCTZ use, the adjusted HRs for HCTZ use were 1.18 (1.00-1.40) for ≤2 years, 1.57 (1.32-1.88) for 2 to 4 years, and 2.09 (1.73-2.52) for >4 years. The HR was 0.90 (0.79-1.03) for an additional year of thiazide-like diuretic use. CONCLUSIONS In patients with diabetes, exposure to HCTZ for >2 years is associated with an increased risk of cSCC, whereas no increased risk associated with thiazide-like diuretics was observed. IMPACT The potential increased risk of cSCC should be a consideration when prescribing HCTZ, with thiazide-like diuretics offering a safer alternative.
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Affiliation(s)
- Jing de Haan-Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Gijs W D Landman
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands.,Langerhans Medical Research Group, Ommen, the Netherlands
| | | | - Pauline A J Vissers
- Department of Research and development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Marieke W J Louwman
- Department of Research and development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, Ommen, the Netherlands.,Department of Internal Medicine, Groningen, University of Groningen, University Medical Center Groningen, the Netherlands.,Department of Forensic Psychiatry, GGZ Drenthe Mental Health Institute, Assen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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de Haan-Du J, Landman GWD, Kleefstra N, Schrijnders D, Manders M, Bos ACRK, Tromp-van Driel C, Denig P, Groenier KH, de Bock GH. Glycemic Control for Colorectal Cancer Survivors Compared to Those without Cancer in the Dutch Primary Care for Type 2 Diabetes: A Prospective Cohort Study. Cancers (Basel) 2021; 13:cancers13112767. [PMID: 34199595 PMCID: PMC8199666 DOI: 10.3390/cancers13112767] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary A growing number of colorectal cancer survivors live with type 2 diabetes, as a result of improved cancer diagnosis and treatment. These patients might have worse glycemic control after their cancer diagnosis, which may increase the risk of cardiovascular diseases. This prospective cohort study evaluated the quality of glycemic control for colorectal cancer survivors, as compared to those without cancer in Dutch primary care for diabetes. During a 10-year follow-up for 57,330 patients, there were 705 patients diagnosed with colorectal cancer. No clinically relevant difference on the probability of reaching the target HbA1c was observed between colorectal cancer survivors and patients with no history of cancer. These results showed a robust diabetes care system, implying that the glycemic control for colorectal cancer survivors can be delegated to the primary care professionals. Abstract Cancer survivors with diabetes tend to have worse glycemic control after their cancer diagnosis, which may increase the risk of cardiovascular diseases. We aimed to investigate whether glycemic control differs between colorectal cancer (CRC) survivors and those without cancer, among patients with type 2 diabetes being treated in the Dutch primary care. The Zwolle Outpatient Diabetes project Integrating Available Care database was linked with the Dutch Cancer Registry (n = 71,648, 1998–2014). The cases were those with stage 0–III CRC, and the controls were those without cancer history. The primary and secondary outcomes were the probability of reaching the glycated hemoglobin (HbA1c) target and the mean of HbA1c during follow-up, respectively. Mixed linear modeling was applied, where the status of CRC was a time-varying variable. Among the 57,330 patients included, 705 developed CRC during follow-up. The mean probability of reaching the HbA1c target during follow-up was 73% versus 74% (p = 0.157) for CRC survivors versus those without cancer, respectively. The mean HbA1c was 51.1 versus 50.8 mmol/mol (p = 0.045) among CRC survivors versus those without cancer, respectively. We observed a clinically comparable glycemic control among the CRC survivors without cancer, indicating that glycemic control for CRC survivors can be delegated to primary care professionals.
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Affiliation(s)
- Jing de Haan-Du
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (G.W.D.L.); (G.H.d.B.)
- Correspondence: ; Tel.: +31-(050)-361-0739
| | - Gijs W. D. Landman
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (G.W.D.L.); (G.H.d.B.)
- Langerhans Medical Research Group, 7731 AT Ommen, The Netherlands; (N.K.); (D.S.); (M.M.)
- Department of Internal Medicine, Gelre Hospital, 7334 DZ Apeldoorn, The Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, 7731 AT Ommen, The Netherlands; (N.K.); (D.S.); (M.M.)
- Department of Forensic Psychiatry, GGZ Drenthe Mental Health Institute, 9404 LA Assen, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Dennis Schrijnders
- Langerhans Medical Research Group, 7731 AT Ommen, The Netherlands; (N.K.); (D.S.); (M.M.)
| | - Marjolijn Manders
- Langerhans Medical Research Group, 7731 AT Ommen, The Netherlands; (N.K.); (D.S.); (M.M.)
| | - Amanda C. R. K. Bos
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands;
| | | | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | | | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (G.W.D.L.); (G.H.d.B.)
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Du J, Kleefstra N, Schrijnders D, Groenier KH, de Bock GH, Landman GWD. Is Gliclazide Associated with a Lower Obesity-Related Cancer Risk Compared to Other Sulfonylureas? A Long-term Prospective Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 29:1596-1605. [PMID: 32404443 DOI: 10.1158/1055-9965.epi-19-1517] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/08/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gliclazide has been suspected to be associated with a lower obesity-related cancer risk; however, current evidence is limited by important methodologic shortcomings. This study aimed to evaluate whether gliclazide is preferred over other sulfonylureas regarding obesity-related cancer risk. METHODS In this prospective cohort study, an annual benchmarking database in Dutch primary care (Zwolle Outpatient Diabetes project Integrating Available CareZODIAC, 1998-2014) was linked to the Netherlands Cancer Registry and the Dutch Personal Record Database. Of the 71,648 patients with type 2 diabetes, we included 26,207 who used sulfonylureas and had no history of cancer or insulin use at baseline. Obesity-related cancer was defined using the latest definition of the World Cancer Research Fund. Cox regression analyses were used to estimate HRs, with both baseline sulfonylurea and cumulative exposure modeled and corrected for baseline covariates. RESULTS During follow-up for 167,692 person-years, there were 1,111 obesity-related cancer events. For males, the adjusted HRs [95% confidence interval (CI)] for baseline sulfonylurea compared with gliclazide were as follows: glibenclamide, 1.10 (0.92-2.69); glimepiride, 1.13 (0.68-1.84); and tolbutamide, 0.93 (0.59-1.48). For females, these were as follows: glibenclamide, 1.49 (0.72-3.13); glimepiride, 0.96 (0.59-1.54); and tolbutamide, 0.84 (0.54-1.28). The adjusted HRs (95% CI) for one more year of cumulative exposure compared with gliclazide were as follows: glibenclamide, 0.90 (0.71-1.14); glimepiride, 0.96 (0.87-1.06); and tolbutamide, 1.00 (0.92-1.09). For females, these were as follows: glibenclamide, 0.93 (0.77-1.13); glimepiride, 0.99 (0.90-1.10); and tolbutamide, 1.04 (0.96-1.13). CONCLUSIONS Obesity-related cancer risk was comparable between gliclazide and other sulfonylureas. IMPACT Gliclazide is not preferred over other sulfonylureas regarding obesity-related cancer risk.
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Affiliation(s)
- Jing Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Nanno Kleefstra
- Langerhans Medical Research Group, Ommen, the Netherlands
- GGZ Drenthe Mental Health Institute, High and Intensive Care, Assen, the Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gijs W D Landman
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Langerhans Medical Research Group, Ommen, the Netherlands
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
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Hendriks AM, Schrijnders D, Kleefstra N, de Vries EGE, Bilo HJG, Jalving M, Landman GWD. Sulfonylurea derivatives and cancer, friend or foe? Eur J Pharmacol 2019; 861:172598. [PMID: 31408647 DOI: 10.1016/j.ejphar.2019.172598] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 02/07/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is associated with a higher risk of cancer and cancer-related mortality. Increased blood glucose and insulin levels in T2DM patients may be, at least in part, responsible for this effect. Indeed, lowering glucose and/or insulin levels pharmacologically appears to reduce cancer risk and progression, as has been demonstrated for the biguanide metformin in observational studies. Studies investigating the influence of sulfonylurea derivatives (SUs) on cancer risk have provided conflicting results, partly due to comparisons with metformin. Furthermore, little attention has been paid to within-class differences in systemic and off-target effects of the SUs. The aim of this systematic review is to discuss the available preclinical and clinical evidence on how the different SUs influence cancer development and risk. Databases including PubMed, Cochrane, Database of Abstracts on Reviews and Effectiveness, and trial registries were systematically searched for available clinical and preclinical evidence on within-class differences of SUs and cancer risk. The overall preclinical and clinical evidence suggest that the influence of SUs on cancer risk in T2DM patients differs between the various SUs. Potential mechanisms include differing affinities for the sulfonylurea receptors and thus differential systemic insulin exposure and off-target anti-cancer effects mediated for example through potassium transporters and drug export pumps. Preclinical evidence supports potential anti-cancer effects of SUs, which are of interest for further studies and potentially repurposing of SUs. At this time, the evidence on differences in cancer risk between SUs is not strong enough to guide clinical decision making.
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Affiliation(s)
- Anne M Hendriks
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Dennis Schrijnders
- Langerhans Medical Research Group, Zwolle, the Netherlands; Diabetes Center, Isala Hospital, Zwolle, the Netherlands
| | | | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Henk J G Bilo
- Diabetes Center, Isala Hospital, Zwolle, the Netherlands; Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Gijs W D Landman
- Langerhans Medical Research Group, Zwolle, the Netherlands; Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
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7
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Nijenhuis-Rosien L, Kleefstra N, van Dijk PR, Wolfhagen MJHM, Groenier KH, Bilo HJG, Landman GWD. Laser therapy for onychomycosis in patients with diabetes at risk for foot ulcers: a randomized, quadruple-blind, sham-controlled trial (LASER-1). J Eur Acad Dermatol Venereol 2019; 33:2143-2150. [PMID: 30920059 DOI: 10.1111/jdv.15601] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients with diabetes mellitus are at high risk for onychomycosis, which is related to the development of foot ulcers. OBJECTIVE The aim of this study was to evaluate the safety and efficacy of the treatment of onychomycosis with local laser therapy. METHODS In a single-centre, randomized (1:1), quadruple-blind, sham-controlled trial, patients and microbiological confirmation with diabetes mellitus, at risk for developing diabetic foot ulcers (Sims classification score 1, 2) and a clinical suspicion on onychomycosis, were randomized to either four sessions neodymium-doped yttrium aluminium garnet (Nd-YAG) 1064 nm laser or sham treatment. The primary outcome was clinical and microbiological cure of onychomycosis after 1-year follow-up. RESULTS From March 2015 to July 2016, 64 patients were randomized; 63 could be analysed. Trichophyton rubrum was the most detected pathogen. There was no difference in the primary outcome between laser and sham treatment. With the exception of a subungual haematoma in the fifth toenail occurring 2 weeks after laser treatment, the results suggested that treatment with Nd-YAG 1064 nm laser is safe. CONCLUSION At this moment, there is no evidence of any effect of laser treatment for onychomycosis in patients with diabetes at increased risk for foot ulcers, at least not within 1 year after treatment.
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Affiliation(s)
- L Nijenhuis-Rosien
- Diabetes Centre, Isala, Zwolle, The Netherlands.,Innofeet, Zwolle, The Netherlands
| | - N Kleefstra
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.,University of Groningen, Groningen, The Netherlands.,Medical Research Group Langerhans, Ommen, The Netherlands
| | - P R van Dijk
- Diabetes Centre, Isala, Zwolle, The Netherlands.,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - M J H M Wolfhagen
- Laboratory of Medical Microbiology and Infectious Diseases, Isala, Zwolle, The Netherlands
| | | | - H J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands.,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.,University of Groningen, Groningen, The Netherlands
| | - G W D Landman
- Medical Research Group Langerhans, Ommen, The Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
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8
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Landman GWD, Kleefstra N, van Hateren KJJ. Residual confounding in the study by van Dalem et al. Diabetes Obes Metab 2018; 20:1547-1548. [PMID: 29493108 DOI: 10.1111/dom.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Gijs W D Landman
- Internal Medicine, Gelre Ziekenhuizen, Apeldoorn, the Netherlands
| | - Nanne Kleefstra
- Research Department, Langerhans Medical Research Group, Ommen, the Netherlands
- Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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9
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Kovesdy CP, Matsushita K, Sang Y, Brunskill NJ, Carrero JJ, Chodick G, Hasegawa T, Heerspink HL, Hirayama A, Landman GWD, Levin A, Nitsch D, Wheeler DC, Coresh J, Hallan SI, Shalev V, Grams ME. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis. Eur Heart J 2018; 39:1535-1542. [PMID: 29554312 PMCID: PMC5930249 DOI: 10.1093/eurheartj/ehy100] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/22/2017] [Accepted: 02/14/2018] [Indexed: 12/20/2022] Open
Abstract
Aims Both hypo- and hyperkalaemia can have immediate deleterious physiological effects, and less is known about long-term risks. The objective was to determine the risks of all-cause mortality, cardiovascular mortality, and end-stage renal disease associated with potassium levels across the range of kidney function and evaluate for consistency across cohorts in a global consortium. Methods and results We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high cardiovascular risk, and 10 chronic kidney disease (CKD)] in the CKD Prognosis Consortium. We used Cox regression followed by random-effects meta-analysis to assess the relationship between baseline potassium and adverse outcomes, adjusted for demographic and clinical characteristics, overall and across strata of estimated glomerular filtration rate (eGFR) and albuminuria. We included 1 217 986 participants followed up for a mean of 6.9 years. The average age was 55 ± 16 years, average eGFR was 83 ± 23 mL/min/1.73 m2, and 17% had moderate- to-severe increased albuminuria levels. The mean baseline potassium was 4.2 ± 0.4 mmol/L. The risk of serum potassium of >5.5 mmol/L was related to lower eGFR and higher albuminuria. The risk relationship between potassium levels and adverse outcomes was U-shaped, with the lowest risk at serum potassium of 4-4.5 mmol/L. Compared with a reference of 4.2 mmol/L, the adjusted hazard ratio for all-cause mortality was 1.22 [95% confidence interval (CI) 1.15-1.29] at 5.5 mmol/L and 1.49 (95% CI 1.26-1.76) at 3.0 mmol/L. Risks were similar by eGFR, albuminuria, renin-angiotensin-aldosterone system inhibitor use, and across cohorts. Conclusions Outpatient potassium levels both above and below the normal range are consistently associated with adverse outcomes, with similar risk relationships across eGFR and albuminuria.
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Affiliation(s)
- Csaba P Kovesdy
- University of Tennessee Health Science Center, Memphis, TN, USA
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Nigel J Brunskill
- Department of Infection Immunity and Inflammation, University of Leicester, Leicester, UK
- John Walls Renal Unit, University Hospitals of Leicester, Leicester, UK
| | - Juan J Carrero
- Department of Medical Epidemiology and Biosatistics (MEB), Karolinska Institutet, Stockholm, Sweden
| | - Gabriel Chodick
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Takeshi Hasegawa
- Showa University, Office for Promoting Medical Research, Tokyo, Japan
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
- Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan
| | - Hiddo L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Atsushi Hirayama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | | | - Adeera Levin
- BC Provincial Renal Agency, Vancouver, BC, Canada
- University of British Columbia, Vancouver, BC, Canada
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David C Wheeler
- Centre for Nephrology, University College London, London, UK
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Stein I Hallan
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science Technology, Trondheim, Norway
- Division of Nephrology, Department of Medicine, St Olav University Hospital, Trondheim, Norway
| | - Varda Shalev
- Medical Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
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10
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Affiliation(s)
- Peter R van Dijk
- a Diabetes Centre , Isala , Zwolle , The Netherlands.,b Department of Internal Medicine , University Medical Center Groningen , Groningen , The Netherlands
| | | | - Nanne Kleefstra
- b Department of Internal Medicine , University Medical Center Groningen , Groningen , The Netherlands.,c Langerhans Medical Research Group , Zwolle , The Netherlands
| | - Gijs W D Landman
- c Langerhans Medical Research Group , Zwolle , The Netherlands.,d Department of Internal Medicine , Gelre hospital , Apeldoorn , The Netherlands
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11
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Schrijnders D, Hendriks SH, Kleefstra N, Vissers PAJ, Johnson JA, de Bock GH, Bilo HJG, Landman GWD. Sex differences in obesity related cancer incidence in relation to type 2 diabetes diagnosis (ZODIAC-49). PLoS One 2018; 13:e0190870. [PMID: 29370205 PMCID: PMC5784905 DOI: 10.1371/journal.pone.0190870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes and obesity seem to be partly overlapping risk factors for the development of obesity-related cancer (mainly breast, prostate and colorectal cancer) in patients with type 2 diabetes (T2DM). In the general population, women have a lower risk for obesity-related cancer compared to men. Previous studies involving cardiovascular disease have shown that T2DM eliminates a female advantage of lower CVD risk in the general population compared to men. It is unclear whether the same could be true for obesity-related cancer. This study aimed to this investigate obesity-related cancer incidence in women and men known with T2DM as compared to the Dutch general population. Methods This study included 69,583 patients with T2DM selected from a prospective primary care cohort, which was linked to the Dutch National Cancer Registry to obtain cancer specific data. Obesity-related cancers included liver, kidney, colorectal, gallbladder, pancreas, ovarian, endometrial, advanced prostate cancer, post-menopausal breast cancer and oesophageal adenocarcinoma. Primary outcome was sex-stratified, age and year of cancer diagnosis adjusted standardized incidence ratios (SIRs) for three time periods: 5 years before, the year after diagnosis and the next 4 years after T2DM diagnosis. The Dutch general population was used as reference group. Results Women with T2DM were at an increased risk for obesity-related cancer compared to women in the general population already 5 years before diabetes diagnosis (SIR 1.77; 95%CI: 1.63–1.91). In both men and women, there was a peak in obesity-related cancer incidence following diabetes diagnosis (SIR: 1.38; 95%CI 1.11–1.64 and SIR: 2.21; 95%CI 1.94–2.30, respectively). From the second to the fifth year after diabetes diagnosis the obesity-related cancer incidence was higher in women compared to women in the general population (SIR: 2.12; 95%CI 1.94–2.30). Conclusions Women with T2DM seem to have a substantially higher obesity-related cancer risk. As opposed to men, in women this risk was already increased years before diabetes diagnosis. These results could imply that a relative advantage of women in the general population with regard to cancer risk is lost in women with T2DM.
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Affiliation(s)
- Dennis Schrijnders
- Langerhans Medical Research Group, Zwolle, the Netherlands
- Diabetes Centre, Zwolle, the Netherlands
- * E-mail:
| | | | - Nanne Kleefstra
- Langerhans Medical Research Group, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | | | | | - Geertruida H. de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
- Department of Internal Medicine, Zwolle, the Netherlands
| | - Gijs W. D. Landman
- Langerhans Medical Research Group, Zwolle, the Netherlands
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
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12
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Hendriks SH, Schrijnders D, van Hateren KJ, Groenier KH, Siesling S, Maas AHEM, Landman GWD, Bilo HJG, Kleefstra N. Association between body mass index and obesity-related cancer risk in men and women with type 2 diabetes in primary care in the Netherlands: a cohort study (ZODIAC-56). BMJ Open 2018; 8:e018859. [PMID: 29371278 PMCID: PMC5786141 DOI: 10.1136/bmjopen-2017-018859] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the relationship between body mass index (BMI) and obesity-related cancers in men and women with type 2 diabetes (T2D). DESIGN Observational cohort study. SETTING Primary care. PARTICIPANTS A total of 52 044 patients with T2D who participated in the ZODIAC (Zwolle Outpatient Diabetes project Integrating Available Care) study between 1998 and 2012 was included (49% women). A dataset of these patients was linked to available information of the Netherlands Cancer Registry to obtain data on cancer incidents. PRIMARY OUTCOME MEASURES Analyses were performed for the total group of obesity-related cancers and for non-sex-specific and sex-specific obesity-related cancers (in men: advanced prostate cancer, in women: ovarian, endometrial and postmenopausal breast cancer). RESULTS The median follow-up period in all analyses was 3.1 (1.7-5.0) years in men and 3.1 (1.7-5.1) in women. During follow-up, 689 men and 914 women were diagnosed with an obesity-related cancer. In men, BMI was associated with a higher risk of the total group of obesity-related cancers and non-sex-specific obesity-related cancers (HR (per 5 kg/m2 increase) 1.12 (95% CI 1.02 to 1.23) and HR 1.18 (95% CI 1.06 to 1.31)). No association was found with prostate cancer. In women, an association between BMI and all obesity-related cancers combined and sex-specific obesity-related cancers was present (HR 1.15 (95% CI 1.08 to 1.22) and HR 1.22 (95% CI 1.14 to 1.32)). No association with non-sex-specific cancers was found in women. CONCLUSIONS BMI is associated with obesity-related cancers in men with T2D, except with advanced prostate cancer. The results of this study provide reason to reconsider the classification of advanced prostate cancer as an obesity-related cancer, at least in T2D. In women, BMI is associated with the total group of obesity-related cancers and with sex-specific obesity-related cancers.
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Affiliation(s)
| | - Dennis Schrijnders
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
| | | | - Klaas H Groenier
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of General Practice, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Centre (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, Universiteit Twente, Enschede, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gijs W D Landman
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, Gelre hospital, Apeldoorn, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
| | - N Kleefstra
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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13
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Hortensius J, Kleefstra N, Landman GWD, Houweling BT, Groenier KH, van der Bijl JJ, Bilo H. Effects of three frequencies of self-monitored blood glucose on HbA1c and quality of life in patients with type 2 diabetes with once daily insulin and stable control: a randomized trial. BMC Res Notes 2018; 11:26. [PMID: 29334997 PMCID: PMC5769429 DOI: 10.1186/s13104-018-3138-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/06/2018] [Indexed: 11/10/2022] Open
Abstract
Objective The optimal frequency of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes (T2DM) with stable glycemic control is unknown. This study investigated effects of 3 frequencies of SMBG on glycemic control and quality of life after 9 months in patients using one long-acting insulin injection a day. In an open-label, multi-center, primary-care, parallel (1:1:1) randomized trial in the Netherlands including patients with T2DM, HbA1c ≤ 58 mmol/mol (≤ 7.5%), stable glycemic control, treated with one insulin injection daily, three frequencies of 4-point glucose measurements (before meals and bedtime) were weekly (n = 22), every 2 weeks (n = 16) and monthly (n = 20) were compared. Results A total of 58 patients with T2DM were included by 38 general practitioners, which was lower then anticipated. There were no significant between group differences in HbA1c (mmol/mol); group C compared to A and B; − 2.7 (95% CI − 6.4, 1.0) and − 1.0 (95% CI − 4.9, 3.0) and quality of life. Baring in mind the lower than anticipated inclusion rate, there were no significant differences in HbA1c and quality of life between three different frequencies of SMBG in patients with stable glycemic control using one long-acting insulin injection. Trial registration NCT01460459, registered 10-2011, recruitment between 05-2011 and 12-2011 Electronic supplementary material The online version of this article (10.1186/s13104-018-3138-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johanna Hortensius
- Langerhans Medical Research Group, Ommen, The Netherlands.,Isala Hospital, Zwolle, The Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, Ommen, The Netherlands.,Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Gijs W D Landman
- Langerhans Medical Research Group, Ommen, The Netherlands. .,Department of Internal Medicine, Gelre Hospitals Apeldoorn, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands. .,Department of Epidemiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
| | - Bas T Houweling
- Langerhans Medical Research Group, Ommen, The Netherlands.,Department of General Practice, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Klaas H Groenier
- Department of General Practice, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - Jaap J van der Bijl
- Faculty of Health, Welfare and Sports, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Henk Bilo
- Isala Hospital, Zwolle, The Netherlands.,Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.,Stichting Onderzoekscentrum Ketenzorg Chronische Ziekten, Zwolle, The Netherlands
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14
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Abstract
OBJECTIVE To investigate sex differences in survival of primary care treated patients with type 2 diabetes (T2D) in the Netherlands. SETTING Primary care. PARTICIPANTS A total of 1815 patients who participated in a prospective observational cohort study (Zwolle Outpatient Diabetes Project Integrating Available Care (ZODIAC)) were included of which 56% was female. Inclusion took place in 1998, 1999 and 2001. Vital status was assessed in 2013. MAIN OUTCOME MEASURE Relative survival of men and women with T2D. The relative survival rate was expressed as the ratio of observed survival of patients divided by the survival of the general population in the Netherlands with comparable age. RESULTS After 14 years, 888 (49%) patients had died. The relative survival rate was 0.88 (0.81-0.94) for men and 0.82 (0.76-0.87) for women with T2D after 14 years (p value for difference between sexes=0.169). In patients without a history of cardiovascular diseases (CVD), the relative survival was 0.99 (0.94-1.05) in men and 0.92 (0.87-0.97) in women (p value for difference between sexes=0.046). CONCLUSIONS The survival of men and women with T2D was 12% and 18% lower, respectively, after 14 years of follow-up compared with men and women in the general population. This corresponds to a decrease in median survival of 2.2 and 3.5 years in men and women, respectively. Only for patients with T2D without a history of CVD, a significantly lower relative survival in women compared with men with T2D was found.
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Affiliation(s)
| | | | - Klaas H Groenier
- Department of General Practice, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Gijs W D Landman
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, Gelre hospital, Apeldoorn, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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15
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Schrijnders D, de Bock GH, Houweling ST, van Hateren KJJ, Groenier KH, Johnson JA, Bilo HJG, Kleefstra N, Landman GWD. Within-class differences in cancer risk for sulfonylurea treatments in patients with type 2 diabetes (ZODIAC-55) - a study protocol. BMC Cancer 2017. [PMID: 28645260 PMCID: PMC5482962 DOI: 10.1186/s12885-017-3433-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Indexed: 02/01/2023] Open
Abstract
Background Patients with type 2 diabetes (T2D) are at increased risk for developing cancer. As approximately 8% of the world’s population is living with T2D, even a slight increase in cancer risk could result in an enormous impact on the number of persons developing cancer. In addition, several glucose lowering drug classes for treating patients with T2D have been associated with a difference in risk of cancer overall, and especially for obesity related cancers. In what way and to what degree cancer risk is modified by the use of different sulfonylureas (SU) is unclear. The primary aim of this study will be to evaluate within-class SU differences in obesity related cancer risk. Secondary aims will be to investigate within-class SU differences in risk for all cancers combined and site-specific cancers separately (i.e. breast, colorectal, prostate, bladder and lung cancer) and to account for duration-response relationships between individual SU use and cancer risk. Methods Patients will be selected from a Dutch primary care cohort of patients with T2D linked with the Dutch Cancer Registration (ZODIAC-NCR). Within this cohort study annually collected clinical data (e.g. blood pressure, weight, HbA1c) and nationwide data on cancer incidence are available. Time-dependent cox proportional hazard analyses will be performed to evaluate SU cancer risk, adjusted for potential confounders. Discussion This study will be the first prospective cohort study investigating within-class SU differences in cancer risk and could contribute to improved decision making regarding the individual drugs within the class of SUs, and possibly improve quality of life and result in an increased cost-effectiveness of healthcare in patients with T2D. Trial registration Nederlands Trialregister (NTR6166), 6 Jan 2017.
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Affiliation(s)
- Dennis Schrijnders
- Diabetes Centre, Isala, P.O. Box 10400, 8000 GK, Zwolle, the Netherlands. .,Langerhans Medical Research Group, Zwolle, the Netherlands.
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Klaas H Groenier
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Henk J G Bilo
- Diabetes Centre, Isala, P.O. Box 10400, 8000 GK, Zwolle, the Netherlands.,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Internal Medicine, Isala, Zwolle, the Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, Zwolle, the Netherlands.,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gijs W D Landman
- Langerhans Medical Research Group, Zwolle, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
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16
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Kleefstra N, Landman GWD, Van Hateren KJJ, Meulepas M, Romeijnders A, Rutten GEH, Klomp M, Houweling ST, Bilo HJG. Dutch diabetes prevalence estimates (DUDE-1). J Diabetes 2016; 8:863-865. [PMID: 26694523 DOI: 10.1111/1753-0407.12370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Received: 07/01/2015] [Revised: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent decades have seen a constant upward projection in the prevalence of diabetes. Attempts to estimate diabetes prevalence rates based on relatively small population samples quite often result in underestimation. The aim of the present study was to investigate whether the Dutch diabetes prevalence estimate of 930 000 for 2013, based on a relatively small sample, still holds true when a larger population is studied using actual prevalence data. METHODS Data were collected from 92 primary care groups, including the total number of people with and without diabetes in 2013. Patients with diabetes were identified using the International Classification of Primary Care codes T90.02 (diabetes mellitus type 2; T2DM), T90.01 (diabetes mellitus type 1) and T90 (diabetes mellitus). Prevalence data were compared with previous estimates made in 2009. Diabetes prevalence was estimated using linear extrapolation. RESULTS Complete data were available from 67 (73%) care groups, which together provided care for 7 922 403 subjects; 431 396 patients were coded as having diabetes, of whom 406 183 were coded as having T2DM. Based on these results, the extrapolated Dutch diabetes prevalence was 914 387 (5.45%). CONCLUSIONS The results show that the previous estimate (reported in 2009), which was based on data collected in 2007, resulted in a <2% (~16 000) overestimation in diabetes prevalence in 2013 compared with the analysis presented. These results indicate that no upward adjustment in Dutch diabetes prevalence estimates is necessary. Repeated large-scale monitoring can help develop more accurate prevalence estimates and improve future prevalence predictions.
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Affiliation(s)
- Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands.
- Langerhans Medical Research Group, Zwolle, The Netherlands.
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | - Kornelis J J Van Hateren
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
| | | | | | - Guy E H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Sebastiaan T Houweling
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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17
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Schrijnders D, Wever R, Kleefstra N, Houweling ST, van Hateren KJJ, de Bock GH, Bilo HJG, Groenier KH, Landman GWD. Addition of sulphonylurea to metformin does not relevantly change body weight: a prospective observational cohort study (ZODIAC-39). Diabetes Obes Metab 2016; 18:973-9. [PMID: 27265756 PMCID: PMC5129585 DOI: 10.1111/dom.12700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/12/2016] [Accepted: 06/01/2016] [Indexed: 12/18/2022]
Abstract
AIM To investigate changes in body weight trajectories after the addition of individual sulphonylureas (SUs) to metformin in patients with type 2 diabetes. MATERIALS AND METHODS We conducted a retrospective observational cohort study, in a primary care setting in the Netherlands. Patients aged ≥18 years with type 2 diabetes who were included in the ZODIAC cohort between 1998 and 2012 and who received metformin monotherapy at inclusion (n = 29 195), and had used metformin as monotherapy for at least 1 year before receiving dual therapy through the addition of an SU for at least 1 year were eligible for inclusion. The primary outcome was within-drug yearly change in body weight after receiving add-on therapy with individual SUs during 5 years of follow-up. The secondary outcome was within-drug yearly change in glycated haemoglobin (HbA1c). Annual changes in weight and HbA1c were estimated with linear mixed models, adjusted for age, gender and diabetes duration. RESULTS A total of 2958 patients were included. No significant weight changes were observed within and between any of the individual SUs after treatment intensification (p = 0.24). In addition, no significant difference in weight between the add-on therapy combinations was observed (p = 0.26). The average HbA1c the year before intensification was 7.2% (55 mmol/mol) and dropped below 7.0% (53 mmol/mol) the year after. CONCLUSIONS In patients with type 2 diabetes treated in primary care, strict glycaemic control can be maintained with SUs used as add-on therapy to metformin, without the offset of relevant weight changes.
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Affiliation(s)
| | - Raiza Wever
- Diabetes Centre, Isala, Zwolle, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sebastiaan T Houweling
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kornelis J J van Hateren
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
| | - Klaas H Groenier
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gijs W D Landman
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
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18
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Hartog LC, Landman GWD, Cimzar-Sweelssen M, Knipscheer A, Groenier KH, Kleefstra N, Bilo HJG, van Hateren KJJ. Health-related quality of life, rehabilitation and mortality in a nursing home population. Neth J Med 2016; 74:247-256. [PMID: 27571722] [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: 06/06/2023]
Abstract
BACKGROUND Health-related quality of life (HRQOL) in nursing home residents is generally low. The purpose of this study was to investigate the associations between HRQOL and two clinically relevant outcome measures, all-cause mortality and successful rehabilitation, in a nursing home population. METHODS In an observational prospective cohort study in a nursing home population, HRQOL was assessed with the RAND-36. A total of 184 patients were included, 159 (86%) completed the RAND-36 and were included in the study. A Cox proportional hazard model was used to investigate the independent association between HRQOL, rehabilitation and mortality with adjustment for confounders. Risk prediction capabilities were assessed with Harrell's C statistics and the proportion of explained variance (R2). RESULTS The median age (interquartile range) was 79 (75-85) years. The health dimensions vitality (HR 0.88 (95% CI 0.77-0.99)) and mental health (HR 0.86 (95% CI 0.75-0.98)) were inversely associated and role functioningphysical (HR 1.08 (95%CI 1.02-1.15)) was positively associated with mortality. The Harrell's C value and the R2 were ≤ 0.02 and ≤ 0.03 higher in the adjusted models with the dimensions role functioning- physical, mental health or vitality compared with the models without these dimensions. None of the health dimensions or summary scales were related to successful rehabilitation. CONCLUSION HRQOL was significantly associated with mortality for three dimensions, but partly in opposite directions. Additional value of HRQOL in mortality prediction is very limited. There were no independent associations between HRQOL and successful rehabilitation. Although HRQOL is an important outcome, this study did not provide evidence for an association between HRQOL and successful rehabilitation.
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Affiliation(s)
- L C Hartog
- Diabetes Centre, Isala, Zwolle, the Netherlands
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19
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Schrijnders D, Hartog LC, Kleefstra N, Groenier KH, Landman GWD, Bilo HJG. Within-Sulfonylurea-Class Evaluation of Time to Intensification with Insulin (ZODIAC-43). PLoS One 2016; 11:e0157668. [PMID: 27327605 PMCID: PMC4915672 DOI: 10.1371/journal.pone.0157668] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies have shown that many within-class differences exist between sulfonylureas (SUs), however, whether differences exist regarding the time it takes between initiating an SU and the need to intensify treatment with insulin is unclear. The aim of this study was investigate the relationships between the three frequently used sulphonylureas, prescribed as dual therapy next to metformin, and the time needed to treatment intensification with either insulin or oral triple therapy in patients with type 2 diabetes mellitus. Methods Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) is a prospective observational cohort study set in primary care in the Netherlands. Annually collected data on diabetes medication and clinical variables within ZODIAC are used to evaluate the primary outcome, time to insulin and secondary outcome, time to either insulin or triple oral therapy. For statistical analysis a time-dependent cox proportional hazard model was used. Results 3507 patients were included in the analysis, with a mean age of 61 (SD 11.4) and a median HbA1c of 6.8% [IQR 6.4–7.4] (50.8 mmol/mol [IQR 46.4–57.4]).The hazard ratio (HR) for the primary endpoint was 1.10 (95% CI 0.78–1.54) for metformin/glimepiride and 0.93 (95% CI 0.67–1.30) for metformin/tolbutamide with metformin/gliclazide as reference group. The HR for the secondary outcome was 1.04 (95% CI 0.78–1.40) and 0.85 (95% CI 0.64–1.13), respectively. Conclusion In this large Dutch primary care cohort, new users of neither gliclazide, glimepiride nor tolbutamide as dual therapy with metformin, resulted in differences in the time needed for further treatment intensification.
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Affiliation(s)
- Dennis Schrijnders
- Diabetes Centre, Isala, Zwolle, the Netherlands
- Langerhans Medical Research Group, Zwolle, the Netherlands
- * E-mail:
| | | | - Nanne Kleefstra
- Langerhans Medical Research Group, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Klaas H. Groenier
- Diabetes Centre, Isala, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Gijs W. D. Landman
- Langerhans Medical Research Group, Zwolle, the Netherlands
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Isala, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
- Department of Internal Medicine, Isala, Zwolle, the Netherlands
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Landman GWD, Kleefstra N, Groenier KH, Bakker SJL, Groeneveld GH, Bilo HJG, van Hateren KJJ. Inflammation biomarkers and mortality prediction in patients with type 2 diabetes (ZODIAC-27). Atherosclerosis 2016; 250:46-51. [PMID: 27179179 DOI: 10.1016/j.atherosclerosis.2016.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/19/2016] [Accepted: 04/19/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (MR-proADM) are inflammation markers associated with long-term mortality risk. We compared the associations and predictive capacities of CRP, PCT and MR-proADM with cardiovascular and all-cause mortality in patients with type 2 diabetes. METHODS This study included primary care treated patients with type 2 diabetes participating in the ZODIAC cohort study. A total of 1005 out of 1688 patients (60%) had complete baseline variables. Baseline CRP, PCT and MR-proADM were assessed in relation to cardiovascular and all-cause mortality with Cox proportional hazard analyses. Hazard Ratios (HR) were adjusted for age, gender, BMI, smoking, systolic blood pressure, cholesterol-HDL ratio, duration of diabetes, HbA1c, history of cardiovascular diseases, albumin-creatinine ratio and creatinine. Risk prediction capabilities were assessed with Harrell's C statistics and proportion of explained variance (R(2)). RESULTS After a median follow-up of 11 years, 472 (47%) of 1005 patients had died. The likelihood ratio test showed that CRP and MR-proADM significantly improved prediction in cardiovascular mortality [HRs 1.20 (95%CI 1.09-1.33) and 1.56 (95%CI 1.06-2.30)] and in all-cause mortality [HRs 1.10 (95%CI: 1.03-1.18) and 1.31 (95%CI 1.02-1.69)]. Harrell's C values and R(2) measures showed slightly improved discrimination for cardiovascular mortality in patients without macrovascular disease (C: 0.80 to 0.81; R(2): 0.50 to 0.52) and MR-proADM (C: 0.80 to 0.82; R(2): 0.50 to 0.52). CONCLUSIONS CRP and MR-proADM, but not PCT, were independently associated with cardiovascular and all-cause mortality. In patients without macrovascular diseases, CRP and MR-proADM slightly improved discrimination, in absolute sense, of patients at risk for cardiovascular mortality.
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Affiliation(s)
- Gijs W D Landman
- Langerhans Medical Research Institute, Zwolle, The Netherlands; Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands.
| | - Nanne Kleefstra
- Langerhans Medical Research Institute, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas H Groenier
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Research Centre, Isala Hospital, Zwolle, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geert H Groeneveld
- Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Research Centre, Isala Hospital, Zwolle, The Netherlands
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Nijenhuis-Rosien L, Vriesendorp TM, Landman GWD. Comment on Tone et al. Six-Week Versus Twelve-Week Antibiotic Therapy for Nonsurgically Treated Diabetic Foot Osteomyelitis: A Multicenter Open-Label Controlled Randomized Study. Diabetes Care 2015;38:302-307. Diabetes Care 2015; 38:e144. [PMID: 26294780 DOI: 10.2337/dc15-0588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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van Hateren KJJ, Landman GWD, Kleefstra N. Re: "RESPeRATE: the role of paced breathing in hypertension treatment". ACTA ACUST UNITED AC 2015; 9:656-7. [PMID: 26319537 DOI: 10.1016/j.jash.2015.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | - Gijs W D Landman
- Diabetes Centre, Isala, Zwolle, The Netherlands; Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Langerhans Medical Research Group, Zwolle, The Netherlands
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23
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Deetman PE, Alkhalaf A, Landman GWD, Groenier KH, Kootstra-Ros JE, Navis G, Bilo HJG, Kleefstra N, Bakker SJL. Alanine aminotransferase and mortality in patients with type 2 diabetes (ZODIAC-38). Eur J Clin Invest 2015; 45:807-14. [PMID: 26046667 DOI: 10.1111/eci.12474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 07/29/2014] [Accepted: 06/01/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Combined data suggest a bimodal association of alanine aminotransferase (ALT) with mortality in the general population. Little is known about the association of ALT with mortality in patients with type 2 diabetes. We therefore investigated the association of ALT with all-cause, cardiovascular and noncardiovascular mortality in patients with type 2 diabetes. DESIGN A prospective study was performed in patients with type 2 diabetes, treated in primary care, participating in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study. Cox regression analyses were performed to determine the associations of log2 -transformed baseline ALT with all-cause, cardiovascular and noncardiovascular mortality. RESULTS In 1187 patients with type 2 diabetes (67 ± 12 years, 45% female), ALT levels were 11 (8-16) U/L. During median follow-up for 11.1 (6.1-14.0) years, 553 (47%) patients died, with 238 (20%) attributable to cardiovascular causes. Overall, ALT was inversely associated with all-cause mortality (hazard ratio [HR] 0.81; 95% confidence interval [CI] 0.72-0.92), independently of potential confounders. This was less attributable to cardiovascular mortality (HR 0.87; 95% CI 0.72-1.05), than to noncardiovascular mortality (HR 0.77; 95% CI 0.65-0.90). Despite the overall inverse association of ALT with mortality, it appeared that a bimodal association with all-cause mortality was present with increasing risk for levels of ALT above normal (P = 0.003). DISCUSSION In patients with type 2 diabetes, low levels of ALT are associated with an increased risk of all-cause mortality, in particular noncardiovascular mortality, compared to normal levels of ALT, while risk again starts to increase when levels are above normal.
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Affiliation(s)
- Petronella E Deetman
- Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alaa Alkhalaf
- Department of Gastroenterology, Isala Clinics, Zwolle, the Netherlands
| | - Gijs W D Landman
- Department of Medicine, Gelre Hospital, Apeldoorn, the Netherlands.,Diabetes Centre, Isala Clinics, Zwolle, the Netherlands
| | - Klaas H Groenier
- Diabetes Centre, Isala Clinics, Zwolle, the Netherlands.,Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jenny E Kootstra-Ros
- Department of Laboratory Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Henk J G Bilo
- Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Diabetes Centre, Isala Clinics, Zwolle, the Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala Clinics, Zwolle, the Netherlands.,Langerhans Medical Research Group, Zwolle, the Netherlands
| | - Stephan J L Bakker
- Department of Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Landman GWD, Kleefstra N, Houweling ST. Comment on Inzucchi et al. Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach. Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015;38:140-149. Diabetes Care 2015. [PMID: 26207067 DOI: 10.2337/dc15-0276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Nanne Kleefstra
- Diabetes Center, Isala, Zwolle, the Netherlands Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, the Netherlands Langerhans Medical Research Group, Zwolle, the Netherlands
| | - Sebastiaan T Houweling
- Diabetes Center, Isala, Zwolle, the Netherlands Langerhans Medical Research Group, Zwolle, the Netherlands University of Groningen and Department of General Practice, University Medical Center Groningen, Groningen, the Netherlands
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25
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van Hateren KJJ, Landman GWD, Arnold JFH, Joosten H, Groenier KH, Navis GJ, Sparwasser A, Bakker SJL, Bilo HJG, Kleefstra N. Serum Proenkephalin A Levels and Mortality After Long-Term Follow-Up in Patients with Type 2 Diabetes Mellitus (ZODIAC-32). PLoS One 2015. [PMID: 26218633 PMCID: PMC4517864 DOI: 10.1371/journal.pone.0133065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Two previous studies concluded that proenkephalin A (PENK-A) had predictive capabilities for stroke severity, recurrent myocardial infarction, heart failure and mortality in patients with stroke and myocardial infarction. OBJECTIVES This study aimed to investigate the value of PENK-A as a biomarker for predicting mortality in patients with type 2 diabetes mellitus. METHODS Patients with type 2 diabetes mellitus were included from the prospective observational ZODIAC (Zwolle Outpatient Diabetes project Integrating Available Care) study. The present analysis incorporated two ZODIAC cohorts (1998 and 2001). Since blood was drawn for 1204 out of 1688 patients (71%), and information on relevant confounders was missing in 47 patients, the final sample comprised 1157 patients. Cox proportional hazard models were used for evaluating the relationship between PENK-A and (cardiovascular) mortality. Risk prediction capabilities were assessed with Harrell's C statistics and the integrated discrimination improvement (IDI). RESULTS After a follow-up period of 14 years, 525 (45%) out of 1157 patients had died, of which 224 (43%) were attributable to cardiovascular factors. Higher Log PENK-A levels were not independently associated with increased (cardiovascular) mortality. Patients with PENK-A values in the highest tertile had a 49% (95%CI 1%-121%) higher risk of cardiovascular mortality compared to patients in the reference category (lowest tertile). C-values were not different after removing PENK-A from the Cox models and there were no significant differences in IDI values. CONCLUSIONS The associations between PENK-A and mortality were strongly attenuated after accounting for all traditional risk factors. Furthermore, PENK-A did not seem to have additional value beyond conventional risk factors when predicting all-cause and cardiovascular mortality.
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Affiliation(s)
| | - Gijs W. D. Landman
- Diabetes Centre, Isala, Zwolle, the Netherlands
- Department of Internal Medicine, Gelre hospital, Apeldoorn, the Netherlands
| | | | - Hanneke Joosten
- Diabetes Centre, Isala, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Klaas H. Groenier
- Diabetes Centre, Isala, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Gerjan J. Navis
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Andrea Sparwasser
- Research Department, B.R.A.H.M.S GmbH (Thermo Fisher Scientific), Hennigsdorf/Berlin, Germany
| | - Stephan J. L. Bakker
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Isala, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
- Department of Internal Medicine, Isala, Zwolle, the Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, 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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de Visser KL, Landman GWD, Meyboom-de Jong B, de Visser W, te Meerman GJ, Bilo HJG. Familial Aggregation between the 14th and 21st Century and Type 2 Diabetes Risk in an Isolated Dutch Population. PLoS One 2015; 10:e0132549. [PMID: 26193086 PMCID: PMC4508118 DOI: 10.1371/journal.pone.0132549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 06/17/2015] [Indexed: 12/29/2022] Open
Abstract
Introduction The development of type 2 diabetes results from an interaction of hereditary factors and environmental factors. This study aimed to investigate the contribution of interrelatedness to the risk of developing type 2 diabetes in an isolated Dutch population. Materials and Methods A genealogical database from inhabitants living on the former island Urk between the 14th and 21st century was constructed. In a case-control study, effects of interrelatedness and the risk of type 2 diabetes were estimated with Kinship Coefficients (KCs). Relative risks in first, second, and third degree relatives and spouses of inhabitants with type 2 diabetes were compared to matched controls. Results Patients with type 2 diabetes were more interrelated, expressed by a higher KC compared to controls (7.2 vs. 5.2, p=0.001). First, second and third degree relatives had an increased risk of developing type 2 diabetes. Second degree relatives had a similar risk,1.7 (1.5-2.0) as third degree relatives,1.8 (1.5-2.2). Spouses of patients with diabetes had a 3.4 (2.7-4.4) higher risk of developing type 2 diabetes. Conclusions Interrelatedness was higher among inhabitants with type 2 diabetes compared to controls. This differences extended beyond the nuclear family, thereby supporting the hypothesis that interrelatedness contributed to the development of type 2 diabetes on Urk. However, the size of this effect was small and the patterns of risk in first, second and third degree relatives suggested that factors other than interrelatedness were the main contributors to the development of type 2 diabetes on Urk.
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Affiliation(s)
- Kees L. de Visser
- Diabetes Centre, Isala, 8025 BT, Zwolle, The Netherlands
- Department of General practice, University Medical Center Groningen and University of Groningen, 9700 RB, Groningen, The Netherlands
- General practice Urk, 8322 BA, The Netherlands
| | - Gijs W. D. Landman
- Diabetes Centre, Isala, 8025 BT, Zwolle, The Netherlands
- Department of internal medicine, Gelre hospital, 7334 DZ, Apeldoorn, The Netherlands
- Langerhans Medical Research Institute, Zwolle, The Netherlands
- * E-mail:
| | - Betty Meyboom-de Jong
- Diabetes Centre, Isala, 8025 BT, Zwolle, The Netherlands
- Department of General practice, University Medical Center Groningen and University of Groningen, 9700 RB, Groningen, The Netherlands
| | | | - Gerard J. te Meerman
- Department of genetics, University Medical Center Groningen and University of Groningen, 9700 RB, Groningen, The Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Isala, 8025 BT, Zwolle, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, 9700 RB, Groningen, The Netherlands
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Riphagen IJ, Logtenberg SJJ, Groenier KH, van Hateren KJJ, Landman GWD, Struck J, Navis G, Kootstra-Ros JE, Kema IP, Bilo HJG, Kleefstra N, Bakker SJL. Is the association of serum sodium with mortality in patients with type 2 diabetes explained by copeptin or NT-proBNP? (ZODIAC-46). Atherosclerosis 2015. [PMID: 26201002 DOI: 10.1016/j.atherosclerosis.2015.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Hyponatremia has been associated with an increased mortality risk in the general population. Diabetes is a condition predisposing for elevated levels of arginine vasopressin (AVP) and heart failure, both common causes of hyponatremia. These factors, however, are also associated with an increased mortality risk. We aimed to investigate whether serum sodium is associated with cardiovascular and all-cause mortality in type 2 diabetes and whether these associations could be explained by copeptin, a surrogate for AVP, or NT-proBNP, a marker for heart failure. METHODS Patients with type 2 diabetes participating in the observational ZODIAC study were included. Cox regression analyses were used to investigate the association of serum sodium with mortality. RESULTS We included 1068 patients (age 67 ± 12 years, 45% male, serum sodium 142 ± 3 mmol/L). After 15 years of follow-up, 519 patients (49%) died, with 225 cardiovascular deaths (21%). In univariable analyses, serum sodium, copeptin, and NT-proBNP were all significantly associated with cardiovascular and all-cause mortality. These associations remained significant after combination of these markers in a multivariable model. Serum sodium and NT-proBNP remained significantly associated with mortality after further adjustment for potential confounders, whereas copeptin lost significance after adjustment for SCr and ACR. CONCLUSION Low serum sodium was associated with an increased risk of cardiovascular and all-cause mortality in type 2 diabetes. Moreover, these associations were not explained by copeptin and NT-proBNP. Whether low serum sodium itself leads to poor outcome or is a marker for (unidentified) co-morbidity severity or use of specific medications remains to be elucidated.
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Affiliation(s)
- Ineke J Riphagen
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The Netherlands.
| | - Susan J J Logtenberg
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
| | - Klaas H Groenier
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands; Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Gijs W D Landman
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands; Department of Medicine, Gelre Hospital, Apeldoorn, The Netherlands
| | - Joachim Struck
- BRAHMS GmbH, Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jenny E Kootstra-Ros
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Langerhans Medical Research Group, Zwolle, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The Netherlands
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Matsushita K, Coresh J, Sang Y, Chalmers J, Fox C, Guallar E, Jafar T, Jassal SK, Landman GWD, Muntner P, Roderick P, Sairenchi T, Schöttker B, Shankar A, Shlipak M, Tonelli M, Townend J, van Zuilen A, Yamagishi K, Yamashita K, Gansevoort R, Sarnak M, Warnock DG, Woodward M, Ärnlöv J. Estimated glomerular filtration rate and albuminuria for prediction of cardiovascular outcomes: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol 2015; 3:514-25. [PMID: 26028594 PMCID: PMC4594193 DOI: 10.1016/s2213-8587(15)00040-6] [Citation(s) in RCA: 538] [Impact Index Per Article: 59.8] [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] [Indexed: 11/24/2022]
Abstract
BACKGROUND The usefulness of estimated glomerular filtration rate (eGFR) and albuminuria for prediction of cardiovascular outcomes is controversial. We aimed to assess the addition of creatinine-based eGFR and albuminuria to traditional risk factors for prediction of cardiovascular risk with a meta-analytic approach. METHODS We meta-analysed individual-level data for 637 315 individuals without a history of cardiovascular disease from 24 cohorts (median follow-up 4·2-19·0 years) included in the Chronic Kidney Disease Prognosis Consortium. We assessed C statistic difference and reclassification improvement for cardiovascular mortality and fatal and non-fatal cases of coronary heart disease, stroke, and heart failure in a 5 year timeframe, contrasting prediction models for traditional risk factors with and without creatinine-based eGFR, albuminuria (either albumin-to-creatinine ratio [ACR] or semi-quantitative dipstick proteinuria), or both. FINDINGS The addition of eGFR and ACR significantly improved the discrimination of cardiovascular outcomes beyond traditional risk factors in general populations, but the improvement was greater with ACR than with eGFR, and more evident for cardiovascular mortality (C statistic difference 0·0139 [95% CI 0·0105-0·0174] for ACR and 0·0065 [0·0042-0·0088] for eGFR) and heart failure (0·0196 [0·0108-0·0284] and 0·0109 [0·0059-0·0159]) than for coronary disease (0·0048 [0·0029-0·0067] and 0·0036 [0·0019-0·0054]) and stroke (0·0105 [0·0058-0·0151] and 0·0036 [0·0004-0·0069]). Dipstick proteinuria showed smaller improvement than ACR. The discrimination improvement with eGFR or ACR was especially evident in individuals with diabetes or hypertension, but remained significant with ACR for cardiovascular mortality and heart failure in those without either of these disorders. In individuals with chronic kidney disease, the combination of eGFR and ACR for risk discrimination outperformed most single traditional predictors; the C statistic for cardiovascular mortality fell by 0·0227 (0·0158-0·0296) after omission of eGFR and ACR compared with less than 0·007 for any single modifiable traditional predictor. INTERPRETATION Creatinine-based eGFR and albuminuria should be taken into account for cardiovascular prediction, especially when these measures are already assessed for clinical purpose or if cardiovascular mortality and heart failure are outcomes of interest. ACR could have particularly broad implications for cardiovascular prediction. In populations with chronic kidney disease, the simultaneous assessment of eGFR and ACR could facilitate improved classification of cardiovascular risk, supporting current guidelines for chronic kidney disease. Our results lend some support to also incorporating eGFR and ACR into assessments of cardiovascular risk in the general population. FUNDING US National Kidney Foundation, National Institute of Diabetes and Digestive and Kidney Diseases.
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Affiliation(s)
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Yingying Sang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Caroline Fox
- National Heart, Lung, and Blood Institute's Framingham Heart Study and the Center for Population Studies Framingham, MA, USA
| | - Eliseo Guallar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Simerjot K Jassal
- VA San Diego Healthcare and University of California San Diego, San Diego, CA, USA
| | | | - Paul Muntner
- Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Paul Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Michael Shlipak
- Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, and Departments of Medicine, Epidemiology, and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jonathan Townend
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Arjan van Zuilen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kentaro Yamashita
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ron Gansevoort
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Mark Sarnak
- Division of Nephrology, Tufts Medical Center, Boston, MA, USA
| | - David G Warnock
- Department of Medicine, University of Alabama at Birmingham, AL, USA
| | - Mark Woodward
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Johan Ärnlöv
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; School of Health and Social Studies, Dalarna University, Falun, Sweden
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Schrijnders D, Houweling ST, Landman GWD. Comment on Genuth. Should sulfonylureas remain an acceptable first-line add-on to metformin therapy in patients with type 2 diabetes? No, it's time to move on! Diabetes Care 2015;38:170-175. Diabetes Care 2015; 38:e94. [PMID: 25998308 DOI: 10.2337/dc15-0293] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Sebastiaan T Houweling
- Diabetes Centre, Isala Clinics, Zwolle, the Netherlands Langerhans Medical Research Group, Zwolle, the Netherlands Department of General Practice, University Medical Center Groningen, Groningen, the Netherlands
| | - Gijs W D Landman
- Diabetes Centre, Isala Clinics, Zwolle, the Netherlands Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands
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Affiliation(s)
- Dennis Schrijnders
- Diabetes Centre, Isala Clinics, Dokter Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands,
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van Dijk PR, Landman GWD, van Essen L, Struck J, Groenier KH, Bilo HJG, Bakker SJL, Kleefstra N. The relationship between N-terminal prosomatostatin, all-cause and cardiovascular mortality in patients with type 2 diabetes mellitus (ZODIAC-35). BMC Endocr Disord 2015; 15:19. [PMID: 25880900 PMCID: PMC4404603 DOI: 10.1186/s12902-015-0009-2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 03/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The hormone somatostatin inhibits growth hormone release from the pituitary gland and is theoretically linked to diabetes and diabetes related complications. This study aimed to investigate the relationship between levels of the stable somatostatin precursor, N-terminal prosomatostatin (NT-proSST), with mortality in type 2 diabetes (T2DM) patients. METHODS In 1,326 T2DM outpatients, participating in this ZODIAC prospective cohort study, Cox proportional hazards models were used to investigate the independent relationship between plasma NT-proSST concentrations with all-cause and cardiovascular mortality. RESULTS Median concentration of NT-proSST was 592 [IQR 450-783] pmol/L. During follow-up for 6 [3-10] years, 413 (31%) patients died, of which 176 deaths (43%) were attributable to cardiovascular causes. The age and sex adjusted hazard ratios (HRs) for all-cause and cardiovascular mortality were 1.48 (95%CI 1.14 - 1.93) and 2.21 (95%CI 1.49 - 3.28). However, after further adjustment for cardiovascular risk factors there was no independent association of log NT-proSST with mortality, which was almost entirely attributable to adjustment for serum creatinine. There were no significant differences in Harrell's C statistics to predict mortality for the models with and without NT-proSST: both 0.79 (95%CI 0.77 - 0.82) and 0.81 (95%CI 0.77 - 0.84). CONCLUSIONS NT-proSST is unsuitable as a biomarker for cardiovascular and all-cause mortality in stable outpatients with T2DM.
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Affiliation(s)
- Peter R van Dijk
- Isala, Diabetes Centre, P.O. box 10400, 8000 G.K, Zwolle, The Netherlands.
| | - Gijs W D Landman
- Isala, Diabetes Centre, P.O. box 10400, 8000 G.K, Zwolle, The Netherlands.
| | - Larissa van Essen
- Isala, Diabetes Centre, P.O. box 10400, 8000 G.K, Zwolle, The Netherlands.
| | | | - Klaas H Groenier
- Isala, Diabetes Centre, P.O. box 10400, 8000 G.K, Zwolle, The Netherlands.
- Department of General Practice, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
| | - Henk J G Bilo
- Isala, Diabetes Centre, P.O. box 10400, 8000 G.K, Zwolle, The Netherlands.
- Department of Internal Medicine, Isala, Zwolle, The Netherlands.
- 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.
| | - Nanne Kleefstra
- Isala, Diabetes Centre, P.O. box 10400, 8000 G.K, Zwolle, The Netherlands.
- Department of Internal Medicine, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
- Langerhans Medical Research group, Zwolle, The Netherlands.
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Nijenhuis-Rosien L, Kleefstra N, Wolfhagen MJ, Groenier KH, Bilo HJG, Landman GWD. Laser therapy for onychomycosis in patients with diabetes at risk for foot complications: study protocol for a randomized, double-blind, controlled trial (LASER-1). Trials 2015; 16:108. [PMID: 25872590 PMCID: PMC4381488 DOI: 10.1186/s13063-015-0622-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/27/2015] [Indexed: 11/25/2022] Open
Abstract
Background In a sham-controlled double-blind trial, we aim to establish the efficacy and safety of the local application of laser therapy in patients with diabetes, onychomycosis and risk factors for diabetes-related foot complications. Onychomycosis leads to thickened and distorted nails, which in turn lead to increased local pressure. The combination of onychomycosis and neuropathy or peripheral arterial disease (PAD) increases the risk of developing diabetes-related foot complications. Usual care for high-risk patients with diabetes and onychomycosis is completely symptomatic with frequent shaving and clipping of the nails. No effective curative local therapies exist, and systemic agents are often withheld due to concerns for side effects and interactions. Methods/Design The primary aim is to evaluate the efficacy of four sessions of Nd:YAG 1064 nM laser application on the one-year clinical and microbiological cure rate in a randomized, double-blind, sham-controlled design with blinded outcome assessment. Mandatory inclusion criteria are diagnosis of diabetes, risk factors for developing foot ulcers defined as a modified Simm’s classification score 1 or 2 and either neuropathy or PAD. A total of 64 patients are randomized to intervention or sham treatment performed by a podiatrist. Discussion This study will be the first double-blind study that investigates the effects of local laser therapy on onychomycosis, specifically performed in patients with diabetes with additional risk factors for foot complications. Trial registration Clinical trials.gov as NCT01996995, first received 22 November 2013.
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Affiliation(s)
- Leonie Nijenhuis-Rosien
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Innofeet Voetencentrum Nijenhuis Podiatry, Simon Stevinweg 13, 8013 NA, Zwolle, the Netherlands.
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands. .,Langerhans Medical Research Group, Postbus 21, 4254 ZG, Sleeuwijk, the Netherlands.
| | - Maurice J Wolfhagen
- Department of Medical Microbiology, Isala, Dr. van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
| | - Klaas H Groenier
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of General Practice, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
| | - Henk J G Bilo
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands. .,Department of General Practice, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands.
| | - Gijs W D Landman
- Diabetes Centre, Isala, Dr Spanjaardweg 11, 8025 BT, Zwolle, the Netherlands. .,Department of Internal Medicine, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, the Netherlands.
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Affiliation(s)
- Gijs W D Landman
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
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Riphagen IJ, Kleefstra N, Drion I, Alkhalaf A, van Diepen M, Cao Q, Groenier KH, Landman GWD, Navis G, Bilo HJG, Bakker SJL. Comparison of methods for renal risk prediction in patients with type 2 diabetes (ZODIAC-36). PLoS One 2015; 10:e0120477. [PMID: 25775414 PMCID: PMC4361549 DOI: 10.1371/journal.pone.0120477] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 09/01/2014] [Accepted: 01/22/2015] [Indexed: 12/03/2022] Open
Abstract
Background Patients with diabetes are at high risk of death prior to reaching end-stage renal disease, but most models predicting the risk of kidney disease do not take this competing risk into account. We aimed to compare the performance of Cox regression and competing risk models for prediction of early- and late-stage renal complications in type 2 diabetes. Methods Patients with type 2 diabetes participating in the observational ZODIAC study were included. Prediction models for (micro)albuminuria and 50% increase in serum creatinine (SCr) were developed using Cox regression and competing risk analyses. Model performance was assessed by discrimination and calibration. Results During a total follow-up period of 10 years, 183 out of 640 patients (28.6%) with normoalbuminuria developed (micro)albuminuria, and 22 patients (3.4%) died without developing (micro)albuminuria (i.e. experienced the competing event). Seventy-nine out of 1,143 patients (6.9%) reached the renal end point of 50% increase in SCr, while 219 (19.2%) died without developing the renal end point. Performance of the Cox and competing risk models predicting (micro)albuminuria was similar and differences in predicted risks were small. However, the Cox model increasingly overestimated the risk of increase in SCr in presence of a substantial number of competing events, while the performance of the competing risk model was quite good. Conclusions In this study, we demonstrated that, in case of substantial numbers of competing events, it is important to account for the competing risk of death in renal risk prediction in patients with type 2 diabetes.
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Affiliation(s)
- Ineke J. Riphagen
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Nanne Kleefstra
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Iefke Drion
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
| | - Alaa Alkhalaf
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Qi Cao
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas H. Groenier
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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36
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van Hateren KJJ, Landman GWD, Groenier KH, Bilo HJG, Kleefstra N. Effectiveness of angiotensin II receptor antagonists in a cohort of Dutch patients with type 2 diabetes mellitus (ZODIAC-14). Can J Diabetes 2014; 39:157-61. [PMID: 25523182 DOI: 10.1016/j.jcjd.2014.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/16/2014] [Revised: 08/01/2014] [Accepted: 10/14/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE There is limited evidence with respect to the between-group effects of various angiotensin receptor blockers (ARBs) on blood pressure and albuminuria in patients with type 2 diabetes mellitus. Therefore, we aimed to investigate the effects of differing ARBs on systolic blood pressure (SBP) and the albumin-creatinine ratio after 1 year in a large cohort of patients with type 2 diabetes mellitus. METHODS In 2007, 24 940 primary care patients with type 2 diabetes mellitus participated in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study, a prospective observational cohort study. Patients were included in the current study if they were prescribed an ARB in 2007 and if 1-year follow-up data were available. The final study population comprised 3610 patients. Multivariate mixed-model analyses were performed to estimate effects of the various ARBs on SBP and albuminuria. Stratified subgroup analyses were performed according to baseline hypertension and albuminuria. RESULTS SBP decreased in all groups, the largest decrease being observed in the group receiving telmisartan. No significant or relevant changes over time were observed among groups for SBP and albuminuria. In the subgroup (n=1225) of normotensive patients, telmisartan was associated with a larger decrease in SBP after 1 year compared to other ARBs, without different effects on the albumin-creatinine ratio. CONCLUSIONS We observed no differences in effects on SBP and the albumin-creatinine ratio among differing ARBs in patients with type 2 diabetes mellitus.
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Affiliation(s)
| | | | - Klaas H Groenier
- Diabetes Centre, Isala, Zwolle, The Netherlands; Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Department of Internal Medicine, Isala Clinics, Zwolle, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands; Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands; Langerhans Medical Research Group, The Netherlands
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Landman GWD, van Hateren KJJ, van Dijk PR, Logtenberg SJJ, Houweling ST, Groenier KH, Bilo HJG, Kleefstra N. Efficacy of device-guided breathing for hypertension in blinded, randomized, active-controlled trials: a meta-analysis of individual patient data. JAMA Intern Med 2014; 174:1815-21. [PMID: 25222103 DOI: 10.1001/jamainternmed.2014.4336] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 11/14/2022]
Abstract
IMPORTANCE Device-guided breathing (DGB) is recommended by the American Heart Association for its blood pressure-lowering effects. Most previous studies that showed beneficial effects on blood pressure had low methodological quality and only investigated short-term blood pressure effects. OBJECTIVE To assess the efficacy of DGB on blood pressure in a meta-analysis of individual patient data from blinded, randomized controlled trials with an active control group. DATA SOURCES MEDLINE, EMBASE, clinicaltrials.gov, and the Cochrane Library. STUDY SELECTION Included were randomized studies of at least 4 weeks' duration, with a single- or double-blind design and an active control group. Bias was assessed with the Cochrane risk of bias tool, and analyses were performed with linear mixed models. DATA EXTRACTION AND SYNTHESIS Articles were searched in MEDLINE (using PubMed), EMBASE, and the Cochrane Library. MAIN OUTCOMES AND MEASURES Office blood pressure. RESULTS From the 15 selected abstracts, 5 studies were suitable for inclusion. Individual patient data from 2 of 5 studies were not provided. The effect of DGB on office systolic blood pressure compared with music therapy or a sham device was 2.2 mm Hg (95% CI, -2.7 to 7.0) in favor of the control group; DGB did not significantly lower office diastolic blood pressure (0.2 mm Hg [95% CI, -2.8 to 3.1] in favor of DGB). CONCLUSIONS AND RELEVANCE All trials included in the analysis had a short follow-up period; therefore, no recommendations could be made regarding hypertension treatment. Treatment with DGB did not significantly lower office blood pressure compared with a sham procedure or music therapy.
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Affiliation(s)
- Gijs W D Landman
- Diabetes Centre, Isala, Zwolle, the Netherlands2Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
| | | | | | - Susan J J Logtenberg
- Diabetes Centre, Isala, Zwolle, the Netherlands3Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Klaas H Groenier
- Diabetes Centre, Isala, Zwolle, the Netherlands4Department of General Practice, University Medical Center Groningen, Groningen, the Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, the Netherlands3Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, the Netherlands3Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands
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Landman GWD, Nijenhuis-Rosien L, Kleefstra N. Comment on Lazaro-Martinez et al. Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial. Diabetes care 2014;37:789-795. Diabetes Care 2014; 37:e115. [PMID: 24757242 DOI: 10.2337/dc13-2979] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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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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Affiliation(s)
| | | | - Nanne Kleefstra
- Diabetes Centre, Isala Clinics, Zwolle, the Netherlands2Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands3Langerhans Medical Research Group, Zwolle, the Netherlands
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Roelofsen Y, Hendriks SH, Sieverink F, Landman GWD, Groenier KH, Bilo HJG, Kleefstra N. Differences Between Patients With Type 2 Diabetes Mellitus Interested and Uninterested in the Use of a Patient Platform (e-VitaDM-2/ZODIAC-41). J Diabetes Sci Technol 2014; 8:230-237. [PMID: 24876572 PMCID: PMC4455415 DOI: 10.1177/1932296814524496] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is rising in the Netherlands, and health care's workload will increase. e-Health applications may increase patients' participation in their care and could help reducing workload. To explore potential users, differences in patients interested and uninterested in e-Health are characterized. A prospective cohort study was initiated in the Drenthe region of the Netherlands. This study included inviting T2DM patients to use e-Health (the e-Vita platform). Patients were offered access to clinical data, laboratory results, educational modules, and a self-management support program. Data were obtained from health record systems of general practices and questionnaires. Out of 2674 patients, 1378 (51.5%) participated in the study. Of the 1378 patients, 974 (70.7%) were interested in e-Health. Of 974, 405 (41.6%) were registered for e-Health. Interested patients were more often male, were younger, had shorter T2DM duration, and were higher educated. Of 405, 110 (27.2%) used the e-Health. No differences were found between users and nonusers of e-Health. Patients interested in e-Health were more often male, were younger, had shorter T2DM duration, and were more often higher educated. However, even in this interested group, the actual participation rate remained low. Together with characteristics and attitudes of caregivers and T2DM patients, the look and content of the e-Health platform strategies that increase interest and participation need to be developed.
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Affiliation(s)
| | | | - Floor Sieverink
- Center for eHealth Research and Disease Management, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
| | | | - Klaas H Groenier
- Diabetes Centre, Isala, Zwolle, the Netherlands University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, the Netherlands University of Groningen and University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, the Netherlands University of Groningen and University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands Langerhans Medical Research Group, Zwolle, the Netherlands
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Gerrits EG, Alkhalaf A, Landman GWD, van Hateren KJJ, Groenier KH, Struck J, Schulte J, Gans ROB, Bakker SJL, Kleefstra N, Bilo HJG. Serum peroxiredoxin 4: a marker of oxidative stress associated with mortality in type 2 diabetes (ZODIAC-28). PLoS One 2014; 9:e89719. [PMID: 24586984 PMCID: PMC3934910 DOI: 10.1371/journal.pone.0089719] [Citation(s) in RCA: 23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 01/22/2014] [Indexed: 12/04/2022] Open
Abstract
Background Oxidative stress plays an underlying pathophysiologic role in the development of diabetes complications. The aim of this study was to investigate peroxiredoxin 4 (Prx4), a proposed novel biomarker of oxidative stress, and its association with and capability as a biomarker in predicting (cardiovascular) mortality in type 2 diabetes mellitus. Methods Prx4 was assessed in baseline serum samples of 1161 type 2 diabetes patients. Cox proportional hazard models were used to evaluate the relationschip between Prx4 and (cardiovascular) mortality. Risk prediction capabilities of Prx4 for (cardiovascular) mortality were assessed with Harrell’s C statistic, the integrated discrimination improvement and net reclassification improvement. Results Mean age was 67 and the median diabetes duration was 4.0 years. After a median follow-up period of 5.8 years, 327 patients died; 137 cardiovascular deaths. Prx4 was associated with (cardiovascular) mortality. The Cox proportional hazard models added the variables: Prx4 (model 1); age and gender (model 2), and BMI, creatinine, smoking, diabetes duration, systolic blood pressure, cholesterol-HDL ratio, history of macrovascular complications, and albuminuria (model 3). Hazard ratios (HR) (95% CI) for cardiovascular mortality were 1.93 (1.57 – 2.38), 1.75 (1.39 – 2.20), and 1.63 (1.28 – 2.09) for models 1, 2 and 3, respectively. HR for all-cause mortality were 1.73 (1.50 – 1.99), 1.50 (1.29 – 1.75), and 1.44 (1.23 – 1.67) for models 1, 2 and 3, respectively. Addition of Prx4 to the traditional risk factors slightly improved risk prediction of (cardiovascular) mortality. Conclusions Prx4 is independently associated with (cardiovascular) mortality in type 2 diabetes patients. After addition of Prx4 to the traditional risk factors, there was a slightly improvement in risk prediction of (cardiovascular) mortality in this patient group.
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Affiliation(s)
- Esther G. Gerrits
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
- * E-mail:
| | - Alaa Alkhalaf
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
- Department of Gastroenterology, Isala Clinics, Zwolle, The Netherlands
| | | | - Kornelis J. J. van Hateren
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
| | - Klaas H. Groenier
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
| | - Joachim Struck
- Thermo Fisher Scientific, BRAHMS Biomarkers, Research Department, Hennigsdorf, Germany
| | - Janin Schulte
- Thermo Fisher Scientific, BRAHMS Biomarkers, Research Department, Hennigsdorf, Germany
| | - Reinold O. B. Gans
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J. L. Bakker
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala Clinics, 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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van Dijk PR, Landman GWD, van Hateren KJJ, Logtenberg SJJ, Bilo HJG, Kleefstra N. Call for a re-evaluation of the American Heart Association's standpoint concerning device-guided slow breathing using the RESPeRATE device. Hypertension 2013; 62:e17. [PMID: 23959556 DOI: 10.1161/hypertensionaha.113.02022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Landman GWD, Drion I, van Hateren KJJ, van Dijk PR, Logtenberg SJJ, Lambert J, Groenier KH, Bilo HJG, Kleefstra N. Device-guided breathing as treatment for hypertension in type 2 diabetes mellitus: a randomized, double-blind, sham-controlled trial. JAMA Intern Med 2013; 173:1346-50. [PMID: 23752780 DOI: 10.1001/jamainternmed.2013.6883] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Biofeedback with device-guided lowering of breathing frequency could be an alternate nonpharmacologic treatment option for hypertension. Evidence from trials with high methodologic quality is lacking. OBJECTIVE To evaluate the effects of device-guided lowering of breathing frequency on blood pressure in patients with type 2 diabetes mellitus and hypertension. DESIGN Single-center, double-blind, sham-controlled trial. SETTING A large nonacademic teaching hospital in the Netherlands. PARTICIPANTS Patients with type 2 diabetes mellitus and hypertension. INTERVENTION Fifteen-minute sessions with either the device that guides breathing through musical tones to a lower breathing frequency (aiming at <10 breaths/min) or a sham device (music without aiming at lowering of breathing frequency) for an 8-week study period. MAIN OUTCOMES AND MEASURES Systolic and diastolic blood pressure measured in the physician's office. RESULTS Forty-eight patients were randomized; 21 patients (88%) in the intervention group and 24 patients (100%) in the control group completed the study. There were no significant changes in systolic and diastolic blood pressure, with a difference in systolic blood pressure of 2.35 mm Hg (95% CI, -6.50 to 11.20) in favor of the control group and a difference in diastolic blood pressure of 2.25 mm Hg (95% CI, -2.16 to 6.67) in favor of the intervention group. Three patients in the intervention group experienced adverse events. CONCLUSIONS AND RELEVANCE This high methodologic quality study shows no significant effect of device-guided lowering of breathing frequency on office-measured blood pressure in patients with type 2 diabetes. On the basis of this study, together with results from all but one previous trial, device-guided lowering of breathing frequency does not appear to be a viable nonpharmacologic option for hypertension treatment.
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Affiliation(s)
- Gijs W D Landman
- Diabetes Centre, Isala Clinics, the Netherlands University Medical Center, Zwolle, the Netherlands.
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van Hateren KJJ, Landman GWD, Kleefstra N, Groenier KH, Struck J, Navis GJ, Bakker SJL, Houweling ST, van der Meer K, Bilo HJG. The midregional fragment of pro-A-type natriuretic peptide, blood pressure, and mortality in a prospective cohort study of patients with type 2 diabetes (ZODIAC-25). Diabetes Care 2013; 36:1347-52. [PMID: 23230100 PMCID: PMC3631859 DOI: 10.2337/dc12-0428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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 Evidence that midregional fragment of pro-A-type natriuretic peptide (MR-proANP) is a marker of mortality in patients with type 2 diabetes is limited. Therefore, we aimed to investigate the capabilities of MR-proANP in predicting mortality. We also investigated whether MR-proANP influences the relationship between blood pressure and mortality in old age. RESEARCH DESIGN AND METHODS In 1998, 1,143 primary care patients with type 2 diabetes participated in the ZODIAC study. Because blood was drawn for 867 patients (76%) and confounders were missing for 19 patients, the final study sample comprised 848 patients. After a follow-up time of 10 years, we used Cox proportional hazard models to evaluate the relationship between MR-proANP and (cardiovascular) mortality. Harrell C statistic was used to compare models with and without MR-proANP. The regression analyses were repeated without MR-proANP for patients aged older than 75 years. RESULTS Median MR-proANP in the total study sample was 75 pmol/L (interquartile range, 48-124 pmol/L). During follow-up, 354 (42%) out of 848 patients had died, of whom 152 (43%) deaths were attributable to cardiovascular factors. MR-proANP was independently associated with all-cause and cardiovascular mortality, irrespective of age. During old age, there was a significant inverse relationship between blood pressure and mortality. This relationship did not change after adjustment for MR-proANP. CONCLUSIONS MR-proANP is independently associated with mortality in patients with type 2 diabetes. MR-proANP did not influence the inverse relationship between blood pressure and mortality in elderly patients.
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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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Papendorp S, Hasenack-Meijer MKE, Landman GWD, van Westerloo DJ. What's crawling in this sputum? Neth J Med 2013; 71:85-88. [PMID: 23462058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- S Papendorp
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
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