1
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Januszewski AS, Chen D, Scott RS, O'Connell RL, Aryal NR, Sullivan DR, Watts GF, Taskinen MR, Barter PJ, Best JD, Simes RJ, Keech AC, Jenkins AJ. Relationship of low molecular weight fluorophore levels with clinical factors and fenofibrate effects in adults with type 2 diabetes. Sci Rep 2021; 11:18708. [PMID: 34548531 PMCID: PMC8455555 DOI: 10.1038/s41598-021-98064-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/26/2021] [Indexed: 12/02/2022] Open
Abstract
People with diabetes are at risk of chronic complications and novel biomarkers, such as Advanced glycation end-products (AGEs) may help stratify this risk. We assessed whether plasma low-molecular weight AGEs, also known as LMW-fluorophores (LMW-F), are associated with risk factors, predict complications, and are altered by fenofibrate in adults with type 2 diabetes. Plasma LMW-F were quantified at baseline, after six weeks fenofibrate, and one year post-randomisation to fenofibrate or placebo. LMW-F associations with existing and new composite vascular complications were determined, and effects of fenofibrate assessed. LMW-F correlated positively with age, glycated haemoglobin (HbA1c), pulse pressure, kidney dysfunction and inflammation; and negatively with urate, body mass index, oxidative stress and leptin, albeit weakly (r = 0.04–0.16, all p < 0.01). Independent determinants of LMW-F included smoking, diastolic blood pressure, prior cardiovascular disease or microvascular complications, Caucasian ethnicity, kidney function, HbA1c and diabetes duration (all p ≤ 0.01). Baseline LMW-F tertiles correlated with on-trial macrovascular and microvascular complications (trend p < 0.001) on univariate analyses only. Six weeks of fenofibrate increased LMW-F levels by 21% (p < 0.001). In conclusion, LMW-F levels correlate with many risk factors and chronic diabetes complications, and are increased with fenofibrate. LMW-F tertiles predict complications, but not independently of traditional risk factors.
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Affiliation(s)
- Andrzej S Januszewski
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, Sydney, NSW, 2050, Australia
| | - David Chen
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, Sydney, NSW, 2050, Australia.,Monash School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Russell S Scott
- Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand
| | - Rachel L O'Connell
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, Sydney, NSW, 2050, Australia
| | - Nanda R Aryal
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, Sydney, NSW, 2050, Australia
| | | | - Gerald F Watts
- Faculty of Health and Medical Sciences, School of Medicine, University of Western Australia, Perth, Australia.,Lipid Disorders Clinic, Cardiometabolic Services, Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Marja-Riitta Taskinen
- Cardiovascular Research Unit, Helsinki, Heart and Lung Centre, University Central Hospital, Helsinki, Finland.,Diabetes and Obesity Research Program, University of Helsinki, Helsinki, Finland
| | - Philip J Barter
- Centre for Vascular Research, University of New South Wales, Sydney, NSW, Australia.,Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - James D Best
- Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore, Singapore
| | - R John Simes
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, Sydney, NSW, 2050, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Anthony C Keech
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, Sydney, NSW, 2050, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alicia J Jenkins
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Level 6 Medical Foundation Building, 92-94 Parramatta Rd, Camperdown, Sydney, NSW, 2050, Australia. .,Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia.
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2
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Lim SS, O'Reilly S, Versace V, Janus E, Skinner TC, Best JD, Dunbar J, Teede H. Recommendations for promoting healthier lifestyles in postpartum women after gestational diabetes. Diabet Med 2020; 37:706-708. [PMID: 31833086 DOI: 10.1111/dme.14208] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- S S Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - S O'Reilly
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - V Versace
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Australia
| | - E Janus
- General Internal Medicine Unit, Western Health and Department of Medicine, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - T C Skinner
- Institut for Psykologi, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - J D Best
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
| | - J Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Australia
| | - H Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
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3
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Toth PP, Keech AC, Januszewski AS, O'Connell RL, Lee LP, Sullivan D, Taskinen MR, Drury PL, Watts GF, Best JD, Ansquer JC, Hankey GJ, Anderson N, Romo M, Jones SR, Jenkins AJ. Abstract WP219: Lipoprotein Subfractions Are Associated With Stroke Among 9,795 Patients in the Field Trial. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In the FIELD trial, a 5-year randomized double-blind placebo-controlled trial of fenofibrate vs. placebo in 9,795 adults with type 2 diabetes (T2D), the only standard lipid parameter correlating with microvascular (renal) events was triglycerides. Given the high prevalence of stroke among diabetic patients, we explored associations between lipoprotein subfractions and risk for stroke in the FIELD trial.
Methods:
We performed ultracentrifugation using the vertical auto profile (VAP, Atherotech) on plasma (baseline and after 6 weeks of fenofibrate). Analyses were performed using Cox proportional hazards and logistic regression for new on-study events. Results were adjusted for gender and fenofibrate or placebo allocation.
Results:
HDL related analytes (HDL-C, HDL3-C, apo A1, apoA2) correlated with reduced risk for all stroke. LDL and its subfractions and Lp(a)-C did not. VLDL and its subfractions, non-HDL-C, triglycerides, apo B, apo En, various ratios incorporating apo C3, and the ratios of apoB/A1 and apoB/apoA2 all correlated with increased risk for stroke.
Conclusions:
VAP identifies multiple lipoprotein subclasses, apoproteins, and VAP subclass/apoprotein ratios associated with stroke. Many of these measures improved with fenofibrate therapy.
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Affiliation(s)
| | | | | | | | - Li Ping Lee
- NHMRC Clinical Trials Cntr, Sydney, Australia
| | | | | | | | | | - James D Best
- Lee Kong Chian Sch of Medicine, Singapore, Singapore
| | | | | | | | | | - Steven R Jones
- Johns Hopkins Heart and Vascular Institute, Baltimor, MD
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4
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Dunbar JA, Versace V, Janus E, Laatikainen T, Vartiainen E, Absetz P, Best JD, Bennett C. Letter to the Editor Regarding "Public Health Approaches to Type 2 Diabetes Prevention: The US National Diabetes Prevention Program and Beyond". Curr Diab Rep 2019; 19:130. [PMID: 31748826 DOI: 10.1007/s11892-019-1262-y] [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] [Indexed: 10/25/2022]
Affiliation(s)
- James A Dunbar
- Deakin Rural Health, Deakin University, Warrnambool Campus, Warrnambool, Victoria, Australia.
| | - Vincent Versace
- Deakin Rural Health, Deakin University, Warrnambool Campus, Warrnambool, Victoria, Australia
| | - Edward Janus
- Western Health, University of Melbourne, Melbourne, Australia
| | | | | | | | - James D Best
- Lee Kong Chian School of Medicine, Nanyang Technical University, Singapore, Singapore
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5
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O'Reilly SL, Dunbar JA, Best JD, Versace V, Ford D, Young D, Shih S, Bills R, Shepherdley W, Janus ED. GooD4Mum: A general practice-based quality improvement collaborative for diabetes prevention in women with previous gestational diabetes. Prim Care Diabetes 2019; 13:134-141. [PMID: 30448412 DOI: 10.1016/j.pcd.2018.10.006] [Citation(s) in RCA: 8] [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: 10/20/2017] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
AIMS Gestational diabetes (GDM) and Type 2 diabetes pose tremendous health and economic burdens as worldwide incidence increases. Primary care-based systematic diabetes screening and prevention programs could be effective in women with previous GDM. GooD4Mum aimed to determine whether a Quality Improvement Collaborative (QIC) would improve postpartum diabetes screening and prevention planning in women with previous GDM in general practice. METHODS Fifteen general practices within Victoria (Australia) participated in a 12-month QIC, consisting of baseline and four quarterly audits, guideline-led workshops and Plan-Do-Study-Act feedback cycles after each audit. The primary outcome measures were the proportion of women on local GDM registers completing a diabetes screening test and a diabetes prevention planning consultation within the previous 15 months. RESULTS Diabetes screening increased with rates more than doubled from 26% to 61% and postpartum screening increased from 43%-60%. Diabetes prevention planning consultations did not show the same level of increase (0%-10%). The recording of body mass index improved overall (51%-69%) but the number of women with normal body mass index did not. CONCLUSIONS GooD4Mum supported increased diabetes screening and the monitoring of high risk women with previous GDM in general practice.
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Affiliation(s)
- S L O'Reilly
- Institute of Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.
| | - J A Dunbar
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, VIC 3280, Australia.
| | - J D Best
- Lee Kong Chian School of Medicine, Imperial College London and Nanyang Technological University, 11 Mandalay Road, 308232, Singapore.
| | - V Versace
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, VIC 3280, Australia.
| | - D Ford
- Improvement Foundation, 8/19 Grenfell St, Adelaide, SA 5000, Australia.
| | - D Young
- Faculty of Medicine, Dentistry and Health Sciences, Building 181, University of Melbourne, Grattan Street, Melbourne, VIC 3010, Australia.
| | - S Shih
- Centre for Population Health Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.
| | - R Bills
- Brooke Street Medical Centre, 14 Brooke Street, Woodend, VIC 3422, Australia.
| | - W Shepherdley
- Brooke Street Medical Centre, 14 Brooke Street, Woodend, VIC 3422, Australia.
| | - E D Janus
- General Internal Medicine Unit, Western Health, Sunshine Hospital, 176 Furlong Rd, St Albans, VIC 3021, Australia; Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, 176 Furlong Rd, St Albans, VIC 3021, Australia.
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6
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Boyle DIR, Versace VL, Dunbar JA, Scheil W, Janus E, Oats JJN, Skinner T, Shih S, O’Reilly S, Sikaris K, Kelsall L, Phillips PA, Best JD. Results of the first recorded evaluation of a national gestational diabetes mellitus register: Challenges in screening, registration, and follow-up for diabetes risk. PLoS One 2018; 13:e0200832. [PMID: 30089149 PMCID: PMC6082534 DOI: 10.1371/journal.pone.0200832] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Gestational Diabetes Mellitus (GDM) increases the risk of type 2 diabetes. A register can be used to follow-up high risk women for early intervention to prevent progression to type 2 diabetes. We evaluate the performance of the world's first national gestational diabetes register. RESEARCH DESIGN AND METHODS Observational study that used data linkage to merge: (1) pathology data from the Australian states of Victoria (VIC) and South Australia (SA); (2) birth records from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM, VIC) and the South Australian Perinatal Statistics Collection (SAPSC, SA); (3) GDM and type 2 diabetes register data from the National Gestational Diabetes Register (NGDR). All pregnancies registered on CCOPMM and SAPSC for 2012 and 2013 were included-other data back to 2008 were used to support the analyses. Rates of screening for GDM, rates of registration on the NGDR, and rates of follow-up laboratory screening for type 2 diabetes are reported. RESULTS Estimated GDM screening rates were 86% in SA and 97% in VIC. Rates of registration on the NGDR ranged from 73% in SA (2013) to 91% in VIC (2013). During the study period rates of screening at six weeks postpartum ranged from 43% in SA (2012) to 58% in VIC (2013). There was little evidence of recall letters resulting in screening 12 months follow-up. CONCLUSIONS GDM Screening and NGDR registration was effective in Australia. Recall by mail-out to young mothers and their GP's for type 2 diabetes follow-up testing proved ineffective.
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Affiliation(s)
- Douglas I. R. Boyle
- Department of General Practice, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Vincent L. Versace
- School of Medicine, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | - James A. Dunbar
- School of Medicine, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | - Wendy Scheil
- Public Health & Clinical Systems, SA Health, Adelaide, South Australia, Australia
- Discipline of Obstetrics & Gynaecology, The University of Adelaide, Adelaide, South Australia, Australia
| | - Edward Janus
- Department of Medicine-Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- General Internal Medicine Unit, Western Health, St Albans, Victoria, Australia
| | - Jeremy J. N. Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Sophy Shih
- Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne, Australia
| | - Sharleen O’Reilly
- School of Agriculture and Food Science, University College, Dublin, Ireland
| | - Ken Sikaris
- Melbourne Pathology, Collingwood, Victoria, Australia
| | - Liza Kelsall
- Health Intelligence Unit, System Intelligence & Analytics, Department of Health and Human Services, Melbourne, Victoria, Australia
| | | | - James D. Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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7
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Waldman B, Ansquer JC, Sullivan DR, Jenkins AJ, McGill N, Buizen L, Davis TME, Best JD, Li L, Feher MD, Foucher C, Kesaniemi YA, Flack J, d'Emden MC, Scott RS, Hedley J, Gebski V, Keech AC. Effect of fenofibrate on uric acid and gout in type 2 diabetes: a post-hoc analysis of the randomised, controlled FIELD study. Lancet Diabetes Endocrinol 2018; 6:310-318. [PMID: 29496472 DOI: 10.1016/s2213-8587(18)30029-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Gout is a painful disorder and is common in type 2 diabetes. Fenofibrate lowers uric acid and reduces gout attacks in small, short-term studies. Whether fenofibrate produces sustained reductions in uric acid and gout attacks is unknown. METHODS In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial, participants aged 50-75 years with type 2 diabetes were randomly assigned to receive either co-micronised fenofibrate 200 mg once per day or matching placebo for a median of 5 years follow-up. We did a post-hoc analysis of recorded on-study gout attacks and plasma uric acid concentrations according to treatment allocation. The outcomes of this analysis were change in uric acid concentrations and risk of on-study gout attacks. The FIELD study is registered with ISRCTN, number ISRCTN64783481. FINDINGS Between Feb 23, 1998, and Nov 3, 2000, 9795 patients were randomly assigned to fenofibrate (n=4895) or placebo (n=4900) in the FIELD study. Uric acid concentrations fell by 20·2% (95% CI 19·9-20·5) during the 6-week active fenofibrate run-in period immediately pre-randomisation (a reduction of 0·06 mmol/L or 1 mg/dL) and remained -20·1% (18·5-21·7, p<0·0001) lower in patients taking fenofibrate than in those on placebo in a random subset re-measured at 1 year. With placebo allocation, there were 151 (3%) first gout events over 5 years, compared with 81 (2%) among those allocated fenofibrate (HR with treatment 0·54, 95% CI 0·41-0·70; p<0·0001). In the placebo group, the cumulative proportion of patients with first gout events was 7·7% in patients with baseline uric acid concentration higher than 0·36 mmol/L and 13·9% in those with baseline uric acid concentration higher than 0·42 mmol/L, compared with 3·4% and 5·7%, respectively, in the fenofibrate group. Risk reductions were similar among men and women and those with dyslipidaemia, on diuretics, and with elevated uric acid concentrations. For participants with elevated baseline uric acid concentrations despite taking allopurinol at study entry, there was no heterogeneity of the treatment effect of fenofibrate on gout risk. Taking account of all gout events, fenofibrate treatment halved the risk (HR 0·48, 95% CI 0·37-0·60; p<0·0001) compared with placebo. INTERPRETATION Fenofibrate lowered uric acid concentrations by 20%, and almost halved first on-study gout events over 5 years of treatment. Fenofibrate could be a useful adjunct for preventing gout in diabetes. FUNDING None.
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Affiliation(s)
- Boris Waldman
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Jean-Claude Ansquer
- Centre Hospitalier Universitaire de Dijon, Dijon, France; Clinsciences, Dijon, France
| | - David R Sullivan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alicia J Jenkins
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Neil McGill
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Luke Buizen
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Timothy M E Davis
- School of Medicine, University of Western Australia, Fremantle, WA, Australia
| | - James D Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Imperial College London, London, UK
| | - Liping Li
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Michael D Feher
- Lipid Clinic, Chelsea and Westminster Hospital Foundation Trust, London, UK; Department of Clinical and Experimental Medicine, University of Surrey, Surrey, UK
| | | | - Y Antero Kesaniemi
- Oulu Medical Research Center, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jeffrey Flack
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Michael C d'Emden
- Endocrine Research Unit, Royal Brisbane Hospital, Brisbane, QLD, Australia
| | - Russell S Scott
- Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand
| | - John Hedley
- Department of Internal Medicine, Wairau Hospital, Blenheim, New Zealand
| | - Val Gebski
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Anthony C Keech
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
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8
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Michalczyk AA, Janus ED, Judge A, Ebeling PR, Best JD, Ackland MJ, Asproloupos D, Dunbar JA, Ackland ML. Transient epigenomic changes during pregnancy and early postpartum in women with and without type 2 diabetes. Epigenomics 2018; 10:419-431. [PMID: 29561170 DOI: 10.2217/epi-2017-0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIM To investigate epigenomic changes in pregnancy and early postpartum in women with and without type 2 diabetes. METHODS Dimethylation of histones H3K4, H3K9, H3K27, H3K36 and H3K79 was measured in white blood cells of women at 30 weeks pregnancy, at 8-10 and 20 weeks postpartum and in never-pregnant women. RESULTS Dimethylation levels of all five histones were different between women in pregnancy and early postpartum compared with never-pregnant women and were different between women with and without type 2 diabetes. CONCLUSION Histone methylation changes are transient in pregnancy and early postpartum and may represent normal physiological responses to hormones. Different epigenomic profiles in women with type 2 diabetes mellitus may correlate with hormonal responses, leading to high risk pregnancy outcomes.
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Affiliation(s)
- Agnes A Michalczyk
- Centre for Cellular & Molecular Biology, School of Life & Environmental Sciences, Deakin University, Burwood, Victoria 3125, Australia
| | - Edward D Janus
- University of Melbourne, Western Centre for Health Research & Education, Western Health, St Albans VIC 3021, Australia.,General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, VIC 3021, Australia
| | - Alisha Judge
- Centre for Cellular & Molecular Biology, School of Life & Environmental Sciences, Deakin University, Burwood, Victoria 3125, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria 3168, Australia
| | - James D Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, 308232, Singapore
| | - Michael J Ackland
- The Alfred Centre, Monash University, Melbourne, Victoria 3004, Australia
| | - Dino Asproloupos
- Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria 3125, Australia
| | - James A Dunbar
- Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria 3125, Australia
| | - M Leigh Ackland
- Centre for Cellular & Molecular Biology, School of Life & Environmental Sciences, Deakin University, Burwood, Victoria 3125, Australia
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9
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Ong KL, O'Connell R, Januszewski AS, Jenkins AJ, Xu A, Sullivan DR, Barter PJ, Scott RS, Taskinen MR, Waldman B, Colman PG, Best JD, Simes JR, Rye KA, Keech AC. Baseline Circulating FGF21 Concentrations and Increase after Fenofibrate Treatment Predict More Rapid Glycemic Progression in Type 2 Diabetes: Results from the FIELD Study. Clin Chem 2017; 63:1261-1270. [DOI: 10.1373/clinchem.2016.270876] [Citation(s) in RCA: 9] [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: 12/23/2016] [Accepted: 04/05/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
It is not known whether circulating fibroblast growth factor 21 (FGF21) concentrations are associated with glycemic progression in patients with established type 2 diabetes. This study reports this relationship in type 2 diabetes patients participating in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial.
METHODS
Plasma FGF21 was quantified in 9697 study participants. Among patients with lifestyle-only glucose control measures at baseline, glycemic progression was defined as the initiation of oral hypoglycemic agents or insulin therapy. We assessed the relationship of FGF21 concentrations with glycohemoglobin (Hb A1c), the homeostasis model assessment of β-cell function (HOMA-B) and insulin resistance (HOMA-IR), and glycemic progression.
RESULTS
Among 2584 patients with lifestyle-only glycemic therapy at baseline, plasma FGF21 concentrations were positively associated with HOMA-IR (5.1% increase per 100% increase in FGF21 concentrations). Patients with higher baseline plasma FGF21 concentrations had higher risk of glycemic progression over a 5-year period (P = 0.02), but the association was not significant after further adjusting for alanine aminotransferase (ALT) enzyme activity. During the fenofibrate active run-in phase, higher tertiles of fenofibrate-induced increase in FGF21 concentrations were associated with higher risk of glycemic progression (adjusted hazards ratio = 1.09 and 1.18 for tertiles 2 and 3, respectively, P for trend = 0.01), even after adjusting for ALT enzyme activity. This association was statistically significant in the fenofibrate group only (P = 0.01).
CONCLUSIONS
Higher baseline and fenofibrate-induced increase in FGF21 concentrations predict more rapid glycemic progression in type 2 diabetes patients. This association may be partly explained by hepatic function.
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Affiliation(s)
- Kwok-Leung Ong
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Rachel O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Aimin Xu
- Department of Medicine, University of Hong Kong, Hong Kong
- State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong
| | - David R Sullivan
- Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Philip J Barter
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Russell S Scott
- Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand
| | - Marja-Riitta Taskinen
- Heart and Lung Centre, Cardiovascular Research Unit, Helsinki University Central Hospital, Helsinki, Finland
- Diabetes and Obesity Research Program, University of Helsinki, Helsinki, Finland
| | - Boris Waldman
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Peter G Colman
- Department of Diabetes & Endocrinology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - James D Best
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - John R Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Kerry-Anne Rye
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Ritte R, Luke J, Nelson C, Brown A, O’Dea K, Jenkins A, Best JD, McDermott R, Daniel M, Rowley K. Clinical outcomes associated with albuminuria in central Australia: a cohort study. BMC Nephrol 2016; 17:113. [PMID: 27495237 PMCID: PMC4974695 DOI: 10.1186/s12882-016-0328-1] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 08/02/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) and end-stage-kidney disease (ESKD) continue to be under-diagnosed and a major burden for Aboriginal communities in central Australia. The aim of this study was to examine the risk of poor clinical outcomes associated with elevated albumin-to-creatinine ratio (ACR) among Aboriginal people in central Australia. METHODS Cox proportional hazards models were used to estimate the risk of end stage kidney disease (ESKD), dialysis, CVD (cardiovascular disease) and mortality associated with participants' baseline albuminuria reading from a 10-year cohort study of Aboriginal people (n = 623) from three communities in central Australia. Predictors of progression of albuminuria were also examined in the context of the Kidney Health Australia (KHA) Risk Matrix. RESULTS A baseline ACR level of ≥3.5 mg/mmol was associated with an almost 10-fold increased risk of ESKD (95%CI 2.07-43.8) and a 15-fold risk of dialysis (95%CI 1.89-121). Albuminuria ≥3.5 mg/mmol was also associated with a borderline 63 % increased risk of CVD (95%CI 0.98-2.71). No significant association was observed with mortality from all-causes or chronic disease. Diabetes and a waist-to-hip ratio ≥0.90 independently predicted a two-fold increased risk of a progression to higher ACR levels. CONCLUSIONS A single measure of moderately increased albuminuria was a strong predictor of renal failure in this population. A single spot urine ACR analysis in conjunction with the KHA Risk Matrix may be a useful and efficient strategy to screen for risk of CKD and progression to dialysis in remote communities. A focus on individuals with diabetes and/or central obesity for strategies to avoid increases in albuminuria may also prevent future CKD and CVD complications.
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Affiliation(s)
- Rebecca Ritte
- Onemda Group, Indigenous Health Equity Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, VIC Melbourne, 3010 Australia
| | - Joanne Luke
- Onemda Group, Indigenous Health Equity Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, VIC Melbourne, 3010 Australia
| | - Craig Nelson
- Western Health, Footscray, VIC 3011 Australia
- Northwest Academic Centre, The University of Melbourne, Melbourne, VIC 3010 Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA 5000 Australia
| | - Kerin O’Dea
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010 Australia
| | - Alicia Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 1450 Australia
| | - James D. Best
- Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3010 Australia
- Lee Kong Chian School of Medicine, Imperial College London and Nanyang Technological University, Singapore, Singapore
| | - Robyn McDermott
- Centre for Chronic Disease Prevention, James Cook University, Cairns, QLD 4870 Australia
| | - Mark Daniel
- School of Population Health, University of South Australia, Adelaide, SA 5000 Australia
| | - Kevin Rowley
- Onemda Group, Indigenous Health Equity Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, VIC Melbourne, 3010 Australia
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O’Reilly SL, Dunbar JA, Versace V, Janus E, Best JD, Carter R, Oats JJN, Skinner T, Ackland M, Phillips PA, Ebeling PR, Reynolds J, Shih STF, Hagger V, Coates M, Wildey C. Mothers after Gestational Diabetes in Australia (MAGDA): A Randomised Controlled Trial of a Postnatal Diabetes Prevention Program. PLoS Med 2016; 13:e1002092. [PMID: 27459502 PMCID: PMC4961439 DOI: 10.1371/journal.pmed.1002092] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/15/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is an increasingly prevalent risk factor for type 2 diabetes. We evaluated the effectiveness of a group-based lifestyle modification program in mothers with prior GDM within their first postnatal year. METHODS AND FINDINGS In this study, 573 women were randomised to either the intervention (n = 284) or usual care (n = 289). At baseline, 10% had impaired glucose tolerance and 2% impaired fasting glucose. The diabetes prevention intervention comprised one individual session, five group sessions, and two telephone sessions. Primary outcomes were changes in diabetes risk factors (weight, waist circumference, and fasting blood glucose), and secondary outcomes included achievement of lifestyle modification goals and changes in depression score and cardiovascular disease risk factors. The mean changes (intention-to-treat [ITT] analysis) over 12 mo were as follows: -0.23 kg body weight in intervention group (95% CI -0.89, 0.43) compared with +0.72 kg in usual care group (95% CI 0.09, 1.35) (change difference -0.95 kg, 95% CI -1.87, -0.04; group by treatment interaction p = 0.04); -2.24 cm waist measurement in intervention group (95% CI -3.01, -1.42) compared with -1.74 cm in usual care group (95% CI -2.52, -0.96) (change difference -0.50 cm, 95% CI -1.63, 0.63; group by treatment interaction p = 0.389); and +0.18 mmol/l fasting blood glucose in intervention group (95% CI 0.11, 0.24) compared with +0.22 mmol/l in usual care group (95% CI 0.16, 0.29) (change difference -0.05 mmol/l, 95% CI -0.14, 0.05; group by treatment interaction p = 0.331). Only 10% of women attended all sessions, 53% attended one individual and at least one group session, and 34% attended no sessions. Loss to follow-up was 27% and 21% for the intervention and control groups, respectively, primarily due to subsequent pregnancies. Study limitations include low exposure to the full intervention and glucose metabolism profiles being near normal at baseline. CONCLUSIONS Although a 1-kg weight difference has the potential to be significant for reducing diabetes risk, the level of engagement during the first postnatal year was low. Further research is needed to improve engagement, including participant involvement in study design; it is potentially more effective to implement annual diabetes screening until women develop prediabetes before offering an intervention. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12610000338066.
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Affiliation(s)
- Sharleen L. O’Reilly
- Institute of Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- * E-mail:
| | - James A. Dunbar
- Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Vincent Versace
- School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Edward Janus
- Department of Medicine, Melbourne Medical School–Western Precinct, University of Melbourne, St Albans, Victoria, Australia
- General Internal Medicine Unit, Western Health, Sunshine Hospital, St Albans, Victoria, Australia
| | - James D. Best
- Lee Kong Chian School of Medicine, Imperial College London and Nanyang Technological University, Singapore
| | - Rob Carter
- Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Jeremy J. N. Oats
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Timothy Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Michael Ackland
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Paddy A. Phillips
- Department of Medicine, Flinders University, Bedford Park, South Australia, Australia
- SA Health, Adelaide, South Australia, Australia
| | - Peter R. Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - John Reynolds
- Alfred Health and Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sophy T. F. Shih
- Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | | | - Michael Coates
- School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Carol Wildey
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
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12
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Michalczyk AA, Dunbar JA, Janus ED, Best JD, Ebeling PR, Ackland MJ, Asproloupos D, Ackland ML. Epigenetic Markers to Predict Conversion From Gestational Diabetes to Type 2 Diabetes. J Clin Endocrinol Metab 2016; 101:2396-404. [PMID: 27045797 DOI: 10.1210/jc.2015-4206] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Lifestyle factors mediate epigenetic changes that can cause chronic diseases. Although animal and laboratory studies link epigenetic changes to diabetes, epigenetic information in women with gestational diabetes (GDM) and type 2 diabetes is lacking. OBJECTIVE This study sought to measure epigenetic markers across pregnancy and early postpartum and identify markers that could be used as predictors for conversion from GDM to type 2 diabetes. DESIGN Global histone H3 dimethylation was measured in white blood cells at three time points: 30 wk gestation, 8-10 wk postpartum, and 20 wk postpartum, from four groups of women with and without diabetes. SETTING AND PARTICIPANTS A total of 39 participants (six to nine in each group) were recruited including: nondiabetic women; women with GDM who developed postpartum type 2 diabetes; women with GDM without postpartum type 2 diabetes; and women with type 2 diabetes. MAIN OUTCOME MEASURE Percentages of dimethylation of H3 histones relative to total H3 histone methylation were compared between diabetic/nondiabetic groups using appropriate comparative statistics. RESULTS H3K27 dimethylation was 50-60% lower at 8-10 and 20 wk postpartum in women with GDM who developed type 2 diabetes, compared with nondiabetic women. H3K4 dimethylation was 75% lower at 8-10 wk postpartum in women with GDM who subsequently developed type 2 diabetes compared with women who had GDM who did not. CONCLUSIONS The percentage of dimethylation of histones H3K27 and H3K4 varied with diabetic state and has the potential as a predictive tool to identify women who will convert from GDM to type 2 diabetes.
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Affiliation(s)
- Agnes A Michalczyk
- Centre for Cellular and Molecular Biology (A.A.M., M.L.A.), School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia 3125; Deakin Population Health Strategic Research Centre (J.A.D., D.A.), Faculty of Health, Deakin University, Burwood, Victoria, Australia 3125; University of Melbourne (E.D.J.) Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia 3021; Lee Kong Chian School of Medicine (J.D.B.), Singapore, 308232; Faculty of Medicine, Nursing and Health Sciences (P.R.E.), Monash University, Victoria, Australia 3168; and Department of Health & Human Services (M.J.A.), Victoria, Australia 3000
| | - James A Dunbar
- Centre for Cellular and Molecular Biology (A.A.M., M.L.A.), School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia 3125; Deakin Population Health Strategic Research Centre (J.A.D., D.A.), Faculty of Health, Deakin University, Burwood, Victoria, Australia 3125; University of Melbourne (E.D.J.) Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia 3021; Lee Kong Chian School of Medicine (J.D.B.), Singapore, 308232; Faculty of Medicine, Nursing and Health Sciences (P.R.E.), Monash University, Victoria, Australia 3168; and Department of Health & Human Services (M.J.A.), Victoria, Australia 3000
| | - Edward D Janus
- Centre for Cellular and Molecular Biology (A.A.M., M.L.A.), School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia 3125; Deakin Population Health Strategic Research Centre (J.A.D., D.A.), Faculty of Health, Deakin University, Burwood, Victoria, Australia 3125; University of Melbourne (E.D.J.) Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia 3021; Lee Kong Chian School of Medicine (J.D.B.), Singapore, 308232; Faculty of Medicine, Nursing and Health Sciences (P.R.E.), Monash University, Victoria, Australia 3168; and Department of Health & Human Services (M.J.A.), Victoria, Australia 3000
| | - James D Best
- Centre for Cellular and Molecular Biology (A.A.M., M.L.A.), School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia 3125; Deakin Population Health Strategic Research Centre (J.A.D., D.A.), Faculty of Health, Deakin University, Burwood, Victoria, Australia 3125; University of Melbourne (E.D.J.) Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia 3021; Lee Kong Chian School of Medicine (J.D.B.), Singapore, 308232; Faculty of Medicine, Nursing and Health Sciences (P.R.E.), Monash University, Victoria, Australia 3168; and Department of Health & Human Services (M.J.A.), Victoria, Australia 3000
| | - Peter R Ebeling
- Centre for Cellular and Molecular Biology (A.A.M., M.L.A.), School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia 3125; Deakin Population Health Strategic Research Centre (J.A.D., D.A.), Faculty of Health, Deakin University, Burwood, Victoria, Australia 3125; University of Melbourne (E.D.J.) Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia 3021; Lee Kong Chian School of Medicine (J.D.B.), Singapore, 308232; Faculty of Medicine, Nursing and Health Sciences (P.R.E.), Monash University, Victoria, Australia 3168; and Department of Health & Human Services (M.J.A.), Victoria, Australia 3000
| | - Michael J Ackland
- Centre for Cellular and Molecular Biology (A.A.M., M.L.A.), School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia 3125; Deakin Population Health Strategic Research Centre (J.A.D., D.A.), Faculty of Health, Deakin University, Burwood, Victoria, Australia 3125; University of Melbourne (E.D.J.) Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia 3021; Lee Kong Chian School of Medicine (J.D.B.), Singapore, 308232; Faculty of Medicine, Nursing and Health Sciences (P.R.E.), Monash University, Victoria, Australia 3168; and Department of Health & Human Services (M.J.A.), Victoria, Australia 3000
| | - Dino Asproloupos
- Centre for Cellular and Molecular Biology (A.A.M., M.L.A.), School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia 3125; Deakin Population Health Strategic Research Centre (J.A.D., D.A.), Faculty of Health, Deakin University, Burwood, Victoria, Australia 3125; University of Melbourne (E.D.J.) Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia 3021; Lee Kong Chian School of Medicine (J.D.B.), Singapore, 308232; Faculty of Medicine, Nursing and Health Sciences (P.R.E.), Monash University, Victoria, Australia 3168; and Department of Health & Human Services (M.J.A.), Victoria, Australia 3000
| | - M Leigh Ackland
- Centre for Cellular and Molecular Biology (A.A.M., M.L.A.), School of Life and Environmental Sciences, Deakin University, Burwood, Victoria, Australia 3125; Deakin Population Health Strategic Research Centre (J.A.D., D.A.), Faculty of Health, Deakin University, Burwood, Victoria, Australia 3125; University of Melbourne (E.D.J.) Western Centre for Health Research and Education, Western Health, St Albans, Victoria, Australia 3021; Lee Kong Chian School of Medicine (J.D.B.), Singapore, 308232; Faculty of Medicine, Nursing and Health Sciences (P.R.E.), Monash University, Victoria, Australia 3168; and Department of Health & Human Services (M.J.A.), Victoria, Australia 3000
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d'Emden MC, Jenkins AJ, Li L, Zannino D, Mann KP, Best JD, Stuckey BGA, Park K, Saltevo J, Keech AC. Erratum to: Favourable effects of fenofibrate on lipids and cardiovascular disease in women with type 2 diabetes: results from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetologia 2015; 58:2200. [PMID: 26186882 DOI: 10.1007/s00125-015-3693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/23/2022]
Affiliation(s)
- Michael C d'Emden
- Endocrine Research Unit, Royal Brisbane Hospital, Brisbane, QLD, Australia
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14
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Blackberry ID, Furler JS, Best JD, Young D. Comment on O'Connor et Al. Randomized trial of telephone outreach to improve medication adherence and metabolic control in adults with diabetes. Diabetes care 2014;37:3317-3324. Diabetes Care 2015; 38:e45. [PMID: 25715426 DOI: 10.2337/dc14-2599] [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)
- Irene D Blackberry
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - John S Furler
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - James D Best
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Fitzroy, Victoria, Australia
| | - Doris Young
- Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
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15
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Dunbar JA, Hernan AL, Janus ED, Vartiainen E, Laatikainen T, Versace VL, Reynolds J, Best JD, Skinner TC, O'Reilly SL, Mc Namara KP, Stewart E, Coates M, Bennett CM, Carter R. Challenges of diabetes prevention in the real world: results and lessons from the Melbourne Diabetes Prevention Study. BMJ Open Diabetes Res Care 2015; 3:e000131. [PMID: 26464804 PMCID: PMC4597415 DOI: 10.1136/bmjdrc-2015-000131] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes. RESEARCH DESIGN AND METHODS Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed. RESULTS PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013). CONCLUSIONS MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention.
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Affiliation(s)
- James A Dunbar
- Faculty of Health, Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Andrea L Hernan
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Edward D Janus
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- Western Academic Centre, Western Centre for Health Research and Education, Western Health, University of Melbourne, St. Albans, Victoria, Australia
| | - Erkki Vartiainen
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- National Institute for Health and Welfare, Helsinki, Finland
- Faculty of Health Sciences, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Vincent L Versace
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - John Reynolds
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - James D Best
- Lee Kong Chian School of Medicine, Nanyang Technological University and Imperial College London, Singapore, Singapore
| | - Timothy C Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sharleen L O'Reilly
- Centre for Physical Activity and Nutrition Research, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Kevin P Mc Namara
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia
| | - Elizabeth Stewart
- Faculty of Health, Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Michael Coates
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia
| | - Catherine M Bennett
- Faculty of Health, Deakin Population Health Strategic Research Centre, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Rob Carter
- Faculty of Health, Deakin Health Economics, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
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d'Emden MC, Jenkins AJ, Li L, Zannino D, Mann KP, Best JD, Stuckey BGA, Park K, Saltevo J, Keech AC. Favourable effects of fenofibrate on lipids and cardiovascular disease in women with type 2 diabetes: results from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetologia 2014; 57:2296-303. [PMID: 25149070 DOI: 10.1007/s00125-014-3344-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 07/03/2014] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS In the double-blind placebo-controlled Fenofibrate Intervention and Event Lowering in Diabetes trial (n = 9,795), fenofibrate reduced major cardiovascular events in type 2 diabetes. Sex-related differences in fenofibrate response could be clinically relevant and were pre-specified analyses. METHODS Women (n = 3,657) and men (n = 6,138) with type 2 diabetes not using statins were assigned fenofibrate (200 mg/day) or placebo for 5 years. Effects on lipoproteins and total cardiovascular events were evaluated by sex. RESULTS Baseline total, LDL-, HDL- and non-HDL cholesterol and apolipoproteins A-I and B differed between sexes, and these and triacylglycerol levels improved with fenofibrate in both sexes (all p < 0.001). Fenofibrate reduced total, LDL- and non-HDL cholesterol and apolipoprotein B more in women (all p < 0.001), independent of menopausal status and statin uptake. Adjusted for covariates, fenofibrate reduced total cardiovascular outcomes (cardiovascular death, fatal and non-fatal stroke and carotid and coronary revascularisation) by 30% in women (95% CI 8%, 46%; p = 0.008) and 13% in men (95% CI -1%, 24%; p = 0.07) with no treatment-by-sex interaction (p > 0.1). In patients with high triacylglycerol levels and low HDL-cholesterol, fenofibrate reduced total cardiovascular outcomes by 30% (95% CI -7%, 54%) in women and 24% (95% CI 2%, 42%) in men, with no treatment-by-sex interaction (p > 0.1). CONCLUSIONS/INTERPRETATION Fenofibrate improved the lipoprotein profile more in women than men. Cardiovascular event reductions with fenofibrate were consistently similar in women and men, both overall and among those with low HDL-cholesterol and high triacylglycerol levels. These data provide reassurance about fenofibrate efficacy in women and men. Both sexes with type 2 diabetes should be considered for fenofibrate therapy for cardioprotection.
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Affiliation(s)
- Michael C d'Emden
- Endocrine Research Unit, Royal Brisbane Hospital, Brisbane, QLD, Australia
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Blackberry ID, Furler JS, Ginnivan LE, Manski-Nankervis JA, Jenkins A, Cohen N, Best JD, Young D, Liew D, Ward G, O'Neal DN. An exploratory trial of basal and prandial insulin initiation and titration for type 2 diabetes in primary care with adjunct retrospective continuous glucose monitoring: INITIATION study. Diabetes Res Clin Pract 2014; 106:247-55. [PMID: 25271117 DOI: 10.1016/j.diabres.2014.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/12/2014] [Accepted: 08/23/2014] [Indexed: 11/21/2022]
Abstract
AIMS To evaluate basal and prandial insulin initiation and titration in people with type 2 diabetes mellitus (T2DM) in primary care and to explore the feasibility of retrospective-continuous glucose monitoring (r-CGM) in guiding insulin dosing. The new model of care features General Practitioners (GPs) and Practice Nurses (PNs) working in an expanded role, with Credentialed Diabetes Educator - Registered Nurse (CDE-RN) support. METHODS Insulin-naïve T2DM patients (HbA1c >7.5% [>58 mmol/mol] despite maximal oral therapy) from 22 general practices in Victoria, Australia commenced insulin glargine, with glulisine added as required. Each was randomised to receive r-CGM or self-monitoring of blood glucose (SMBG). Glycaemic control (HbA1c) was benchmarked against specialist ambulatory patients referred for insulin initiation. RESULTS Ninety-two patients mean age (range) 59 (28-77) years; 40% female; mean (SD) diabetes duration 10.5 (6.1) years participated. HbA1c decreased from (median (IQR)) 9.9 (8.8, 11.2)%; 85 (73, 99) mmol/mol to 7.3 (6.9, 7.8)%; 56 (52, 62) mmol/mol at 24 weeks (p < 0.0001). Comparing r-CGM (n = 46) with SMBG (n = 42), there were no differences in major hypoglycaemia (p=0.17) or ΔHbA1c (p = 0.31). More r-CGM than SMBG participants commenced glulisine (26/48 vs. 7/44; p < 0.001). Results were comparable to 82 benchmark patients, with similar low rates of major hypoglycaemia (2/89 vs. 0/82; p = 0.17) and less loss to follow up in the INITIATION group (3/92 vs. 14/82; p = 0.002). CONCLUSIONS Insulin initiation and titration for T2DM patients in primary care was safe and improved HbA1c with low rates of major hypoglycaemia. CDE-RNs were effective in a new consultant role. r-CGM use in primary care was feasible and enhanced post-prandial hyperglycaemia recognition. Trial registration ACTRN12610000797077.
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Affiliation(s)
- Irene D Blackberry
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley St, Carlton 3053, Australia.
| | - John S Furler
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley St, Carlton 3053, Australia.
| | - Louise E Ginnivan
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley St, Carlton 3053, Australia.
| | - Jo-Anne Manski-Nankervis
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley St, Carlton 3053, Australia.
| | - Alicia Jenkins
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Level 4, Clinical Sciences Building, 29 Regent St Fitzroy, Melbourne, VIC 3065, Australia.
| | - Neale Cohen
- Baker-IDI Heart and Diabetes Institute, PO Box 6492, St Kilda Road Central, 8008, Australia.
| | - James D Best
- Melbourne Medical School, Level 2 West, Medical Building, The University of Melbourne, VIC 3010, Australia.
| | - Doris Young
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley St, Carlton 3053, Australia.
| | - Danny Liew
- Melbourne EpiCentre, The University of Melbourne, c/- The Royal Melbourne Hospital, 7 East, Main Building, Grattan St, Parkville, VIC 3050, Australia.
| | - Glenn Ward
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Level 4, Clinical Sciences Building, 29 Regent St Fitzroy, Melbourne, VIC 3065, Australia.
| | - David N O'Neal
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Level 4, Clinical Sciences Building, 29 Regent St Fitzroy, Melbourne, VIC 3065, Australia.
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Januszewski AS, Mason N, Karschimkus CS, Rowley KG, Best JD, O'Neal DN, Jenkins AJ. Plasma semicarbazide-sensitive amine oxidase activity in type 1 diabetes is related to vascular and renal function but not to glycaemia. Diab Vasc Dis Res 2014; 11:262-269. [PMID: 24853908 DOI: 10.1177/1479164114532963] [Citation(s) in RCA: 10] [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] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Associations of semicarbazide-sensitive amine oxidase (SSAO) activity with renal and vascular function, oxidative stress, glycaemia and diabetes complications were determined. METHODS Plasma SSAO activity in 94 type 1 diabetes (T1DM) patients, including 34 with microvascular complications T1DM CX[+], and in 96 healthy subjects (CON) was measured by production of benzaldehyde using high-performance liquid chromatography (HPLC). RESULTS SSAO activity (mean ± SD) was greater in T1DM than in CON (1049 ± 294 vs 749 ± 204 mU/L; p < 0.00001) and was higher in T1DM CX[+] vs complication-free DM subjects (1148 ± 313 mU/L vs 982 ± 269 mU/L; p = 0.01). In T1DM, SSAO activity correlated with renal dysfunction [estimated glomerular filtration rate (eGFR): r = -0.44; p = 0.0001; cystatin C: r = 0.47; p = 0.0001] and markers of inflammation [soluble vascular cell adhesion molecule-1 (sVCAM-1): r = 0.41, p = 0.0001; soluble intercellular adhesion molecule-1 (sICAM-1): r = 0.33, p = 0.002] and was inversely related to small artery elasticity (SAE) (r = -0.23, p = 0.03). In CON, SSAO activity correlated with HbA1c (r = 0.26; p = 0.02). CONCLUSION In T1DM, SSAO activity correlates with renal dysfunction, but not with glycaemia, and may promote vascular inflammation and be a therapeutic target.
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Affiliation(s)
- Andrzej S Januszewski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Nick Mason
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Connie S Karschimkus
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Kevin G Rowley
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - James D Best
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - David N O'Neal
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia
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Shih STF, Davis-Lameloise N, Janus ED, Wildey C, Versace VL, Hagger V, Asproloupos D, O'Reilly SL, Phillips PA, Ackland M, Skinner T, Oats J, Carter R, Best JD, Dunbar JA. Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: an update to the study protocol for a randomized controlled trial. Trials 2014; 15:259. [PMID: 24981503 PMCID: PMC4083860 DOI: 10.1186/1745-6215-15-259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial (RCT) that aims to assess the effectiveness of a structured diabetes prevention intervention for women who had gestational diabetes. METHODS/DESIGN The original protocol was published in Trials (http://www.trialsjournal.com/content/14/1/339). This update reports on an additional exclusion criterion and change in first eligibility screening to provide greater clarity. The new exclusion criterion "surgical or medical intervention to treat obesity" has been added to the original protocol. The risks of developing diabetes will be affected by any medical or surgical intervention as its impact on obesity will alter the outcomes being assessed by MAGDA-DPP. The screening procedures have also been updated to reflect the current recruitment operation. The first eligibility screening is now taking place either during or after pregnancy, depending on recruitment strategy. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ANZCTRN 12610000338066.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - James A Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders University, PO Box 423, 3280 Warrnambool, VIC, Australia.
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20
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Blackberry ID, Furler JS, Ginnivan LE, Derraz H, Jenkins A, Cohen N, Best JD, Young D, Liew D, Ward G, Manski-Nankervis JA, O'Neal DN. An exploratory trial of insulin initiation and titration among patients with type 2 diabetes in the primary care setting with retrospective continuous glucose monitoring as an adjunct: INITIATION study protocol. BMC Fam Pract 2014; 15:82. [PMID: 24886287 PMCID: PMC4037429 DOI: 10.1186/1471-2296-15-82] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 04/22/2014] [Indexed: 01/22/2023]
Abstract
Background Insulin initiation and titration in primary care is necessary to respond to the growing epidemic of type 2 diabetes (T2D). The INITIATION study aims to evaluate the impact of implementing a new model of care with Primary Care Physician and Practice Nurse (PN) teams supported by a Credentialed Diabetes Educator-Registered Nurse (CDE-RN) and endocrinologist in initiating and titrating basal and prandial insulin for T2D patients in the Australian healthcare system over 24 weeks. This study also explores the feasibility and efficacy of retrospective continuous glucose monitoring (r-CGM) in comparison with self-monitoring of blood glucose (SMBG) among people with T2D in primary care. Methods/Design The study employs a before and after design with a nested exploratory trial of SMBG and r-CGM. A total of 102 insulin naïve T2D patients with a glycated haemoglobin (HbA1c) level of >7.5% in the previous 6 months while treated with maximal oral therapy will be recruited and screened from 22 primary care practices in Melbourne, Australia. All patients will be commenced on a basal insulin regimen following randomization into one of the two blood glucose monitoring arms, with intensification to a “basal plus” regimen if required. The outcomes of the new model of care will be benchmarked with data collected over the same period from a specialist setting in Melbourne, Australia. Discussion This article describes the study protocol and insulin treatment algorithm employed in the first study to explore r-CGM use among T2D in primary care. Findings from the INITIATION study will inform development of a larger randomized controlled trial. Trial registration ACTRN12610000797077.
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Affiliation(s)
- Irene D Blackberry
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, 200 Berkeley St, Carlton 3053, Australia.
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Dunbar JA, Jayawardena A, Johnson G, Roger K, Timoshanko A, Versace VL, Shill J, Philpot B, Vartiainen E, Laatikainen T, Best JD, Janus ED. Scaling up diabetes prevention in Victoria, Australia: policy development, implementation, and evaluation. Diabetes Care 2014; 37:934-42. [PMID: 24319121 DOI: 10.2337/dc12-2647] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [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 Australian lifestyle intervention program Life! is only the second reported, large-scale diabetes prevention program. This article describes the genesis and the successful establishment of Life! and its key outcomes for participants and implementation. RESEARCH DESIGN AND METHODS Life!, a behavior-change intervention, comprises six group sessions over 8 months. The Victorian Department of Health funded Diabetes Australia-Victoria to implement the program. Experience of the Greater Green Triangle diabetes prevention implementation trial was used for intervention design, workforce development, training, and infrastructure. Clinical and anthropometric data from participants, used for program evaluation, were recorded on a central database. RESULTS Life! has a statewide workforce of 302 trained facilitators within 137 organizations. Over 29,000 Victorians showed interest in Life!, and 15,000 individuals have been referred to the program. In total, 8,412 participants commenced a Life! program between October 2007 and June 2011, and 37% of the original participants completed the 8-month program. Participants completing sessions 1 to 5 lost an average of 1.4 kg weight (P < 0.001) and waist circumference of 2.5 cm (P < 0.001). Those completing six sessions lost an average of 2.4 kg weight (P < 0.001) and waist circumference of 3.8 cm (P < 0.001). The weight loss of 2.4 kg represents 2.7% of participants' starting body weight. CONCLUSIONS The impact of Life! is attributable to applying available evidence for the system's design of the intervention and collaboration between policy makers, implementers, and evaluators using the principles of continuous quality improvement to support successful, large-scale recruitment and implementation.
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Jelinek MV, Santamaria JD, Best JD, Thompson DR, Tonkin AM, Vale MJ. Reversing social disadvantage in secondary prevention of coronary heart disease. Int J Cardiol 2014; 171:346-50. [DOI: 10.1016/j.ijcard.2013.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/04/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
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Luke JN, Brown A, Daniel M, O'Dea K, Best JD, Jenkins AJ, Wang Z, McDermott RA, Wang Z, Rowley KG. Response to the Letter by Kawada et al. regarding the manuscript entitled "The metabolic syndrome and CVD outcomes for a central Australian cohort". Diabetes Res Clin Pract 2013; 102:e22-3. [PMID: 24209598 DOI: 10.1016/j.diabres.2013.08.013] [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: 08/01/2013] [Revised: 08/01/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
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24
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Shih STF, Davis-Lameloise N, Janus ED, Wildey C, Versace VL, Hagger V, Asproloupos D, O'Reilly S, Phillips PA, Ackland M, Skinner T, Oats J, Carter R, Best JD, Dunbar JA. Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: study protocol for a randomized controlled trial. Trials 2013; 14:339. [PMID: 24135085 PMCID: PMC3853589 DOI: 10.1186/1745-6215-14-339] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 07/29/2013] [Accepted: 09/26/2013] [Indexed: 02/08/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk individuals. Methods/Design The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial aiming to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women. This trial has an intervention group participating in a diabetes prevention program (DPP), and a control group receiving usual care from their general practitioners during the same time period. The 12-month intervention comprises an individual session followed by five group sessions at two-week intervals, and two follow-up telephone calls. A total of 574 women will be recruited, with 287 in each arm. The women will undergo blood tests, anthropometric measurements, and self-reported health status, diet, physical activity, quality of life, depression, risk perception and healthcare service usage, at baseline and 12 months. At completion, primary outcome (changes in diabetes risk) and secondary outcome (changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors) will be assessed in both groups. Discussion This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women. The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population. Trial registration Australian New Zealand Clinical Trials Registry ANZCTRN 12610000338066
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - James A Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders University, PO Box 423, Warrnambool VIC 3280, Australia.
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25
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Blackberry ID, Furler JS, Best JD, Chondros P, Vale M, Walker C, Dunning T, Segal L, Dunbar J, Audehm R, Liew D, Young D. Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement and Coaching for Health (PEACH) pragmatic cluster randomised controlled trial. BMJ 2013; 347:f5272. [PMID: 24048296 PMCID: PMC3776648 DOI: 10.1136/bmj.f5272] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of goal focused telephone coaching by practice nurses in improving glycaemic control in patients with type 2 diabetes in Australia. DESIGN Prospective, cluster randomised controlled trial, with general practices as the unit of randomisation. SETTING General practices in Victoria, Australia. PARTICIPANTS 59 of 69 general practices that agreed to participate recruited sufficient patients and were randomised. Of 829 patients with type 2 diabetes (glycated haemoglobin (HbA1c) >7.5% in the past 12 months) who were assessed for eligibility, 473 (236 from 30 intervention practices and 237 from 29 control practices) agreed to participate. INTERVENTION Practice nurses from intervention practices received two days of training in a telephone coaching programme, which aimed to deliver eight telephone and one face to face coaching episodes per patient. MAIN OUTCOME MEASURES The primary end point was mean absolute change in HbA1c between baseline and 18 months in the intervention group compared with the control group. RESULTS The intervention and control patients were similar at baseline. None of the practices dropped out over the study period; however, patient attrition rates were 5% in each group (11/236 and 11/237 in the intervention and control group, respectively). The median number of coaching sessions received by the 236 intervention patients was 3 (interquartile range 1-5), of which 25% (58/236) did not receive any coaching sessions. At 18 months' follow-up the effect on glycaemic control did not differ significantly (mean difference 0.02, 95% confidence interval -0.20 to 0.24, P=0.84) between the intervention and control groups, adjusted for HbA1c measured at baseline and the clustering. Other biochemical and clinical outcomes were similar in both groups. CONCLUSIONS A practice nurse led telephone coaching intervention implemented in the real world primary care setting produced comparable outcomes to usual primary care in Australia. The addition of a goal focused coaching role onto the ongoing generalist role of a practice nurse without prescribing rights was found to be ineffective. TRIAL REGISTRATION Current Controlled Trials ISRCTN50662837.
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Affiliation(s)
- Irene D Blackberry
- General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley St, Carlton, VIC 3053, Australia
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26
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Luke JN, Brown A, Daniel M, O'Dea K, Best JD, Jenkins AJ, Wang Z, McDermott RA, Wang Z, Rowley KG. The metabolic syndrome and CVD outcomes for a central Australian cohort. Diabetes Res Clin Pract 2013; 100:e70-3. [PMID: 23540681 DOI: 10.1016/j.diabres.2013.03.020] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/06/2013] [Indexed: 11/21/2022]
Abstract
We investigated if the metabolic syndrome (MetS) and its component risk factors predict cardiovascular disease (CVD) for Aboriginal people from central Australia. WHO (HR 2.83), NCEP (1.80) and IDF (2.47) definitions of the MetS all had positive associations with CVD, however offered little above individual MetS components for hyperglycaemia.
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Affiliation(s)
- Joanne N Luke
- Onemda VicHealth Koori Health Unit, The University of Melbourne, 4/207 Bourerie Street, Carlton South, 3053, Victoria, Australia.
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27
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Best JD, McColl GJ. Is the Melbourne MD a misnomer? Med J Aust 2012. [DOI: 10.5694/mja12.11533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- James D Best
- Melbourne Medical School, University of Melbourne, Melbourne, VIC
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28
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Janus ED, Best JD, Davis-Lameloise N, Philpot B, Hernan A, Bennett CM, O'Reilly S, Carter R, Vartiainen E, Dunbar JA. Scaling-up from an implementation trial to state-wide coverage: results from the preliminary Melbourne Diabetes Prevention Study. Trials 2012; 13:152. [PMID: 22929458 PMCID: PMC3502588 DOI: 10.1186/1745-6215-13-152] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [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: 02/03/2012] [Accepted: 08/01/2012] [Indexed: 11/10/2022] Open
Abstract
Background The successful Greater Green Triangle Diabetes Prevention Program (GGT DPP), a small implementation trial, has been scaled-up to the Victorian state-wide ‘Life!’ programme with over 10,000 individuals enrolled. The Melbourne Diabetes Prevention Study (MDPS) is an evaluation of the translation from the GGT DPP to the Life! programme. We report results from the preliminary phase (pMDPS) of this evaluation. Methods The pMDPS is a randomised controlled trial with 92 individuals aged 50 to 75 at high risk of developing type 2 diabetes randomised to Life! or usual care. Intervention consisted of six structured 90-minute group sessions: five fortnightly sessions and the final session at 8 months. Participants underwent anthropometric and laboratory tests at baseline and 12 months, and provided self-reported psychosocial, dietary, and physical activity measures. Intervention group participants additionally underwent these tests at 3 months. Paired t tests were used to analyse within-group changes over time. Chi-square tests were used to analyse differences between groups in goals met at 12 months. Differences between groups for changes over time were tested with generalised estimating equations and analysis of covariance. Results Intervention participants significantly improved at 12 months in mean body mass index (−0.98 kg/m2, standard error (SE) = 0.26), weight (−2.65 kg, SE = 0.72), waist circumference (−7.45 cm, SE = 1.15), and systolic blood pressure (−3.18 mmHg, SE = 1.26), increased high-density lipoprotein-cholesterol (0.07 mmol/l, SE = 0.03), reduced energy from total (−2.00%, SE = 0.78) and saturated fat (−1.54%, SE = 0.41), and increased fibre intake (1.98 g/1,000 kcal energy, SE = 0.47). In controls, oral glucose at 2 hours deteriorated (0.59 mmol/l, SE = 0.27). Only waist circumference reduced significantly (−4.02 cm, SE = 0.95). Intervention participants significantly outperformed controls over 12 months for body mass index and fibre intake. After baseline adjustment, they also showed greater weight loss and reduced saturated fat versus total energy intake. At least 5% weight loss was achieved by 32% of intervention participants versus 0% controls. Conclusions pMDPS results indicate that scaling-up from implementation trial to state-wide programme is possible. The system design for Life! was fit for purpose of scaling-up from efficacy to effectiveness. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12609000507280
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Affiliation(s)
- Edward D Janus
- Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, PO Box 423, Warrnambool, VIC 3280, Australia
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29
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Best JD, Drury PL, Davis TME, Taskinen MR, Kesäniemi YA, Scott R, Pardy C, Voysey M, Keech AC. Glycemic control over 5 years in 4,900 people with type 2 diabetes: real-world diabetes therapy in a clinical trial cohort. Diabetes Care 2012; 35:1165-70. [PMID: 22432105 PMCID: PMC3329812 DOI: 10.2337/dc11-1307] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [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 Glycemic control in type 2 diabetes generally worsens over time, requiring intensification of therapy. The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial provided the opportunity to observe glycemic control in a real-world setting. We assessed the adequacy of metformin, sulfonylureas, and insulin to maintain glycemic control and their effects on weight. RESEARCH DESIGN AND METHODS Diabetes control was measured at baseline and yearly for a median of 5 years in the 4,900 patients from the nonintervention arm of this study allocated to placebo. RESULTS Median HbA(1c) was 6.9% at baseline and increased by an average of 0.22% over 5 years (P < 0.001). Median weight was 86.3 kg at baseline and decreased by 0.4 kg over 5 years (P = 0.002). Baseline therapy was lifestyle measures only in 27%, oral agents without insulin in 59%, and insulin in 14% (7% also taking oral agents). Over 5 years, insulin use increased to 32% (21% also taking oral agents). Use of oral agents remained similar at 56%. Only 2% of patients at baseline and 4% after 5 years were taking oral agents other than metformin or sulfonylureas. Initiation of insulin therapy in 855 patients produced a sustained reduction of HbA(1c) from a median of 8.2 to 7.7%, with a weight gain of 4.6 kg over 5 years. CONCLUSIONS With intensification of traditional therapies, glycemic control deteriorated very little over 5 years in a large cohort of type 2 diabetes. However, the requirement for insulin therapy doubled, at the expense of significant weight gain and risk of hypoglycemia.
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Affiliation(s)
- James D Best
- Department of Medicine, University of Melbourne Medical School, St. Vincent’s Hospital, Melbourne, Victoria, Australia.
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30
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Luke JN, Brown AD, Brazionis L, O’Dea K, Best JD, McDermott RA, Wang Z, Wang Z, Rowley KG. Exploring clinical predictors of cardiovascular disease in a central Australian Aboriginal cohort. Eur J Prev Cardiol 2012; 20:246-53. [DOI: 10.1177/2047487312437713] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 01/09/2023]
Affiliation(s)
- Joanne N Luke
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Australia
| | - Alex D Brown
- Centre for Indigenous Diabetes and Vascular Disease Research, Baker IDI, Alice Springs, Australia
| | - Laima Brazionis
- Department of Medicine (St Vincent’s Hospital), University of Melbourne, Australia
| | - Kerin O’Dea
- University of South Australia, Adelaide, Australia
| | - James D Best
- Department of Medicine (St Vincent’s Hospital), University of Melbourne, Australia
| | | | - Zaimin Wang
- Health Gains Planning, Department of Health and Families, Darwin, Australia
| | | | - Kevin G Rowley
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Australia
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31
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Itsiopoulos C, Brazionis L, Kaimakamis M, Cameron M, Best JD, O'Dea K, Rowley K. Can the Mediterranean diet lower HbA1c in type 2 diabetes? Results from a randomized cross-over study. Nutr Metab Cardiovasc Dis 2011; 21:740-747. [PMID: 20674309 DOI: 10.1016/j.numecd.2010.03.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 03/14/2010] [Accepted: 03/25/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS To investigate the impact of a diet modeled on the traditional Cretan Mediterranean diet on metabolic control and vascular risk in type 2 diabetes. METHODS AND RESULTS Twenty-seven subjects (47-77 yrs) with type 2 diabetes were randomly assigned to consume either the intervention diet ad libitum or their usual diet for 12 weeks and then cross over to the alternate diet. Most of the meals and staple foods for the intervention diet were provided. Lipids, glycemic variables, blood pressure, homocysteine, C-reactive protein, plasma carotenoids and body composition (anthropometry and dual energy X-ray absorptiometry) were assessed at baseline, and at the end of both diet periods. Dietary adherence was monitored using plasma carotenoid and fatty acid (FA) analysis, complemented by diet diaries. Compared with usual diet, on the ad libitum Mediterranean intervention diet glycosylated haemoglobin fell from 7.1% (95% CI: 6.5-7.7) to 6.8% (95% CI: 6.3-7.3) (p=0.012) and diet quality improved significantly [plant:animal (g/day) food ratio increased from 1.3 (95% CI: 1.1-1.5) to 5.4 (95% CI: 4.3-6.6) (p<0.001)], plasma lycopene and lutein/zeaxanthin increased (36% and 25%, respectively), plasma saturated and trans FAs decreased, and monounsaturated FAs increased. CONCLUSION A traditional moderate-fat Mediterranean diet improves glycemic control and diet quality in men and women with well-controlled type 2 diabetes, without adverse effects on weight.
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Affiliation(s)
- C Itsiopoulos
- Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia.
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32
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Jenkins AJ, Krishnamurthy B, Best JD, Cameron FJ, Colman PG, Hamblin PS, O'Connell MA, Rodda C, Teede H, O'Neal DN. An algorithm guiding patient responses to real-time-continuous glucose monitoring improves quality of life. Diabetes Technol Ther 2011; 13:105-9. [PMID: 21284476 DOI: 10.1089/dia.2010.0139] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study evaluated the impact on quality of life (QoL) of an algorithm guiding the responses of continuous subcutaneous insulin infusion (CSII)-treated type 1 diabetes (T1D) patients using real-time (RT)-continuous glucose monitoring (CGM). RESEARCH DESIGN AND METHODS Sixty CSII-treated T1D participants (13-70 years old, glycosylated hemoglobin [HbA1c] ≤ 9.5%), including adult and adolescent subgroups, were randomized in age-, gender-, and HbA1c-matched pairs. Phase 1 was an open 16-week multicenter randomized controlled trial; Group A received CSII/RT-CGM with the algorithm, and Group B received CSII/RT-CGM without algorithm. Phase 2 was the 16-32-week follow-up study; Group A returned to usual care (CSII without RT-CGM), and Group B was provided with algorithm at 16 weeks. QoL was assessed by DQOL (adults) and DQOLY (adolescents) questionnaires at baseline, 16 weeks, and 32 weeks. Higher scores (range 1-5) indicate poorer QoL. Analysis was by analysis of variance (between group for baseline-16 weeks) and paired two-tailed t tests (within group for baseline and 32 weeks) with significance at P < 0.05. RESULTS Withdrawals left 28 of 30 patients in Group A and 27 of 30 patients in Group B at 32 weeks. In Phase 1, QoL in Group A (2.16 [0.44] baseline to 1.86 [0.40] at 16 weeks) improved compared with Group B (2.03 [0.47] to 2.03 [0.50]) (P = 0.002). Change in QoL correlated with changes in HbA1c (R = 0.36; P = 0.007). In Phase 2, Group A QoL was better at 32 weeks compared with baseline (2.16 [0.44] vs. 2.02 [0.43]) (P = 0.04) but was not in Group B (2.03 [0.47] vs. 1.99 [0.51]) (P = not significant). CONCLUSIONS An algorithm guiding CSII-treated T1D responses to RT-CGM improved QoL, which persisted post-RT-CGM withdrawal. Algorithm provision at RT-CGM initiation was required to benefit QoL.
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Affiliation(s)
- Alicia J Jenkins
- University of Melbourne Department of Medicine, St. Vincent's Hospital, Fitzroy, Australia
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Davis TME, Ting R, Best JD, Donoghoe MW, Drury PL, Sullivan DR, Jenkins AJ, O'Connell RL, Whiting MJ, Glasziou PP, Simes RJ, Kesäniemi YA, Gebski VJ, Scott RS, Keech AC. Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study. Diabetologia 2011; 54:280-90. [PMID: 21052978 DOI: 10.1007/s00125-010-1951-1] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 09/15/2010] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Fenofibrate caused an acute, sustained plasma creatinine increase in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) studies. We assessed fenofibrate's renal effects overall and in a FIELD washout sub-study. METHODS Type 2 diabetic patients (n = 9,795) aged 50 to 75 years were randomly assigned to fenofibrate (n = 4,895) or placebo (n = 4,900) for 5 years, after 6 weeks fenofibrate run-in. Albuminuria (urinary albumin/creatinine ratio measured at baseline, year 2 and close-out) and estimated GFR, measured four to six monthly according to the Modification of Diet in Renal Disease Study, were pre-specified endpoints. Plasma creatinine was re-measured 8 weeks after treatment cessation at close-out (washout sub-study, n = 661). Analysis was by intention-to-treat. RESULTS During fenofibrate run-in, plasma creatinine increased by 10.0 μmol/l (p < 0.001), but quickly reversed on placebo assignment. It remained higher on fenofibrate than on placebo, but the chronic rise was slower (1.62 vs 1.89 μmol/l annually, p = 0.01), with less estimated GFR loss (1.19 vs 2.03 ml min(-1) 1.73 m(-2) annually, p < 0.001). After washout, estimated GFR had fallen less from baseline on fenofibrate (1.9 ml min(-1) 1.73 m(-2), p = 0.065) than on placebo (6.9 ml min(-1) 1.73 m(-2), p < 0.001), sparing 5.0 ml min(-1) 1.73 m(-2) (95% CI 2.3-7.7, p < 0.001). Greater preservation of estimated GFR with fenofibrate was observed with baseline hypertriacylglycerolaemia (n = 169 vs 491 without) alone, or combined with low HDL-cholesterol (n = 140 vs 520 without) and reductions of ≥ 0.48 mmol/l in triacylglycerol over the active run-in period (pre-randomisation) (n = 356 vs 303 without). Fenofibrate reduced urine albumin concentrations and hence albumin/creatinine ratio by 24% vs 11% (p < 0.001; mean difference 14% [95% CI 9-18]; p < 0.001), with 14% less progression and 18% more albuminuria regression (p < 0.001) than in participants on placebo. End-stage renal event frequency was similar (n = 21 vs 26, p = 0.48). CONCLUSIONS/INTERPRETATION Fenofibrate reduced albuminuria and slowed estimated GFR loss over 5 years, despite initially and reversibly increasing plasma creatinine. Fenofibrate may delay albuminuria and GFR impairment in type 2 diabetes patients. Confirmatory studies are merited. TRIAL REGISTRATION ISRCTN64783481.
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Affiliation(s)
- T M E Davis
- School of Medicine and Pharmacology, Fremantle Hospital, University of Western Australia, Fremantle, WA, Australia
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Taskinen MR, Barter PJ, Ehnholm C, Sullivan DR, Mann K, Simes J, Best JD, Hamwood S, Keech AC. Ability of traditional lipid ratios and apolipoprotein ratios to predict cardiovascular risk in people with type 2 diabetes. Diabetologia 2010; 53:1846-55. [PMID: 20526762 DOI: 10.1007/s00125-010-1806-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 04/22/2010] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS The apolipoprotein B (ApoB):apolipoprotein A (ApoA)-I ratio may be a better indicator of cardiovascular disease (CVD) risk in people with type 2 diabetes than traditional lipid risk markers (LDL-cholesterol, HDL-cholesterol and triacylglycerol), but whether the ApoB:ApoA-I ratio should be used to indicate lipid-lowering therapy is still debated. METHODS The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study randomised 9,795 patients with type 2 diabetes to fenofibrate (200 mg daily) or placebo and followed them up for a median of 5 years. We compared ApoB, ApoA-I, ApoAII and the ApoB:ApoA-I ratio with traditional lipid variables as predictors of CVD risk. We estimated the HR of the effect of 1 SD difference in baseline concentrations of lipids, apolipoproteins and respective ratios on the risk of CVD events and also used receiver operating characteristic curve analysis. RESULTS In the placebo group, the variables best predicting CVD events were non-HDL-cholesterol:HDL-cholesterol, total cholesterol:HDL-cholesterol (HR 1.21, p < 0.001 for both), ApoB:ApoA-I (HR 1.20, p < 0.001), LDL-cholesterol:HDL-cholesterol (HR 1.17, p < 0.001), HDL-cholesterol (HR 0.84, p < 0.001) and ApoA-I (HR 0.85, p < 0.001). In the fenofibrate group, the first four predictors were very similar (but ApoB:ApoA-I was fourth), followed by non-HDL-cholesterol and ApoB. Lipid ratios and ApoB:ApoA-I performed better than any single lipid or apolipoprotein in predicting CVD risk. CONCLUSIONS/INTERPRETATION In patients with type 2 diabetes in the FIELD study, traditional lipid ratios were as strong as the ApoB:ApoA-I ratio in predicting CVD risk. The data provide little evidence for replacement of traditional lipids and their ratios with measures of ApoB, ApoA-I and their ratio.
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Affiliation(s)
- M-R Taskinen
- Department of Medicine, Division of Cardiology, Helsinki University Central Hospital, Biomedicum, Haartmaninkatu 8, Helsinki, Finland.
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Affiliation(s)
- Doris Young
- Department of General Practice, University of Melbourne, Melbourne, VIC
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, Faculty of Business and Economics, University of Melbourne, Melbourne, VIC
| | - James D Best
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, VIC
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC
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Jenkins AJ, Krishnamurthy B, Best JD, Cameron FJ, Colman PG, Farish S, Hamblin PS, O'Connell MA, Rodda C, Rowley K, Teede H, O'Neal DN. Evaluation of an algorithm to guide patients with type 1 diabetes treated with continuous subcutaneous insulin infusion on how to respond to real-time continuous glucose levels: a randomized controlled trial. Diabetes Care 2010; 33:1242-8. [PMID: 20215457 PMCID: PMC2875432 DOI: 10.2337/dc09-1481] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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 To evaluate an algorithm guiding responses of continuous subcutaneous insulin infusion (CSII)-treated type 1 diabetic patients using real-time continuous glucose monitoring (RT-CGM). RESEARCH DESIGN AND METHODS Sixty CSII-treated type 1 diabetic participants (aged 13-70 years, including adult and adolescent subgroups, with A1C <or=9.5%) were randomized in age-, sex-, and A1C-matched pairs. Phase 1 was an open 16-week multicenter randomized controlled trial. Group A was treated with CSII/RT-CGM with the algorithm, and group B was treated with CSII/RT-CGM without the algorithm. The primary outcome was the difference in time in target (4-10 mmol/l) glucose range on 6-day masked CGM. Secondary outcomes were differences in A1C, low (<or=3.9 mmol/l) glucose CGM time, and glycemic variability. Phase 2 was the week 16-32 follow-up. Group A was returned to usual care, and group B was provided with the algorithm. Glycemia parameters were as above. Comparisons were made between baseline and 16 weeks and 32 weeks. RESULTS In phase 1, after withdrawals 29 of 30 subjects were left in group A and 28 of 30 subjects were left in group B. The change in target glucose time did not differ between groups. A1C fell (mean 7.9% [95% CI 7.7-8.2to 7.6% [7.2-8.0]; P < 0.03) in group A but not in group B (7.8% [7.5-8.1] to 7.7 [7.3-8.0]; NS) with no difference between groups. More subjects in group A achieved A1C <or=7% than those in group B (2 of 29 to 14 of 29 vs. 4 of 28 to 7 of 28; P = 0.015). In phase 2, one participant was lost from each group. In group A, A1C returned to baseline with RT-CGM discontinuation but did not change in group B, who continued RT-CGM with addition of the algorithm. CONCLUSIONS Early but not late algorithm provision to type 1 diabetic patients using CSII/RT-CGM did not increase the target glucose time but increased achievement of A1C <or=7%. Upon RT-CGM cessation, A1C returned to baseline.
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Affiliation(s)
- Alicia J Jenkins
- Department of Medicine, The University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Simes J, Voysey M, O'Connell R, Glasziou P, Best JD, Scott R, Pardy C, Byth K, Sullivan DR, Ehnholm C, Keech A. A novel method to adjust efficacy estimates for uptake of other active treatments in long-term clinical trials. PLoS One 2010; 5:e8580. [PMID: 20072614 PMCID: PMC2798963 DOI: 10.1371/journal.pone.0008580] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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: 09/07/2009] [Accepted: 11/26/2009] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND When rates of uptake of other drugs differ between treatment arms in long-term trials, the true benefit or harm of the treatment may be underestimated. Methods to allow for such contamination have often been limited by failing to preserve the randomization comparisons. In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, patients were randomized to fenofibrate or placebo, but during the trial many started additional drugs, particularly statins, more so in the placebo group. The effects of fenofibrate estimated by intention-to-treat were likely to have been attenuated. We aimed to quantify this effect and to develop a method for use in other long-term trials. METHODOLOGY/PRINCIPAL FINDINGS We applied efficacies of statins and other cardiovascular drugs from meta-analyses of randomized trials to adjust the effect of fenofibrate in a penalized Cox model. We assumed that future cardiovascular disease events were reduced by an average of 24% by statins, and 20% by a first other major cardiovascular drug. We applied these estimates to each patient who took these drugs for the period they were on them. We also adjusted the analysis by the rate of discontinuing fenofibrate. Among 4,900 placebo patients, average statin use was 16% over five years. Among 4,895 assigned fenofibrate, statin use was 8% and nonuse of fenofibrate was 10%. In placebo patients, use of cardiovascular drugs was 1% to 3% higher. Before adjustment, fenofibrate was associated with an 11% reduction in coronary events (coronary heart disease death or myocardial infarction) (P = 0.16) and an 11% reduction in cardiovascular disease events (P = 0.04). After adjustment, the effects of fenofibrate on coronary events and cardiovascular disease events were 16% (P = 0.06) and 15% (P = 0.008), respectively. CONCLUSIONS/SIGNIFICANCE This novel application of a penalized Cox model for adjustment of a trial estimate of treatment efficacy incorporates evidence-based estimates for other therapies, preserves comparisons between the randomized groups, and is applicable to other long-term trials. In the FIELD study example, the effects of fenofibrate on the risks of coronary heart disease and cardiovascular disease events were underestimated by up to one-third in the original analysis. TRIAL REGISTRATION Controlled-Trials.com ISRCTN64783481.
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Affiliation(s)
- John Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia.
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Blackberry ID, Furler JS, Young D, Best JD. What does it cost to establish a practice‐nurses‐led clinical trial in general practice? Med J Aust 2009; 191:492-5. [DOI: 10.5694/j.1326-5377.2009.tb02911.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 07/14/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Irene D Blackberry
- Department of General Practice, University of Melbourne, Melbourne, VIC
- NHMRC Centre for Clinical Research Excellence in Clinical Science in Diabetes, Melbourne, VIC
| | - John S Furler
- Department of General Practice, University of Melbourne, Melbourne, VIC
- NHMRC Centre for Clinical Research Excellence in Clinical Science in Diabetes, Melbourne, VIC
| | - Doris Young
- Department of General Practice, University of Melbourne, Melbourne, VIC
- NHMRC Centre for Clinical Research Excellence in Clinical Science in Diabetes, Melbourne, VIC
| | - James D Best
- NHMRC Centre for Clinical Research Excellence in Clinical Science in Diabetes, Melbourne, VIC
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC
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Valaydon ZS, Lee P, Dale GL, Januszewski AS, Rowley KG, Nandurkar H, Karschimkus C, Best JD, Lyons TJ, Jenkins AJ. Increased coated-platelet levels in chronic haemodialysis patients. Nephrology (Carlton) 2009; 14:148-54. [PMID: 19076292 DOI: 10.1111/j.1440-1797.2008.01026.x] [Citation(s) in RCA: 19] [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] [Indexed: 02/05/2023]
Abstract
AIM To determine if levels of coated-platelets, which are potentially pro-thrombotic, are increased in end-stage renal disease patients on haemodialysis, a condition associated with high cardiovascular disease risk. METHODS In a cross-sectional observational study, coated-platelet levels were measured by flow cytometry in 25 end-stage renal failure haemodialysis patients and 25 controls without renal disease. Associations between coated-platelet levels and clinical and biochemical factors relevant to renal and cardiovascular disease were evaluated. RESULTS Mean +/- SD coated-platelet levels were higher in the dialysis group than in the control group (39.3+/-14.3% vs 30.9+/-10.3%, P=0.02). The number of subjects with high coated-platelet levels (>40%) was larger in the dialysis than in the control group (13/25 vs 4/25, chi(2) test, P=0.007). On univariate analysis, coated-platelet levels correlated with serum C-reactive protein levels in renal failure (r=0.47, P=0.02) and inversely with white cell count in the control group (r= -0.60, P=0.001). Coated-platelet levels were higher in dialysis patients reporting alcohol abstinence than among those reporting 'social' drinking (44.3+/-12.6 vs 28.8+/-13.5%, P=0.01). Age, gender, body weight, smoking, diabetes, lipid levels and lipid-lowering drugs were not associated with coated-platelet levels (all P>0.05). CONCLUSION Coated-platelet levels are increased in haemodialysis patients relative to subjects with normal renal function, and are related to inflammation and alcohol abstinence. Other vascular risk factors, such as smoking, lipids and diabetes, were not related to coated-platelet levels. Coated-platelets may be implicated in the increased thrombosis and vascular risk in end-stage renal disease.
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Affiliation(s)
- Zina S Valaydon
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
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40
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Rajamani K, Colman PG, Li LP, Best JD, Voysey M, D'Emden MC, Laakso M, Baker JR, Keech AC. Effect of fenofibrate on amputation events in people with type 2 diabetes mellitus (FIELD study): a prespecified analysis of a randomised controlled trial. Lancet 2009; 373:1780-8. [PMID: 19465233 PMCID: PMC2687887 DOI: 10.1016/s0140-6736(09)60698-x] [Citation(s) in RCA: 184] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Amputations in people with type 2 diabetes mellitus substantially impair their quality of life and impose high costs on health-care systems. Our aim was to assess the effect of fenofibrate on amputation events in a large cohort of patients with type 2 diabetes. METHODS In the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study, 9795 patients aged 50-75 years with type 2 diabetes were randomly assigned by computer-generated randomisation sequence to receive fenofibrate 200 mg per day (n=4895) or matching placebo (n=4900) for 5 years' duration. Information about non-traumatic amputation-a prespecified tertiary endpoint of the study-was routinely gathered. Clinicians who were masked to treatment allocation adjudicated amputations as minor or major (below or above the ankle, respectively). Amputations were also classified on the basis of whether or not large-vessel disease was present in the limb, to distinguish those related to large-artery atherosclerosis from those predominantly related to microvascular disease. Analysis was by intention to treat (ITT). The FIELD study is registered as an International Standard Randomised Controlled Trial, number ISRCTN64783481. FINDINGS All 9795 patients were included in the ITT population. 115 patients had one or more non-traumatic lower-limb amputations due to diabetes. Previous cardiovascular disease, microvascular disease, previous non-traumatic amputation or skin ulcer, smoking, and longer duration of diabetes were more frequent in patients who had amputations during the trial than in those who had other cardiovascular events or in those who had neither event (all p<0.001 for three-way comparison). Mean lipid concentrations differed between patients who had on-study amputations and those who had other cardiovascular events or neither event, but by no more than 0.2 mmol/L. The risks of first amputation (45 vs 70 events; hazard ratio [HR] 0.64, 95% CI 0.44-0.94; p=0.02) and minor amputation events without known large-vessel disease (18 vs 34 events; 0.53, 0.30-0.94; p=0.027) were lower for patients assigned to fenofibrate than for patients assigned to placebo, with no difference between groups in risk of major amputations (24 vs 26 events; 0.93, 0.53-1.62; p=0.79). INTERPRETATION Classic markers of macrovascular and microvascular risk were associated with lower extremity amputations in patients with type 2 diabetes. Treatment with fenofibrate was associated with a lower risk of amputations, particularly minor amputations without known large-vessel disease, probably through non-lipid mechanisms. These findings could lead to a change in standard treatment for the prevention of diabetes-related lower-limb amputations. FUNDING Laboratoires Fournier SA (now part of Solvay Pharmaceuticals) and National Health and Medical Research Council of Australia.
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Affiliation(s)
- Kushwin Rajamani
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
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Luke JN, Brown A, O’Neal DN, O’Dea K, Jenkins AJ, Kelaher M, Best JD, Rowley KG. Lipid treatment guidelines and cardiovascular risk for Aboriginal people in Central Australia. Med J Aust 2009; 190:552-6. [DOI: 10.5694/j.1326-5377.2009.tb02561.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 04/03/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Joanne N Luke
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Melbourne,
| | - Alex Brown
- Centre for Indigenous Diabetes and Vascular Disease Research, Baker IDI Heart and Diabetes Institute, Alice Springs, NT
| | - David N O’Neal
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC
| | - Kerin O’Dea
- Sansom Institute, University of South Australia, Adelaide, SA
| | - Alicia J Jenkins
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC
| | - Margaret Kelaher
- Centre for Health Policy and Program Evaluation, School of Population Health, University of Melbourne, Melbourne, VIC
| | - James D Best
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC
| | - Kevin G Rowley
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Melbourne,
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Shemesh T, Rowley KG, Jenkins AJ, Best JD, O'Dea K. C-Reactive Protein Concentrations Are Very High and More Stable over Time Than the Traditional Vascular Risk Factors Total Cholesterol and Systolic Blood Pressure in an Australian Aboriginal Cohort. Clin Chem 2009; 55:336-41. [DOI: 10.1373/clinchem.2008.115360] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground: Stability of circulating high-sensitivity C-reactive protein (hsCRP) concentrations has implications for its utility in assessing cardiovascular disease (CVD) risk. We sought to determine hsCRP reproducibility in an indigenous Australian cohort with a view to use hsCRP as a marker of future CVD in community-based risk-factor screenings.Methods: Seventy people living in a community on the northern coast of Australia participated in 2 risk-factor screenings over a median (interquartile range) follow-up time of 829 (814–1001) days. hsCRP was measured by high-sensitivity nephelometry.Results: Geometric mean hsCRP concentrations at baseline and follow-up were 4.5 and 5.1 mg/L, respectively (P = 0.220), and Pearson product-moment correlation was 0.775. The proportion of people at high CVD risk (hsCRP >3.0 mg/L) at baseline was 67.1% and remained consistently high (68.6%) at follow-up. Linear regression analysis for follow-up hsCRP as a function of baseline hsCRP, sex, and differences in total and regional body fatness showed that baseline hsCRP was the single predictor in the model, accounting for 63.9% of the total variance in follow-up hsCRP (Pmodel < 0.001). Prevalence agreement (95% CI) between baseline and follow-up for the hsCRP >3.0 mg/L category was 84% (73%–92%) (PMcNemar = not significant), and κ coefficient was fair (0.64, compared with 0.31 for systolic blood pressure ≥140 mmHg and 0.43 for total cholesterol ≥5.5 mmol/L).Conclusions: hsCRP concentrations remained consistently reproducible over time across a wide concentration range in an Aboriginal cohort. Correlations between concentrations over time were better than for other traditional CVD risk factors. hsCRP concentration has potential as a marker of future CVD risk.
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Affiliation(s)
- Tomer Shemesh
- Menzies School of Health Research, John Mathews Building, Royal Darwin Hospital, Darwin, NT, Australia
- Institute of Advanced Studies, Charles Darwin University, Darwin, NT, Australia
- The University of Melbourne, Department of Medicine, St Vincent’s Hospital, Fitzroy, VIC, Australia
| | - Kevin G Rowley
- The University of Melbourne, Department of Medicine, St Vincent’s Hospital, Fitzroy, VIC, Australia
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, The University of Melbourne, Parkville, VIC, Australia
| | - Alicia J Jenkins
- The University of Melbourne, Department of Medicine, St Vincent’s Hospital, Fitzroy, VIC, Australia
| | - James D Best
- The University of Melbourne, Department of Medicine, St Vincent’s Hospital, Fitzroy, VIC, Australia
| | - Kerin O'Dea
- Menzies School of Health Research, John Mathews Building, Royal Darwin Hospital, Darwin, NT, Australia
- The University of Melbourne, Department of Medicine, St Vincent’s Hospital, Fitzroy, VIC, Australia
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Dunbar JA, Reddy P, Davis-Lameloise N, Philpot B, Laatikainen T, Kilkkinen A, Bunker SJ, Best JD, Vartiainen E, Kai Lo S, Janus ED. Depression: an important comorbidity with metabolic syndrome in a general population. Diabetes Care 2008; 31:2368-73. [PMID: 18835951 PMCID: PMC2584197 DOI: 10.2337/dc08-0175] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is a recognized association among depression, diabetes, and cardiovascular disease. The aim of this study was to examine in a sample representative of the general population whether depression, anxiety, and psychological distress are associated with metabolic syndrome and its components. RESEARCH DESIGN AND METHODS Three cross-sectional surveys including clinical health measures were completed in rural regions of Australia during 2004-2006. A stratified random sample (n = 1,690, response rate 48%) of men and women aged 25-84 years was selected from the electoral roll. Metabolic syndrome was defined by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III (NCEP ATP III), and International Diabetes Federation (IDF) criteria. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale and psychological distress by the Kessler 10 measure. RESULTS Metabolic syndrome was associated with depression but not psychological distress or anxiety. Participants with the metabolic syndrome had higher scores for depression (n = 409, mean score 3.41, 95% CI 3.12-3.70) than individuals without the metabolic syndrome (n = 936, mean 2.95, 95% CI 2.76-3.13). This association was also present in 338 participants with the metabolic syndrome and without diabetes (mean score 3.37, 95% CI 3.06-3.68). Large waist circumference and low HDL cholesterol showed significant and independent associations with depression. CONCLUSIONS Our results show an association between metabolic syndrome and depression in a heterogeneous sample. The presence of depression in individuals with the metabolic syndrome has implications for clinical management.
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Affiliation(s)
- James A Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Warrnambool, Victoria, Australia.
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Abstract
As the population ages, there is a growing need for effective therapies for the treatment of neurological diseases. A limited number of therapeutics are currently available to improve cognitive function and research is limited by the need for in vivo models. Zebrafish have recently become a focus of neurobehavioral studies since larvae display neuropathological and behavioral phenotypes that are quantifiable and relate to those seen in man. Due to the small size of Zebrafish larvae, assays can be undertaken in 96 well plates and as the larvae can live in as little as 200 mul of fluid, only a few milligrams of compound are needed for screening. Thus in vivo analysis of the effects of compounds can be undertaken at much earlier stages in the drug discovery process. This review will look at the utility of the zebrafish in the study of neurological diseases and its role in improving the throughput of candidate compounds in in vivo screens.
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Affiliation(s)
- J D Best
- Summit (Cambridge) Ltd., Beach Drive Cambridge, UK
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Hoffmann P, Woon J, Rowley KG, Karschimkus C, Nelson CL, Dragicevic G, O'Neal D, Wilson A, Croft KD, Mori TA, Kemp BE, Best JD, Jenkins AJ. Glutathionyl haemoglobin is not increased in diabetes nor related to glycaemia, complications, dyslipidaemia, inflammation or other measures of oxidative stress. Diabetes Res Clin Pract 2008; 80:e1-3. [PMID: 18313786 DOI: 10.1016/j.diabres.2008.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 01/17/2008] [Indexed: 11/25/2022]
Abstract
Modified haemoglobin levels were quantified in 21 Type 1 and 21 Type 2 diabetic patients and two groups of 17 non-diabetic subjects. Glycated haemoglobin levels were increased in diabetes but glutathionyl haemoglobin (HbSSG) levels did not differ between groups, nor by complications; nor correlate with haemoglobin glycation or vascular risk factors.
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Affiliation(s)
- Peter Hoffmann
- St. Vincent's Institute of Medical Research, Fitzroy, Melbourne, Australia.
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O'Neal DN, Piers LS, Iser DM, Rowley KG, Jenkins AJ, Best JD, O'Dea K. Australian Aboriginal people and Torres Strait Islanders have an atherogenic lipid profile that is characterised by low HDL-cholesterol level and small LDL particles. Atherosclerosis 2008; 201:368-77. [PMID: 18599067 DOI: 10.1016/j.atherosclerosis.2008.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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] [Received: 07/19/2007] [Revised: 03/06/2008] [Accepted: 03/07/2008] [Indexed: 10/22/2022]
Abstract
AIM To characterise lipid profiles for Australian Aboriginal people and Torres Strait Islanders. METHODS Community-based, cross-sectional surveys in 1995-1997 including: 407 female and 322 male Australian Aboriginal people and 207 female and 186 male Torres Strait Islanders over 15 years old. A comparator of 78 female (44 with diabetes) and 148 male (73 with diabetes) non-indigenous participants recruited to clinical epidemiological studies was used. Lipids were determined by standard assays and LDL diameter by gradient gel electrophoresis. RESULTS Diabetes prevalence was 14.8% and 22.6% among Aboriginal people and Torres Strait Islanders, respectively. LDL size (mean [95% CI (confidence interval)]) was smaller (P<0.05) in non-diabetic Aboriginal (26.02 [25.96-26.07] nm) and Torres Strait Islander women (26.01 [25.92-26.09] nm) than in non-diabetic non-indigenous women (26.29 [26.13-26.44] nm). LDL size correlated (P<0.0005) inversely with triglyceride, WHR, and fasting insulin and positively with HDL-cholesterol. HDL-cholesterol (mean [95% CI] mmol/L) was lower (P<0.0005) in indigenous Australians than in non-indigenous subjects, independent of age, sex, diabetes, WHR, insulin, triglyceride, and LDL size: Aboriginal (non-diabetic women, 0.86 [0.84-0.88]; diabetic women, 0.76 [0.72-0.80]; non-diabetic men, 0.79 [0.76-0.81]; diabetic men, 0.76 [0.71-0.82]); Torres Strait Islander (non-diabetic women, 1.00 [0.95-1.04]; diabetic women, 0.89 [0.83-0.96]; non-diabetic men, 1.00 [0.95-1.04]; diabetic men, 0.87 [0.79-0.96]); non-indigenous (non-diabetic women, 1.49 [1.33-1.67]; diabetic women, 1.12 [1.03-1.21]; non-diabetic men, 1.18 [1.11-1.25]; diabetic men, 1.05 [0.98-1.12]). CONCLUSIONS Indigenous Australians have a dyslipidaemia which includes small LDL and very low HDL-cholesterol levels. The dyslipidaemia was equally severe in both genders. Strategies aimed at increasing HDL-cholesterol and LDL size may reduce high CVD risk for indigenous populations.
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Affiliation(s)
- D N O'Neal
- The University of Melbourne, Department of Medicine, St Vincent's Hospital, Fitzroy, VIC, Australia.
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Rowley KG, O’Dea K, Anderson I, McDermott R, Saraswati K, Tilmouth R, Roberts I, Fitz J, Wang Z, Jenkins A, Best JD, Wang Z, Brown A. Lower than expected morbidity and mortality for an Australian Aboriginal population: 10‐year follow‐up in a decentralised community. Med J Aust 2008; 188:283-7. [DOI: 10.5694/j.1326-5377.2008.tb01621.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 11/19/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Kevin G Rowley
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Melbourne, VIC
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC
| | - Kerin O’Dea
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC
- Menzies School of Health Research, Darwin, NT
| | - Ian Anderson
- Onemda VicHealth Koori Health Unit, Centre for Health and Society, School of Population Health, University of Melbourne, Melbourne, VIC
| | | | | | | | - Iris Roberts
- Menzies School of Health Research, Darwin, NT
- Centre for Indigenous Vascular and Diabetes Research, Baker Heart Research Institute, Alice Springs, NT
| | - Joseph Fitz
- Menzies School of Health Research, Darwin, NT
| | - Zaimin Wang
- School of Population Health, University of Queensland, Brisbane, QLD
| | - Alicia Jenkins
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC
| | - James D Best
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC
| | - Zhiqiang Wang
- School of Population Health, University of Queensland, Brisbane, QLD
| | - Alex Brown
- Menzies School of Health Research, Darwin, NT
- Centre for Indigenous Vascular and Diabetes Research, Baker Heart Research Institute, Alice Springs, NT
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S Januszewski A, C Thomas M, S Karschimkus C, S Chung J, G Rowley K, L Nelson C, N O’Neal D, Dragicevic G, A Harper C, D Best J, J Jenkins A. Longitudinal analysis of low-molecular weight fluorophores in type 1 diabetes mellitus. J Med Invest 2008; 55:29-36. [DOI: 10.2152/jmi.55.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | | | - Jasmine S Chung
- University of Melbourne, Department of Medicine, St Vincent’s Hospital
| | - Kevin G Rowley
- University of Melbourne, Department of Medicine, St Vincent’s Hospital
| | - Craig L Nelson
- University of Melbourne, Department of Medicine, St Vincent’s Hospital
| | - David N O’Neal
- University of Melbourne, Department of Medicine, St Vincent’s Hospital
| | - George Dragicevic
- University of Melbourne, Department of Medicine, St Vincent’s Hospital
| | | | - James D Best
- University of Melbourne, Department of Medicine, St Vincent’s Hospital
| | - Alicia J Jenkins
- University of Melbourne, Department of Medicine, St Vincent’s Hospital
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Jenkins AJ, Zhang SX, Rowley KG, Karschimkus CS, Nelson CL, Chung JS, O'Neal DN, Januszewski AS, Croft KD, Mori TA, Dragicevic G, Harper CA, Best JD, Lyons TJ, Ma JX. Increased serum pigment epithelium-derived factor is associated with microvascular complications, vascular stiffness and inflammation in Type 1 diabetes. Diabet Med 2007; 24:1345-51. [PMID: 17971181 DOI: 10.1111/j.1464-5491.2007.02281.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS To determine in Type 1 diabetes patients if levels of pigment epithelium-derived factor (PEDF), an anti-angiogenic, anti-inflammatory and antioxidant factor, are increased in individuals with complications and positively related to vascular and renal dysfunction, body mass index, glycated haemoglobin, lipids, inflammation and oxidative stress. METHODS Serum PEDF levels were measured by ELISA in a cross-sectional study of 123 Type 1 diabetic patients (71 without and 52 with microvascular complications) and 31 non-diabetic control subjects. PEDF associations with complication status, pulse-wave analysis and biochemical results were explored. RESULTS PEDF levels [geometric mean (95% CI)] were increased in patients with complications 8.2 (7.0-9.6) microg/ml, vs. complication-free patients [5.3 (4.7-6.0) microg/ml, P < 0.001] and control subjects [5.3 (4.6-6.1) microg/ml, P < 0.001; anova between three groups, P < 0.001], but did not differ significantly between control subjects and complication-free patients (P > 0.05). In diabetes, PEDF levels correlated (all P < 0.001) with systolic blood pressure (r = 0.317), pulse pressure (r = 0.337), small artery elasticity (r = -0.269), glycated haemoglobin (r = 0.245), body mass index (r = 0.362), renal dysfunction [including serum creatinine (r = 0.491), cystatin C (r = 0.500)], triglycerides (r = 0.367), and inflammation [including log(e)C-reactive protein (CRP; r = 0.329), and soluble vascular cell adhesion molecule-1 (r = 0.363)]. Age, blood urea nitrogen, systolic blood pressure, pulse pressure and log(e)CRP correlated with PEDF levels in control subjects (all P < 0.04). PEDF levels were not significantly correlated with measures of oxidative stress: isoprostanes, oxidized low-density lipoprotein or paraoxonase-1 activity. On stepwise linear regression analysis (all subjects), independent determinants of PEDF levels were renal function, triglycerides, inflammation, small artery elasticity and age (r(2) = 0.427). CONCLUSIONS In Type 1 diabetes, serum PEDF levels are associated with microvascular complications, poor vascular health, hyperglycaemia, adiposity and inflammation.
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Affiliation(s)
- A J Jenkins
- University of Melbourne, Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
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Laatikainen T, Dunbar JA, Chapman A, Kilkkinen A, Vartiainen E, Heistaro S, Philpot B, Absetz P, Bunker S, O'Neil A, Reddy P, Best JD, Janus ED. Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project. BMC Public Health 2007; 7:249. [PMID: 17877832 PMCID: PMC2039742 DOI: 10.1186/1471-2458-7-249] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 09/19/2007] [Indexed: 12/29/2022] Open
Abstract
Background Randomised controlled trials demonstrate a 60% reduction in type 2 diabetes incidence through lifestyle modification programmes. The aim of this study is to determine whether such programmes are feasible in primary health care. Methods An intervention study including 237 individuals 40–75 years of age with moderate or high risk of developing type 2 diabetes. A structured group programme with six 90 minute sessions delivered during an eight month period by trained nurses in Australian primary health care in 2004–2006. Main outcome measures taken at baseline, three, and 12 months included weight, height, waist circumference, fasting plasma glucose and lipids, plasma glucose two hours after oral glucose challenge, blood pressure, measures of psychological distress and general health outcomes. To test differences between baseline and follow-up, paired t-tests and Wilcoxon rank sum tests were performed. Results At twelve months participants' mean weight reduced by 2.52 kg (95% confidence interval 1.85 to 3.19) and waist circumference by 4.17 cm (3.48 to 4.87). Mean fasting glucose reduced by 0.14 mmol/l (0.07 to 0.20), plasma glucose two hours after oral glucose challenge by 0.58 mmol/l (0.36 to 0.79), total cholesterol by 0.29 mmol/l (0.18 to 0.40), low density lipoprotein cholesterol by 0.25 mmol/l (0.16 to 0.34), triglycerides by 0.15 mmol/l (0.05 to 0.24) and diastolic blood pressure by 2.14 mmHg (0.94 to 3.33). Significant improvements were also found in most psychological measures. Conclusion This study provides evidence that a type 2 diabetes prevention programme using lifestyle intervention is feasible in primary health care settings, with reductions in risk factors approaching those observed in clinical trials. Trial Number Current Controlled Trials ISRCTN38031372
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Affiliation(s)
- Tiina Laatikainen
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
- National Public Health Institute, Mannerheimintie 166, FI – 00300, Helsinki, Finland
| | - James A Dunbar
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
| | - Anna Chapman
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
| | - Annamari Kilkkinen
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
| | - Erkki Vartiainen
- National Public Health Institute, Mannerheimintie 166, FI – 00300, Helsinki, Finland
| | - Sami Heistaro
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
- National Public Health Institute, Mannerheimintie 166, FI – 00300, Helsinki, Finland
| | - Ben Philpot
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
| | - Pilvikki Absetz
- National Public Health Institute, Mannerheimintie 166, FI – 00300, Helsinki, Finland
| | - Stephen Bunker
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
| | - Adrienne O'Neil
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
| | - Prasuna Reddy
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
| | - James D Best
- Department of Medicine, University of Melbourne, St Vincent's Hospital, PO Box 2900, Fitzroy, Victoria, 3065, Australia
| | - Edward D Janus
- Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, PO Box 423, Warrnambool, Victoria, 3280, Australia
- Department of Medicine, University of Melbourne, Western Hospital, Footscray, Victoria, 3011 Australia
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