| 1. |
- Nyström, Thomas, et al.
(författare)
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Evaluation of Effects of Continuous Glucose Monitoring on Physical Activity Habits and Blood Lipid Levels in Persons With Type 1 Diabetes Managed With MDI: An Analysis Based on the GOLD Randomized Trial (GOLD 8)
- 2024
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Ingår i: Journal of diabetes science and technology. - : SAGE Publications. - 1932-2968. ; 18:1, s. 89-98
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Tidskriftsartikel (refereegranskat)abstract
- Background: People with type 1 diabetes generally view it easier to exercise when having continuous information of the glucose levels. We evaluated whether patients with type 1 diabetes managed with multiple daily insulin injections (MDI) exercised more after initiating continuous glucose monitoring (CGM) and whether the improved glycemic control and well-being associated with CGM translates into improved blood lipids and markers of inflammation. Method: The GOLD trial was a randomized cross-over trial over 16 months where patients used either CGM or capillary self-monitoring of blood glucose (SMBG) over six months, with a four-month wash-out period between the two treatment periods. We compared grade of physical activity, blood lipids, apolipoproteins, and high-sensitivity C-reactive protein (hsCRP) levels during CGM and SMBG. Results: There were 116 patients with information of physical activity estimated by the International Physical Activity Questionnaire (IPAQ) during both CGM and SMBG. No changes were found during CGM or SMBG, IPAQ scores 3305 versus 3878 (P =.16). In 136 participants with information of blood lipid levels with no change in lipid-lowering medication during the two treatment periods, HbA1c differed by 4.2 mmol/mol (NGSP 0.39%) between SMBG and CGM treatment (P <.001). No significant changes existed in low-density lipoprotein, high-density lipoprotein, triglycerides, total cholesterol, apolipoprotein A1, apolipoprotein B1, or hsCRP, during CGM and SMBG. Conclusion: Although many patients experience it easier to perform physical activity when monitoring glucose levels with CGM, it does not influence the amount of physical activity in persons with type 1 diabetes. Blood lipids, apolipoprotein, and hsCRP levels were similar during CGM and SMBG.
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| 2. |
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| 3. |
- Holmer, Magnus
(författare)
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Aspects of diagnosis, prognosis and treatment of nonalcoholic fatty liver disease
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease globally. NAFLD is caused by obesity, often in combination with type 2 diabetes mellitus (T2D). Lifestyle modifications that lead to weight loss, primarily diet change, is the only treatment proven to reverse steatosis and nonalcoholic steatohepatitis (NASH). The projects included in this thesis explore different aspects of epidemiology, pathophysiology, and treatment of NAFLD. A significant number of NAFLD patients will develop cirrhosis, and NAFLD has become a leading cause for the need of a liver transplantation in several parts of the world. We first performed a population-based cohort study including 4609 patients from the Nordic Liver Transplant Registry who were listed for liver transplantation between 1994 to 2015. We observed that NAFLD is increasing as a cause of severe liver disease in the Nordic countries. Common genetic variants have been linked to more advanced forms of NAFLD in cross- sectional studies. How these polymorphisms affect the long-term risk of progressive disease is less known. Study 2 was a cohort study on 546 patients with NAFLD and 5,234 reference individuals matched on age, sex, and municipality. DNA samples were collected from all subjects with NAFLD. Genetic variants previously associated with NAFLD, NASH, and fibrosis were determined from blood samples or stored biopsies. Long-term outcomes were collected from national patient registers during a median follow-up of 20 years. The main finding was an association of the G/G genotype of the patatin-like phospholipase domain containing 3 (PNPLA3 rs738409) gene with an increased prevalence of NASH at baseline and the risk of developing severe liver disease during follow-up. More research is needed to establish the role of adipose tissue in the pathogenesis of NAFLD and NASH. In study 3 we collected subcutaneous adipose tissue (SAT) from 32 patients with NAFLD and 15 healthy controls matched on BMI. We studied the association between SAT morphology and NASH or fibrosis. We found that subjects with NAFLD have hypertrophic SAT adipocytes compared to controls. Using RNA-sequencing of SAT, we explored genes that were differently expressed in subjects with NASH and compared our results to those seen in previous studies on morbidly obese subjects. The final study of this thesis was an open label randomized controlled trial on 74 patients with NAFLD. We compared the efficacy of a low-carb high-fat diet (the LCHF diet), intermittent calorie restriction (the 5:2 diet) and standard diet recommendations on reduction of hepatic steatosis. Liver fat content was measured with magnetic resonance spectroscopy at baseline and after 12 weeks of treatment. The main finding was that the LCHF and the 5:2 diets were equally effective in reducing steatosis. Both were superior to the standard treatment given to the control group. The results of this thesis have implications on several aspects of NAFLD epidemiology, pathogenesis, and treatment.
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| 4. |
- Holmer, Magnus, et al.
(författare)
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Effect of common genetic variants on the risk of cirrhosis in non-alcoholic fatty liver disease during 20 years of follow-up
- 2022
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Ingår i: Liver international (Print). - : Wiley. - 1478-3223 .- 1478-3231. ; 42:12, s. 2769-2780
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims Several genotypes associate with a worse histopathological profile in patients with non-alcoholic fatty liver disease (NAFLD). Whether genotypes impact long-term outcomes is unclear. We investigated the importance of PNPLA3, TM6SF2, MBOAT7 and GCKR genotype for the development of severe outcomes in NAFLD. Method DNA samples were collected from 546 patients with NAFLD. Advanced fibrosis was diagnosed by liver biopsy or elastography. Non-alcoholic steatohepatitis (NASH) was histologically defined. Additionally, 5396 controls matched for age, sex and municipality were identified from population-based registers. Events of severe liver disease and all-cause mortality were collected from national registries. Hazard ratios (HRs) adjusted for age, sex, body mass index and type 2 diabetes were estimated with Cox regression. Results In NAFLD, the G/G genotype of PNPLA3 was associated with a higher prevalence of NASH at baseline (odds ratio [OR] 3.67, 95% CI = 1.66-8.08), but not with advanced fibrosis (OR 1.81, 95% CI = 0.79-4.14). After up to 40 years of follow-up, the PNPLA3 G/G genotype was associated with a higher rate of severe liver disease (adjusted hazard ratio [aHR] 2.27, 95% CI = 1.15-4.47) compared with the C/C variant. NAFLD patients developed cirrhosis at a higher rate than controls (aHR 9.00, 95% CI = 6.85-11.83). The PNPLA3 G/G genotype accentuated this rate (aHR 23.32, 95% = CI 9.14-59.47). Overall mortality was not affected by any genetic variant. Conclusion The PNPLA3 G/G genotype is associated with an increased rate of cirrhosis in NAFLD. Our results suggest that assessment of the PNPLA3 genotype is of clinical relevance in patients with NAFLD to individualize monitoring and therapeutic strategies.
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| 5. |
- Holmer, Magnus, et al.
(författare)
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Extended lymph node dissection in patients with urothelial cell carcinoma of the bladder: can it make a difference?
- 2009
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Ingår i: World Journal of Urology. - : Springer Science and Business Media LLC. - 1433-8726 .- 0724-4983. ; 27, s. 521-526
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We compared extended and limited lymph node dissections performed during radical cystectomy with regard to impact on survival and time to recurrence in bladder cancer patients. METHODS: We analyzed 170 patients who underwent radical cystectomy for urothelial carcinoma between January 1997 and December 2005. From 1997 to 2000, 69 of the patients were subjected to limited lymph dissection that included perivesical nodes and nodes in the obturator fossa. In 2001-2005, the remaining 101 patients underwent extended lymph dissection that included perivesical nodes; nodes in the obturator fossa; the internal, external, and common iliac nodes; and the presacral nodes. RESULTS: Tumors penetrating the bladder wall (pT3 and pT4a) were more common in the extended than in the limited dissection group (48 and 33%, respectively). The median numbers of lymph nodes removed in the two groups were 37 and 8, respectively. Lymph node metastases were detected in 38% of the extended dissection patients but only in 17% of the limited dissection patients. There was no significant difference in survival or time to recurrence between the two groups. Subgroup analyses showed a significantly longer time to recurrence (HR 0.45, 95% CI 0.22-0.93; P = 0.032) in patients with non-organ-confined disease who underwent extended lymph node dissection. In a multivariate analysis adjusting for tumor stage, lymph node status, age, sex, and adjuvant chemotherapy, there was a significantly improved survival (HR 0.47, 95% CI 0.25-0.88; P = 0.018) and time to recurrence (HR 0.42, 95% CI 0.23-0.79; P = 0.007) in the patients with extended lymph node dissections. CONCLUSIONS: Extended lymph node dissection did not improve disease-specific survival, but was in multivariate analysis related to significantly improved disease-specific survival and prolonged time to recurrence in radical cystectomy patients. These results should be interpreted cautiously, since they might have been affected by stage migration and the shorter follow-up in the extended dissection group.
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| 6. |
- Isaksson, Sofia Sterner, et al.
(författare)
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Discordance between mean glucose and time in range in relation to HbA1c in individuals with type 1 diabetes: results from the GOLD and SILVER trials
- 2024
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Ingår i: DIABETOLOGIA. - : SPRINGER. - 0012-186X .- 1432-0428.
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis Previous studies have shown that individuals with similar mean glucose levels (MG) or percentage of time in range (TIR) may have different HbA(1c) values. The aim of this study was to further elucidate how MG and TIR are associated with HbA(1c). Methods Data from the randomised clinical GOLD trial (n=144) and the follow-up SILVER trial (n=98) of adults with type 1 diabetes followed for 2.5 years were analysed. A total of 596 paired HbA(1c)/continuous glucose monitoring measurements were included. Linear mixed-effects models were used to account for intra-individual correlations in repeated-measures data. Results In the GOLD trial, the mean age of the participants (+/- SD) was 44 +/- 13 years, 63 (44%) were female, and the mean HbA(1c) (+/- SD) was 72 +/- 9.8 mmol/mol (8.7 +/- 0.9%). When correlating MG with HbA(1c), MG explained 63% of the variation in HbA(1c) (r=0.79, p<0.001). The variation in HbA(1c) explained by MG increased to 88% (r=0.94, p value for improvement of fit <0.001) when accounting for person-to-person variation in the MG-HbA(1c) relationship. Time below range (TBR; <3.9 mmol/l), time above range (TAR) level 2 (>13.9 mmol/l) and glycaemic variability had little or no effect on the association. For a given MG and TIR, the HbA(1c) of 10% of individuals deviated by >8 mmol/mol (0.8%) from their estimated HbA(1c) based on the overall association between MG and TIR with HbA(1c). TBR and TAR level 2 significantly influenced the association between TIR and HbA(1c). At a given TIR, each 1% increase in TBR was related to a 0.6 mmol/mol lower HbA(1c) (95% CI 0.4, 0.9; p<0.001), and each 2% increase in TAR level 2 was related to a 0.4 mmol/mol higher HbA(1c) (95% CI 0.1, 0.6; p=0.003). However, neither TIR, TBR nor TAR level 2 were significantly associated with HbA(1c) when accounting for MG. Conclusions/interpretation Inter-individual variations exist between MG and HbA(1c), as well as between TIR and HbA(1c), with clinically important deviations in relatively large groups of individuals with type 1 diabetes. These results may provide important information to both healthcare providers and individuals with diabetes in terms of prognosis and when making diabetes management decisions.
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| 7. |
- Jansson, Tomas, et al.
(författare)
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An ultrasonic method for detection of fluid properties in the paranasal sinuses
- 2005
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Ingår i: Proceedings of the International Federation for Medical & Biomedical Engineering. 13th Nordic Baltic Conference on Biomedical Engineering and Medical Physics. - 9173059102 ; , s. 115-116
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Konferensbidrag (refereegranskat)abstract
- We propose a method for detection of the degree of infection in the paranasal sinuses utilizing a previously published method whereby the viscosity in a sealed container may be measured using an ultrasound Doppler method. As ultrasound propagates in a liquid medium, due to attenuation, the resulting pressure gradient will cause the liquid to move in the propagation direction - the wellknown effect of acoustic streaming. The streaming velocity will, for a given acoustic output, be proportional to the viscosity of the fluid. In this study, we verify that acoustic streaming can be induced in an anthropomorphic sinus phantom cast from a human cranium. The sinus phantom was made from agar with added graphite providing sound attenuation prior to the sinus cavity corresponding to an in vivo situation. A number of water-glycerol solutions with scattering particles, were prepared to mimic a clinically interesting range of viscosities (7-47 mPas). Using a 4.2 MHz continuous wave Doppler probe, clearly detectable Doppler shifts in the range of 6.5 to 20 Hz were recorded. A linear relationship was found between the Doppler shifts and 1/viscosity (R2=0.94, corrected for the square-law dependence of sound speed variation due to varying glycerol concentration)
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| 8. |
- Jansson, Tomas, et al.
(författare)
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Ultrasound Doppler for improved diagnosis of disease in the paranasal sinuses
- 2005
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Ingår i: Proceedings - IEEE Ultrasonics Symposium. - 1051-0117. - 0780393821 ; 2, s. 839-841
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Konferensbidrag (refereegranskat)abstract
- We propose a method to improve the diagnosis of infection in the paranasal sinuses, distinguishing between mucous and serous cases. The method utilizes a previously published method whereby the viscosity in a sealed container may be measured using an ultrasound Doppler method. As ultrasound propagates in a liquid medium, due to attenuation, the resulting pressure gradient will cause the liquid to move in the propagation direction - the wellknown effect of acoustic streaming. The streaming velocity will, for a given acoustic output, be proportional to the viscosity of the fluid. In this study, we verify that acoustic streaming can be induced in an anthropomorphic sinus phantom cast from a human cranium. The sinus phantom was made from agar with added graphite providing sound attenuation prior to the sinus cavity corresponding to an in vivo situation. A number of water-glycerol solutions with scattering particles, were prepared to mimic a clinically interesting range of viscosities (7-47 mPas). Using a 4.2 MHz continuous wave Doppler probe, clearly detectable mean Doppler shifts in the range of 6.5 to 20 Hz were recorded A linear relationship was found between the Doppler shifts and 1/viscosity (R2=0.94, corrected for the square-law dependence of sound speed variation due to varying glycerol concentration).
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| 9. |
- Jönsson, Peter, et al.
(författare)
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Feasibility of measuring acoustic streaming for improved diagnosis of rhinosinusitis
- 2008
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Ingår i: Ultrasound in Medicine and Biology. - : Elsevier BV. - 0301-5629. ; 34:2, s. 228-238
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Tidskriftsartikel (refereegranskat)abstract
- No noninvasive methods exist currently with the capability of distinguishing between various stages of a sinus infection. We studied a method based on induced acoustic streaming in the accumulated fluid within the maxillary sinuses. The hypothesis was that acoustic streaming will not be induced at clinically acceptable intensity levels in infectious mucous fluid because of its high viscosity, whereas detected acoustic streaming is a strong indication that the sinus content is a noninfectious serous fluid. As a model, an anthropomorphic sinus phantom with bovine cortical bone to mimic the bone surrounding the maxillary sinus was constructed. Milk (1.5% fat content) was used as model fluid. From fluid and bone attenuation measurements, an ultrasound frequency of about 5 MHz was estimated to produce the highest acoustic streaming in the sinus phantom. Simulations of the acoustic streaming in a sealed cavity also showed that the width of the ultrasound beam should be about half the size of the cavity to optimize the streaming velocity. With a 4.9-MHz continuous-wave transducer operating at a spatial peak temporal average intensity of 640 mW/cm(2), an acoustic streaming velocity of 0.19 cm/s was generated and detected in the sinus phantom.
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| 10. |
- Liedberg, Fredrik, et al.
(författare)
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Preoperative staging of locally advanced bladder cancer before radical cystectomy using 3 tesla magnetic resonance imaging with a standardized protocol
- 2013
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Ingår i: Scandinavian Journal of Urology. - : Informa UK Limited. - 2168-1813 .- 2168-1805. ; 47:2, s. 108-112
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The correlation between clinical tumour stage and pathological tumour stage in radical cystectomy specimens in locally advanced bladder cancer is suboptimal. Radiological methods have so far been of limited value in preoperative staging; however, the resolution with magnetic resonance imaging (MRI) has improved with further technical developments of the method. The aim of this study was to compare tumour stage at MRI with pathological tumour stage in the cystectomy specimen. Material and methods. Prospectively, 53 patients with invasive bladder cancer were preoperatively investigated with 3 tesla (3T) MRI using a standardized protocol. 3T MRI was performed at a standardized bladder volume. Clinical tumour stage, tumour stage at MRI and pathological tumour stage groups (Ta, Cis, T1/T2a, T2b/T3a, T3b/T4a), were compared, and sensitivity and specificity for organ-confined and non-organ-confined disease (stage T3a or above or lymph-node metastases) were analysed. Results. MRI overestimated tumour stage in 23 out of 47 patients (49%), whereas six patients (13%) were understaged. In the three groups of patients (those with the same stage group at MRI as in the cystectomy specimen, overestimated tumour stage and understaged patients), the time interval between transurethral resection of the bladder (TURB) and MRI did not differ significantly. Conclusions. Preoperative MRI overestimated tumour stage in almost half of the patients investigated in this study. Postoperative changes could have contributed to such overstaging with MRI.
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| 11. |
- Malm, Joakim, et al.
(författare)
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UTVÄRDERING AV SI-VERKSAMHETEN VID LUNDS UNIVERSITET 2016/17
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Samverkansinlärning/Supplemental Instruction (SI) är en pedagogisk metod som syftar till att öka genomströmningen i svåra kurser. Metoden uppstod i USA vid University of Missouri Kansas City i mitten på 1970-talet och har därefter spridits till mer än 1500 högre lärosäten i ett trettiotal länder (Martin, 2008). Kort kan SI sägas vara ett studentdrivet komplement till ordinarie undervisning vid högre utbildning. Material i en kurs bearbetas tillsammans i en studiegrupp genom diskussion och grupparbeten under ledning av en äldre student – den s.k. SI-ledaren. Samverkansinlärning kom till Lunds universitet 1994 och har fått stor spridning på universitetet. Lund universitet utgör också ett nav för SI både i Sverige (SI finns på ca 15 svenska högre lärosäten) och i Europa och är också platsen för det nordeuropeiska SI-centret som ansvarar för utbildning och uppföljning i området på uppdrag av det internationella SI-centret i USA. Denna rapport sammanfattar resultaten från en utvärdering av SI-verksamheten vid Lunds universitet under läsåret 2016/17. SI-programmet vid Lunds universitet är omfattande med verksamhet på sex av universitetets fakulteter. Totalt har vi årligen ca 230 verksamma SIledare i ett sjuttiotal kurser. Organisationen av SI varierar mellan de olika fakulteterna. En ytterlighet finns vid LTH och naturvetenskaplig fakultet där verksamheten är starkt centraliserad. Den andra ytterligheten är vid samhällsvetenskaplig fakultet där SI-verksamheten är decentraliserad till de olika ämnena. Det som förenar de olika verksamhetsansvariga är den entusiasm som finns för SI-konceptet samt de dedikerade studenter som är SI-ledare. Närvaron på SI-möten är relativt god. Totalt har vi över 4000 studenter vid Lunds universitet som nyttjar SI varje år och en närvaro kring 30 % av kursregistrerade i snitt. Antalet deltagare på ett SI-möte ligger kring 10 i medeltal med en standardavvikelse kring 5 studenter, vilket ger goda förutsättningar för produktiva SI-möten generellt sett. De utvärderingar som gjorts av sambandet mellan SI-närvaro och kursresultat antyder att aktivt deltagande på SI ökar chanserna till ett bra resultat på kursen oavsett ämne. En specialundersökning i en kurs i matematik antyder också att alla studenter verkar gynnas av att gå på SI oavsett förkunskapsnivå. Enkätutvärderingar bland deltagarna antyder att den främsta drivkraften att delta på SI är att förstå kursmaterialet oavsett ämne och fakultet. Strategiska motiv som att klara kursen är normalt underordnade även om detta varierar beroende på fakultet/ämne. Det är roligt att konstatera att studiesocial interaktion mestadels värderas högt som motiv att delta på SI. Arbetsmiljön på SI upplevs som bra (lätt att fråga, lättsam, positiv och stödjande atmosfär samt lagom tempo) och generellt verkar mötena följa SI-metodiken väl. Oavsett fakultet verkar majoriteten av deltagarna känna att SI-mötena hjälper dem i deras kursarbete. De får en bättre förståelse av vad som förväntas av dem i kursen, ett ökat intresse för ämnet samt stöd i kursarbetet. De allra flesta verkar känna att de får en betydligt djupare förståelse för det kursmaterial man går igenom på SI-mötena. Dessutom upplever många att de sannolikt kommer att förbättra sitt kursresultat genom deltagande på SI. Detta antagande stödjs också som nämnts ovan av SI-närvaro och examinationsstatistik från kurser och ju högre SI närvaro desto bättre verkar det gå oavsett ämnesområde. Att döma av deltagarnas enkätsvar är det inte bara kursen med tillhörande SI som gynnas av SI-deltagande. Flera generella färdigheter tränas som bör gynna studenter i studier i andra kurser utan SI. Många deltagare upplever att färdigheter som problemlösningsförmåga, kritiskt tänkande, lagsamverkan och samarbete, presentation inför andra och sätt att studera utvecklats genom att delta på SI. Dessutom får flera ett förbättrat självförtroende i sina studier samt ett ökat nätverk av studiekamrater. Tidigare studier vid LTH antyder att de som deltagit på SI också presterar bättre i andra kurser utan SI och att de är mindre benägna att göra studieavbrott och tar ut examen i högre utsträckning (Malm, Bryngfors, & Mörner, 2012; Malm, Bryngfors, & Mörner, 2015; Malm, Bryngfors, & Fredriksson, 2017). Deltagarnas svar på frågan med ”Vad tycker du är det bästa med SI-mötena?” betonar möjligheten till diskussion och social interaktion, en god studiemiljö samt förståelseinriktad studietid. Detta gäller oavsett ämnesområde. Vad kan då förbättras med SI-mötena? Några antyder att strukturen/effektiviteten på mötena kan vara bristande. Detta kan i sin tur bero av att stödet för SI-ledare i form av observationer och handledning inte alltid fungerar som det skall. Detta är något att titta närmare på inom universitetet. Annat som kan förbättras med SI-verksamheten är att man vill ha fler möten, mer tid till mötena eller bättre schematider. Internationellt anses det ofta att SI-ledarna är de största ”vinnarna” i SI-konceptet pga de ledarskaps- och grupphanteringsfärdigheter de erhåller. Detta antyds även i enkätutvärderingarna för SI-ledare vid Lunds universitet. SI-ledarna verkar dessutom få ett bättre självförtroende, djupare förståelse av kursämnet samt bli bättre på att prata inför andra. Både deltagare och SI-ledare är generellt nöjda med sina möten.
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| 12. |
- Pylov, Daniel, et al.
(författare)
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Treatment Satisfaction and Well-Being With CGM in People With T1D: An Analysis Based on the GOLD Randomized Trial
- 2023
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Ingår i: Journal of Diabetes Science and Technology. - : Sage Publications. - 1932-2968.
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Tidskriftsartikel (refereegranskat)abstract
- Background: The GOLD trial demonstrated that continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D) managed with multiple daily insulin injections (MDI) improved not only glucose control but also overall well-being and treatment satisfaction. This analysis investigated which factors contributed to improved well-being and treatment satisfaction with CGM. Methods: The GOLD trial was a randomized crossover trial comparing CGM versus self-monitored blood glucose (SMBG) over 16 months. Endpoints included well-being measured by the World Health Organization-Five Well-Being Index (WHO-5) and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire (DTSQ) as well as glucose metrics. Multivariable R-2-decomposition was used to understand which variables contributed most to treatment satisfaction. Results: A total of 139 participants were included. Multivariable analyses revealed that increased convenience and flexibility contributed to 60% (95% confidence interval [CI] = 50%-69%) of the improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version [DTSQc]) observed with CGM, whereas perceived effects on hypoglycemia and hyperglycemia only contributed to 6% (95% CI = 2%-11%) of improvements. Significant improvements in well-being (WHO-5) by CGM were observed for the following: feeling cheerful (P = .025), calm and relaxed (P = .024), being active (P = .046), and waking up fresh and rested (P = .044). HbA1c reductions and increased time in range (TIR) were associated with increased treatment satisfaction, whereas glycemic variability was not. HbA1c reduction showed also an association with increased well-being and increased TIR with less diabetes-related distress. Conclusions: While CGM improves glucose control in people with T1D on MDI, increased convenience and flexibility through CGM is of even greater importance for treatment satisfaction and patient well-being. These CGM-mediated effects should be taken into account when considering CGM initiation.
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| 13. |
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| 14. |
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| 15. |
- Yang, Wen, et al.
(författare)
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Risk of major adverse liver outcomes among first-degree relatives of individuals with MASLD
- 2024
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Ingår i: LIVER INTERNATIONAL. - : WILEY. - 1478-3223 .- 1478-3231.
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Tidskriftsartikel (refereegranskat)abstract
- Background & AimsPrevious studies have suggested an increased risk of major adverse liver outcomes (MALO) in relatives of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). However, granular and longitudinal evidence is lacking on the future risk of MALO among family members of individuals with MASLD.MethodsWe identified 3526 first-degree relatives (FDRs) and 11 079 general population comparators to 1328 patients with MASLD diagnosed between 1974 and 2021, with detailed clinical data, including liver histology in 71% of patients. MALO was defined through diagnostic coding for cirrhosis or its complications. Cox regression models were used to estimate adjusted hazard ratios (aHRs) for MALO among FDRs compared to general population comparators. Cumulative incidence accounting for competing risks was calculated.ResultsDuring a median follow-up of 13.4 years, there were 65 (2%, 1.12/1000 person-years) and 225 (2%, 1.26/1000 person-years) MALO events in FDRs and general population comparators respectively. After adjusting for demographic factors and comorbidities, FDRs were at no increased risk of MALO (aHR = 0.99, 95% CI: 0.74-1.33). Increased relative rates of MALOs were, however, observed in some subgroups, including parents, although absolute risk estimates were low and comparable to the general population.ConclusionsFDRs of patients with MASLD did not have a higher rate of incident MALO than the general population. Since the absolute risk of MALO in relatives of patients with MASLD was low, these results do not support systematic screening of MASLD-related fibrosis in relatives of patients with MASLD.
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