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- Jansson, Stefan P.O. 1959-
(författare)
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A Longitudinal Study of Diabetes Mellitus : With Special Reference to Incidence and Prevalence, and to Determinants of Macrovascular Complications and Mortality
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives. To investigate diabetes prevalence, incidence, mortality trends, the effects of hyperglycaemia and blood pressure, diabetes and hypertension treatment, and the effect of screening detection on total and cardiovascular disease (CVD), myocardial infarction (MI) and stroke incidence.Study population and methods. Between 1972 and 2001 all patients with diabetes, some detected clinically and some by case-finding procedures (screening), were entered in a diabetes register at Laxå Primary Health Care Center in Sweden. The register included information on medical treatment and laboratory data as well as information on mortality and morbidity from National Registers. The register was supplemented with five non-diabetic subjects, matched to each diabetes patients by age, sex, and year of detection.Results. During the study period 776 new diabetes cases was found, 36 type 1 diabetes mellitus and 740 type 2 diabetes mellitus. Age standardised incidence and prevalence rates for type 1 and type 2 diabetes did not increase over time. Diabetic patients had 17% higher mortality rate than non-diabetic persons, 22% in women and 13% in men. The corresponding over-mortality in CVD was 33%, 41% in women and 27% in men. CVD mortality decreased across time in non-diabetic subjects and in diabetic men but not in diabetic women. Results regarding coronary heart disease (CHD) were similar. CVD incidence increased with fasting blood glucose (FBG), body mass index (BMI), mean arterial blood pressure (MABP), and decreased with metformin treatment and sulfonylurea. Myocardial infarction incidence increased with FBG, BMI and MABP, and decreased with metformin treatment. Stroke incidence increased with MABP. There was no difference in prognoses between those detected by screening or clinically.Conclusions. Diabetes prevalence and incidence did not change over time. The over-mortality according to diabetes was moderate. CVD and MI during follow up were negatively affected by hypertension and hyperglycaemia, and positively by pharmacological diabetic treatment. For stroke no pharmacological protective effect was seen. Screening did not improve prognosis.
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| 2. |
- Jansson, Stefan P. O., 1959-, et al.
(författare)
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Effects of fasting blood glucose levels and blood pressure and treatment of diabetes and hypertension on the incidence of cardiovascular disease : a study of 740 patients with incident Type 2 diabetes with up to 30 years' follow-up
- 2014
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Ingår i: Diabetic Medicine. - : Wiley-Blackwell. - 0742-3071 .- 1464-5491. ; 31:9, s. 1055-1063
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To analyse the effects of hyperglycaemia and hypertension and treatment of diabetes and hypertension on cardiovascular disease incidence in patients with Type 2 diabetes with up to 30 years of follow-up.Methods: A total of 740 patients with incident Type 2 diabetes were registered at the Laxa Primary Health Care Centre, Sweden between 1972 and 2001. Annual data on mean fasting blood glucose, systolic, diastolic and mean arterial blood pressure, and type of diabetes and hypertension treatment were obtained from patient records, and information on cardiovascular disease, myocardial infarction and stroke events was obtained from national registers.Results: During the follow-up period, cumulative cardiovascular disease incidence increased significantly with male sex (hazard ratio 1.48, 95% CI 1.21-1.82), number of previous cardiovascular disease events (hazard ratio 1.13, 95% CI 1.08-1.18), age, per year (HR 1.05, 95% CI 1.04-1.07), mean fasting blood glucose, per mmol/l (hazard ratio 1.05, 95% CI 1.00-1.10) BMI (hazard ratio 1.04, 95% CI 1.01-1.06), mean arterial blood pressure, per mmHg (hazard ratio 1.02, 95% CI 1.01-1.03), and decreased significantly with metformin treatment (hazard ratio 0.58, 95% CI 0.38-0.90) and sulfonylurea (hazard ratio 0.73, 95% CI 0.55-0.97). Cumulative myocardial infarction incidence increased significantly with male sex, number of previous myocardial infarction events, mean fasting blood glucose level, BMI, age and mean arterial blood pressure, and decreased with metformin treatment. Cumulative stroke incidence increased with number of previous stroke events, age and mean arterial blood pressure.Conclusions: The cumulative incidence of cardiovascular disease and myocardial infarction increased with number of previous events and presence of hyperglycaemia and hypertension and decreased with pharmacological treatment of diabetes. A higher number of previous stroke events increased the cumulative incidence of stroke but no protective effect of pharmacological treatment was observed.
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| 3. |
- Jansson, Stefan P. O., 1959-, et al.
(författare)
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Interventions for lifestyle changes to promote weight reduction, a randomized controlled trial in primary health care
- 2013
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Ingår i: BMC Research Notes. - UK : BioMed Central Ltd.. - 1756-0500. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Overweight and obesity are growing public health problems in high income countries and is now growing at a dramatic pace in low and middle income countries, particularly in urban settings. The aim of this trial was to examine the effects of a weight reduction program in adults and to determine whether or not a more extensive intervention was superior to ordinary care.Methods: Patients seeking advice for overweight/obesity or illness related to overweight/obesity at eight primary health care centers in Sweden were randomized either to intervention or control care groups with both groups given dietary advice and individualized information on increased regular physical activity. In the intervention group advice was more extensive and follow-up more frequent than in the control group during the study period of two years. Main outcome measure was reduction in body weight of five percent or more from study start.Results: From October 2004 to April 2006, 133 patients, 67 in the intervention group and 66 in the control group, were randomized over a period of 18 months. Target weight was achieved at 12 months by 26.7% of the patients in the intervention group compared with 18.4% in the control group (p = 0.335). There was an average absolute weight loss of 2.5 kg in the intervention group and 0.8 kg in the control group at 12 months as compared with the weight at study entry. There were no significant differences between the groups in quality of life, blood glucose and lipids. At 24 months target weight was achieved in 21.9% versus 15.6%, with an average weight reduction of 1.9 kg and 1.2 kg in the two groups, respectively.Conclusions: Promotion of a diet with limited energy intake, appropriate composition of food and increased physical activity had limited effects on body weight in a Swedish primary care setting. More extensive advice and more frequent visits made no significant difference to the outcome.
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| 4. |
- Jansson, Stefan P. O., 1959-
(författare)
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Överdödligheten vid diabetes minskar
- 2010
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Ingår i: Läkartidningen. - Stockholm : Läkartidningen förlag. - 0023-7205 .- 1652-7518. ; :7
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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