| 1. |
- Anderson, J., et al.
(författare)
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Effect on glycemic control by short- and long-term use of continuous glucose monitoring in clinical practice
- 2011
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Ingår i: Journal of diabetes science and technology. - : SAGE Publications. - 1932-2968. ; 5:6, s. 1472-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In Sweden, patients with diabetes mellitus frequently receive short-term (<3 months) continuous glucose monitoring (CGM) to study glucose patterns or long-term CGM to treat poor glycemic control or severe hypoglycemia. The effects of CGM on glycemic control in clinical practice in relation to indication and duration of use has not been completely studied. METHODS: Patients with diabetes, among which 99% were diagnosed as type 1, receiving CGM at 10 outpatient clinics in Sweden were studied retrospectively. Long-term use of CGM was defined as >/= 3 months use of CGM and short-term as <3 months. A control group matched on start date and date of latest value 3 months after the start was selected for both long- and short-term groups. RESULTS: In 34 long-term users of CGM, over a mean follow-up of 1.1 years, the adjusted mean difference of hemoglobin A1c (HbA1c) compared with controls (n = 408) was -0.76 (95% confidence interval -1.17; -0.33, p < .001). Long-term users with indications for high HbA1c (n = 15) had a reduction of 1.2% in HbA1c from 10.1 to 8.9% (p = .003), whereas patients with hypoglycemia as their indication (n = 16) decreased by 0.3% (p = .17). Nonsevere hypoglycemic events decreased in long-term users within the same follow-up period (p = .004). Short-term users showed no statistically significant improvement in HbA1c compared with controls at 1.1 years (n = 41), p = .85 or at 2.6 years (n = 43), p = .19. CONCLUSION: Long-term CGM use was associated with improved glycemic control in clinical practice and a reduction in nonsevere hypoglycemic events, whereas short-term use had no effect on HbA1c. The effect on glycemic control varied by indication.
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| 2. |
- Arnold, S. V., et al.
(författare)
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The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction
- 2014
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Ingår i: BMJ Open Diabetes Research and Care. - : BMJ. - 2052-4897. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Incident diabetes mellitus (DM) is important to recognize in patients with acute myocardial infarction (AMI). To develop an efficient screening strategy, we explored the use of random plasma glucose (RPG) at admission and fasting plasma glucose (FPG) to select patients with AMI for glycosylated hemoglobin (HbA1c) testing. DESIGN SETTING ANDPARTICIPANTS: Prospective registry of 1574 patients with AMI not taking glucose-lowering medication from 24 US hospitals. All patients had HbA1c measured at a core laboratory and admission RPG and >/=2 FPGs recorded during hospitalization. We examined potential combinations of RPG and FPG and compared these with HbA1c>/=6.5%-considered the gold standard for DM diagnosis in these analyses. RESULTS: An RPG>140 mg/dL or FPG>/=126 mg/dL had high sensitivity for DM diagnosis. Combining these into a screening protocol (if admission RPG>140, check HbA1c; or if FPG>/=126 on a subsequent day, check HbA1c) led to HbA1c testing in 50% of patients and identified 86% with incident DM (number needed to screen (NNS)=3.3 to identify 1 case of DM; vs NNS=5.6 with universal HbA1c screening). Alternatively, using an RPG>180 led to HbA1c testing in 40% of patients with AMI and identified 82% of DM (NNS=2.7). CONCLUSIONS: We have established two potential selective screening methods for DM in the setting of AMI that could identify the vast majority of incident DM by targeted screening of 40-50% of patients with AMI with HbA1c testing. Using these methods may efficiently identify patients with AMI with DM so that appropriate education and treatment can be promptly initiated.
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| 3. |
- Berndt, Sonja I., et al.
(författare)
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Genome-wide meta-analysis identifies 11 new loci for anthropometric traits and provides insights into genetic architecture
- 2013
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 45:5, s. 501-U69
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Tidskriftsartikel (refereegranskat)abstract
- Approaches exploiting trait distribution extremes may be used to identify loci associated with common traits, but it is unknown whether these loci are generalizable to the broader population. In a genome-wide search for loci associated with the upper versus the lower 5th percentiles of body mass index, height and waist-to-hip ratio, as well as clinical classes of obesity, including up to 263,407 individuals of European ancestry, we identified 4 new loci (IGFBP4, H6PD, RSRC1 and PPP2R2A) influencing height detected in the distribution tails and 7 new loci (HNF4G, RPTOR, GNAT2, MRPS33P4, ADCY9, HS6ST3 and ZZZ3) for clinical classes of obesity. Further, we find a large overlap in genetic structure and the distribution of variants between traits based on extremes and the general population and little etiological heterogeneity between obesity subgroups.
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| 4. |
- Carlsson, Britt-Marie, et al.
(författare)
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Availability of insulin pump therapy in clinical practice
- 2012
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 29:8, s. 1055-1059
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Tidskriftsartikel (refereegranskat)abstract
- Diabet. Med. 29, 10551059 (2012) Aim To examine the availability of insulin pump therapy in patients with Type 1 diabetes. Methods Patients using insulin pumps among a cohort of 7224 patients with Type 1 diabetes were studied. Results In logistic regression, used to evaluate variables not changing over time among the total cohort, use of insulin pumps varied by outpatient clinic (P < 0.001) and sex (P < 0.001). Cox regression analysis in 5854 patients with detailed patient data prior to use of an insulin pump showed higher HbA1c (P < 0.0001), lower creatinine (P = 0.002), high and low insulin doses (P < 0.0001), younger age (P < 0.0001) and female sex (P < 0.0001) to be associated with use of an insulin pump. Women were 1.5-fold more likely to start using an insulin pump (hazard ratio 1.52, 95% confidence interval 1.291.79) and patients in the 20- to 30-years age range were more than twice as likely to begin use of an insulin pump than patients aged 4050 years (hazard ratio 8.63, 95% confidence interval 5.9112.59 and hazard ratio 3.98, 95% confidence interval 2.805.64, respectively). A 10-mu mol/l higher level of creatinine was associated with a hazard ratio of 0.56 (95% confidence interval 0.390.81) of starting use of an insulin pump. Conclusions At 10 hospital outpatient clinics in Sweden, use of insulin pumps therapy varied by clinic. A higher proportion of women began using insulin pumps. Younger patients and patients with fewer complications were also more likely to start using an insulin pump. Further research is needed to confirm these findings in other geographical regions and to understand whether the availability of insulin pumps today is optimized.
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| 5. |
- Carlsson, Britt-Marie, et al.
(författare)
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Insulin Pump-Long-Term Effects on Glycemic Control: An Observational Study at 10 Diabetes Clinics in Sweden
- 2013
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 15:4, s. 302-307
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study examined long-term effects of continuous subcutaneous insulin infusion (CSII) in clinical practice on glycemic control in patients with type 1 diabetes. Subjects and Methods: We evaluated all type 1 diabetes patients at 10 diabetes outpatient clinics in Sweden who had been treated with CSII for at least 5.5 years and had valid glycated hemoglobin (HbA1c) data before starting pump use and at 5 years±6 months. Controls treated with multiple daily insulin injections (MDI) over a time-matched period were also evaluated. Results: There were 331 patients treated with CSII at least 5.5 years at the 10 clinics. Of these, 272 (82%) fulfilled the inclusion criteria. Patients treated with CSII were younger than those treated with MDI (mean age, 38.6 vs. 45.6 years; P<0.001), more were women (56% vs. 43%; P<0.001), and diabetes duration was shorter (mean, 15.1 years vs. 20.1 years; P<0.001). After adjusting for variables differing at baseline and influencing the change in HbA1c over the study period, the reduction in HbA1c remained statistically significant at 5 years and was estimated to be 0.20% (95% confidence interval [CI] 0.07–0.32) (2.17mmol/mol [95% CI 0.81–3.53]) (P=0.002). The corresponding adjusted reduction at years 1 and 2 was 0.42% (95% CI 0.31–0.53) (4.59mmol/mol [95% CI 3.41–5.77]) (P<0.001) and 0.43% (95% CI 0.31–0.55) (4.71mmol/mol [95% CI 3.38–6.04]) (P<0.001), respectively. The effect of insulin pump use versus controls on HbA1c decreased significantly with time (P<0.001). Conclusions: Use of CSII in clinical practice in Sweden is associated with an approximately 0.2% (2mmol/mol) reduction in HbA1c after 5 years.
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| 6. |
- Clements, M. A., et al.
(författare)
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Age at diagnosis predicts deterioration in glycaemic control among children and adolescents with type 1 diabetes
- 2014
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Ingår i: BMJ Open Diabetes Research and Care. - : BMJ. - 2052-4897 .- 2052-4897. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Poor glycemic control early in the course of type 1 diabetes mellitus (T1DM) increases the risk for microvascular complications. However, predictors of deteriorating control after diagnosis have not been described, making it difficult to identify high-risk patients and proactively provide aggressive interventions. OBJECTIVE: We examined whether diagnostic age, gender, and race were associated with deteriorating glycemic control during the first 5 years after diagnosis. PARTICIPANTS: 2218 pediatric patients with T1DM. METHODS: We conducted a longitudinal cohort study of pediatric patients with T1DM from the Midwest USA, 1993-2009, evaluating within-patient glycated hemoglobin (HbA1c) trajectories constructed from all available HbA1c values within 5 years of diagnosis. RESULTS: 52.6% of patients were male; 86.1% were non-Hispanic Caucasian. The mean diagnostic age was 9.0+/-4.1 years. The mean number of HbA1c values/year/participant was 2.4+/-0.9. HbA1c trajectories differed markedly across age groups, with older patients experiencing greater deterioration than their younger counterparts (p<0.001). HbA1c trajectories, stratified by age, varied markedly by race (p for racexdiagnostic age <0.001). Non-Hispanic African-American patients experienced higher initial HbA1c (8.7% vs 7.6% (71.6 vs 59.6 mmol/mol); p<0.001), and greater deterioration in HbA1c than non-Hispanic Caucasian patients across diagnostic ages (rise of 2.04% vs 0.99% per year (22.3 vs 10.8 mmol/mol/year); p<0.0001). CONCLUSIONS: Older diagnostic age and black race are major risk factors for deterioration in glycemic control early in the course of T1DM. These findings can inform efforts to explore the reasons behind these differences and develop preventive interventions for high-risk patients.
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| 7. |
- Do, Ron, et al.
(författare)
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Common variants associated with plasma triglycerides and risk for coronary artery disease
- 2013
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 45:11, s. 1345-
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Tidskriftsartikel (refereegranskat)abstract
- Triglycerides are transported in plasma by specific triglyceride-rich lipoproteins; in epidemiological studies, increased triglyceride levels correlate with higher risk for coronary artery disease (CAD). However, it is unclear whether this association reflects causal processes. We used 185 common variants recently mapped for plasma lipids (P < 5 x 10(-8) for each) to examine the role of triglycerides in risk for CAD. First, we highlight loci associated with both low-density lipoprotein cholesterol (LDL-C) and triglyceride levels, and we show that the direction and magnitude of the associations with both traits are factors in determining CAD risk. Second, we consider loci with only a strong association with triglycerides and show that these loci are also associated with CAD. Finally, in a model accounting for effects on LDL-C and/or high-density lipoprotein cholesterol (HDL-C) levels, the strength of a polymorphism's effect on triglyceride levels is correlated with the magnitude of its effect on CAD risk. These results suggest that triglyceride-rich lipoproteins causally influence risk for CAD.
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| 8. |
- Falk Kieri, Catarina, et al.
(författare)
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EDAR-induced hypohidrotic ectodermal dysplasia : a clinical study on signs and symptoms in individuals with a heterozygous c.1072C > T mutation
- 2014
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Ingår i: BMC Medical Genetics. - : BioMed Central. - 1471-2350. ; 15, s. 57-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mutations in the EDAR-gene cause hypohidrotic ectodermal dysplasia, however, the oral phenotype has been described in a limited number of cases. The aim of the present study was to clinically describe individuals with the c.1072C > T mutation (p. Arg358X) in the EDAR gene with respect to dental signs and saliva secretion, symptoms from other ectodermal structures and to assess orofacial function.METHODS: Individuals in three families living in Sweden, where some members had a known c.1072C > T mutation in the EDAR gene with an autosomal dominant inheritance (AD), were included in a clinical investigation on oral signs and symptoms and self-reported symptoms from other ectodermal structures (n = 37). Confirmation of the c.1072C > T mutation in the EDAR gene were performed by genomic sequencing. Orofacial function was evaluated with NOT-S.RESULTS: The mutation was identified in 17 of 37 family members. The mean number of missing teeth due to agenesis was 10.3 ± 4.1, (range 4-17) in the mutation group and 0.1 ± 0.3, (range 0-1) in the non-mutation group (p < 0.01). All individuals with the mutation were missing the maxillary lateral incisors and one or more of the mandibular incisors; and 81.3% were missing all four. Stimulated saliva secretion was 0.9 ± 0.5 ml/min in the mutation group vs 1.7 ± 0.6 ml/min in the non-mutation group (p < 0.01). Reduced ability to sweat was reported by 82% in the mutation group and by 20% in the non-mutation group (p < 0.01). The mean NOT-S score was 3.0 ± 1.9 (range 0-6) in the mutation group and 1.5 ± 1.1 (range 0-5) in the non-mutation group (p < 0.01). Lisping was present in 56% of individuals in the mutation group.CONCLUSIONS: Individuals with a c.1072C > T mutation in the EDAR-gene displayed a typical pattern of congenitally missing teeth in the frontal area with functional consequences. They therefore have a need for special attention in dental care, both with reference to tooth agenesis and low salivary secretion with an increased risk for caries. Sweating problems were the most frequently reported symptom from other ectodermal structures.
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| 9. |
- Glogner, S., et al.
(författare)
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The association between BMI and hospitalization for heart failure in 83 021 persons with Type 2 diabetes: a population-based study from the Swedish National Diabetes Registry
- 2014
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 31:5, s. 586-594
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Tidskriftsartikel (refereegranskat)abstract
- AIM'S: The aim was to To study the relationship between BMI and hospitalization for heart failure in people with Type 2 diabetes. METHODS: We identified 83 021 individuals with Type 2 diabetes from the Swedish National Diabetes Registry during 1998-2003, who were followed until hospitalization for heart failure, death or end of follow-up on 31 December 2009. Cox regression analyses were performed, adjusting for age, sex, HbA1c , blood pressure, diabetes duration, smoking, microalbuminuria, cardiac co-morbidities, glucose-lowering and anti-hypertensive medications. RESULTS: During a median follow-up of 7.2 years, 10 969 patients (13.2%) were hospitalized with heart failure. By categories of BMI, with BMI 20 to < 25 kg/m2 as the reference, hazard ratios for patients during follow-up were 1.07 (95% CI 0.91-1.26) for a mean BMI of < 20 kg/m2 , 1.04 (95% CI 0.98-1.11) for BMI 25 to < 27.5 kg/m2 , 1.22 (95% CI 1.15-1.30) for BMI 27.5 to < 30 kg/m2 , 1.54 (95% CI 1.45-1.63) for BMI 30 to < 35 kg/m2 , 2.16 (95% CI 2.00-2.33) for BMI 35 to < 40 kg/m2 and 3.22 (95% CI 2.88-3.60) for BMI 40 kg/m2 or higher. There was a significant interaction between BMI and sex (P = 0.0006), with numerically higher hazard ratios for hospitalization for heart failure within each BMI category for men than for women. CONCLUSIONS: Obesity is strongly related to hospitalization for heart failure in people with Type 2 diabetes, and the relationship is somewhat stronger for men than for women. Preventing weight gain and promoting weight loss may be crucial in reducing the incidence of future hospitalizations for heart failure in this population.
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| 10. |
- Jansson-Fröjmark, Markus, 1971-, et al.
(författare)
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Don't worry, be constructive : a randomized controlled feasibility study comparing behaviour therapy singly and combined with constructive worry for insomnia
- 2012
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Ingår i: British Journal of Clinical Psychology. - : Wiley-Blackwell. - 0144-6657 .- 2044-8260. ; 51:2, s. 142-157
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Based on the lack of research on interventions targeting intrusive and worrisome thinking for insomnia, the aim was to examine whether a constructive worry (CW) intervention adds to the effects of behaviour therapy (BT).Design: A randomized, controlled design was used. The design included a 2-week baseline, a 4-week intervention phase (sleep restriction and stimulus control [BT] or sleep restriction and stimulus control plus constructive worry [BT + CW]), and a 2-week follow-up.Methods: Twenty-two patients with primary insomnia participated. The primary outcome was the Anxiety and Preoccupation about Sleep Questionnaire (APSQ), and secondary endpoints were subjective sleep estimates, the Insomnia Severity Index (ISI), and the Work and Social Adjustment Scale (WSAS).Results: Although both conditions produced significant improvements in subjective sleep estimates, no significant group differences over time were shown for total wake time (TWT) and total sleep time (TST). Both interventions resulted in reductions over time in insomnia severity, worry, and dysfunction. Compared to BT, BT + CW led to a larger decrease in insomnia severity at all three time points (controlled d= 1.101.68). In comparison with BT, BT + CW resulted in a larger reduction in worry at two of the time points (controlled d= 0.761.64). No significant differences between the two conditions were demonstrated for dysfunction. While more participants responded positively to treatment in the BT + CW (80100%) than in the BT condition (1827%), none of the participants remitted.Conclusions: The findings suggest that, compared to BT alone, CW might result in additional improvements in insomnia severity and worry. Given the small sample size and short follow-up, future studies are warranted.
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