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| 3. |
- Eeg-Olofsson, Katarina, 1968, et al.
(författare)
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Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients.
- 2009
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 52:1, s. 65-73
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Tidskriftsartikel (refereegranskat)abstract
- AIMS/HYPOTHESIS: The aim of this study of type 2 diabetic patients in the Swedish National Diabetes Register was to study the associations of BMI, overweight (BMI 25-29.9 kg/m(2)) and obesity (BMI >or= 30 kg/m(2)) with cardiovascular disease in type 2 diabetes, as these associations have not previously been clarified. METHODS: Patients aged 30-74 years with no previous CHD or stroke (N = 13,087) were followed for a mean of 5.6 years until 2003 for fatal or non-fatal CHD, stroke, cardiovascular disease (CHD or stroke) and total mortality. In total, 1,922 cardiovascular-disease events occurred, based on 64,864 person-years. RESULTS: The relative risks of CHD, stroke, cardiovascular disease and total mortality for a 5 unit increase in BMI at baseline were 15%, 11%, 13% and 27%, respectively, using Cox regression analysis, after adjusting for age, sex, diabetes duration, hypoglycaemic treatment and smoking (model 1), and were 9%, 4% (not significant), 7% and 20%, respectively, when adjusting also for HbA(1c), blood pressure, antihypertensive drugs, lipid-reducing drugs and microalbuminuria (model 2). Adjusted hazard ratios (model 1) for CHD, cardiovascular disease and total mortality with overweight were 1.27 (95% CI 1.09-1.48), 1.24 (1.09-1.41) and 1.16 (0.94-1.45), respectively, and 1.49 (1.27-1.76), 1.44 (1.26-1.64) and 1.71 (1.36-2.14) with obesity, as compared with normal weight. Significant hazard ratios were attenuated when adjusted according to model 2. For a 1 unit increase in BMI during follow-up, the relative risk of CHD (model 2) was 1.13 (1.04-1.23; p = 0.005). CONCLUSIONS/INTERPRETATION: Both overweight and obesity independently increased the risk of CHD and cardiovascular disease in patients with type 2 diabetes. The CHD risk was higher with increasing BMI than with stable or decreasing BMI during the study.
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| 4. |
- Eriksson, Jan W, 1959, et al.
(författare)
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Diabetisk kärlsjukdom och diabetesfoten
- 2009
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Ingår i: Kärlsjukdom - Vaskulär medicin, Lindgärde F, Thulin T, Östergren J (eds). - Lund : Studentlitteratur. ; , s. 191-211
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Gudbjörnsdottir, Soffia, 1962, et al.
(författare)
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Risk factor control in patients with Type 2 diabetes and coronary heart disease : findings from the Swedish National Diabetes Register (NDR)
- 2009
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 26:1, s. 53-60
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Patients with Type 2 diabetes and coronary heart disease (CHD) are infrequently treated to risk factor targets in current guidelines. We aimed to examine risk factor management and control levels in a large sample of patients with Type 2 diabetes with CHD. METHODS: This was an observational study of 1612 patients with first incidence of CHD before 2002, and of 4570 patients with first incidence of CHD before 2005, from the Swedish National Diabetes Register (NDR). RESULTS: In patients with CHD 1-2 years before follow-up, the achievement of cardiovascular risk factor targets (follow-up 2002/follow-up 2005) was: HbA(1c) < 7%, 47%/54% (P < 0.01); blood pressure < or = 130/80 mmHg, 31%/40% (P < 0.001); total cholesterol < 4.5 mmol/l, 47%/60% (P < 0.001); and low-density lipoprotein-cholesterol < 2.5 mmol/l, 49%/65% (P < 0.001). Use of medication: antihypertensives, 90%/94% (P < 0.01); lipid-lowering drugs, 75%/86% (P < 0.001); and aspirin, 85%/89% (P < 0.05). A high prevalence of adverse lifestyle characteristics prevailed (2002/2005): overweight [body mass index (BMI) > or = 25 kg/m(2)], 86%/85%; obesity (BMI > or = 30 kg/m(2)), 41%/42%; smokers in age group < 65 years, 16-23%/18-19%; as well as waist circumference > or = 102 cm (men) or > or = 88 cm (women), 68% in 2005. CONCLUSIONS: Patients with a combination of Type 2 diabetes and CHD showed an increased use of lipid-lowering drugs over time, corresponding to improving blood lipid levels. A discrepancy existed between the prevalent use of antihypertensive drugs and the low proportion reaching blood pressure targets. Regretfully, a high prevalence of adverse lifestyle characteristics prevailed. Evidence-based therapy with professional lifestyle intervention and drugs seems urgent for improved quality of secondary prevention in these patients.
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| 6. |
- Kalani, Majid, et al.
(författare)
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Beneficial effects of dalteparin on haemostatic function and local tissue oxygenation in patients with diabetes, severe vascular disease and foot ulcers.
- 2007
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Ingår i: Thrombosis research. - : Elsevier BV. - 0049-3848 .- 1879-2472. ; 120:5, s. 653-61
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: A state of hypercoagulation and fibrinolytic dysfunction is present in individuals with diabetes, which may contribute to disturbed skin microcirculation and impaired ulcer healing. We have previously reported an improved outcome of chronic diabetic foot ulcers during treatment with dalteparin. In the present study we investigated the effects of dalteparin on skin microcirculation and haemostatic function. MATERIALS AND METHODS: 87 patients with diabetes, peripheral arterial obliterative disease and chronic foot ulcers were investigated in a prospective, randomised, double-blind and placebo-controlled study. They were randomised to treatment with subcutaneous injections of 5000 U dalteparin (n=44) or placebo (n=43), once daily until ulcer healing or for a maximum of six months. Plasma fibrinogen, fibrin gel structure [permeability coefficient (Ks) and fiber mass/length ratio (mu)], prothrombin fragment 1+2 (F1+2) antigen, plasminogen activator inhibitor-1 (PAI-1) activity and tissue plasminogen activator (tPA) antigen were analysed before randomization (baseline value), and at the end of the treatment period. The skin microcirculation of the foot was investigated by transcutaneous oxygen tension (TcPO(2)) and laser Doppler fluxmetry (LDF). RESULTS: The changes (Delta-values) of Ks, mu, tPA and TcPO(2) were higher (p<0.05) during treatment with dalteparin, as compared to the changes during treatment with placebo. At baseline, plasma fibrinogen and Ks were significantly correlated to TcPO(2). CONCLUSIONS: Local skin oxygenation improved and a less thrombogenic fibrin gel structure was formed in patients treated with dalteparin. Beneficial effects on haemostatic function are likely to contribute to the improved skin oxygenation observed during treatment with dalteparin.
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| 12. |
- Bunck, M. C., et al.
(författare)
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One-year treatment with exenatide improves beta-cell function, compared with insulin glargine, in metformin-treated type 2 diabetic patients: a randomized, controlled trial
- 2009
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Ingår i: Diabetes Care. - 1935-5548. ; 32:5, s. 762-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Traditional blood glucose-lowering agents do not sustain adequate glycemic control in most type 2 diabetic patients. Preclinical studies with exenatide have suggested sustained improvements in beta-cell function. We investigated the effects of 52 weeks of treatment with exenatide or insulin glargine followed by an off-drug period on hyperglycemic clamp-derived measures of beta-cell function, glycemic control, and body weight. RESEARCH DESIGN AND METHODS: Sixty-nine metformin-treated patients with type 2 diabetes were randomly assigned to exenatide (n = 36) or insulin glargine (n = 33). beta-Cell function was measured during an arginine-stimulated hyperglycemic clamp at week 0, at week 52, and after a 4-week off-drug period. Additional end points included effects on glycemic control, body weight, and safety. RESULTS: Treatment-induced change in combined glucose- and arginine-stimulated C-peptide secretion was 2.46-fold (95% CI 2.09-2.90, P < 0.0001) greater after a 52-week exenatide treatment compared with insulin glargine treatment. Both exenatide and insulin glargine reduced A1C similarly: -0.8 +/- 0.1 and -0.7 +/- 0.2%, respectively (P = 0.55). Exenatide reduced body weight compared with insulin glargine (difference -4.6 kg, P < 0.0001). beta-Cell function measures returned to pretreatment values in both groups after a 4-week off-drug period. A1C and body weight rose to pretreatment values 12 weeks after discontinuation of either exenatide or insulin glargine therapy. CONCLUSIONS: Exenatide significantly improves beta-cell function during 1 year of treatment compared with titrated insulin glargine. After cessation of both exenatide and insulin glargine therapy, beta-cell function and glycemic control returned to pretreatment values, suggesting that ongoing treatment is necessary to maintain the beneficial effects of either therapy.
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| 13. |
- Cederholm, Jan, et al.
(författare)
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Microalbuminuria and risk factors in type 1 and type 2 diabetic patients
- 2005
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Ingår i: Diabetes Res Clin Pract. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 67:3, s. 258-66
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Tidskriftsartikel (refereegranskat)abstract
- A prospective study of normoalbuminuric diabetic patients was performed between 1997 and 2002 on 4097 type 1 and 6513 type 2 diabetic patients from the Swedish National Diabetes Register (NDR); mean study period, 4.6 years. The strongest independent baseline risk factors for the development of microalbuminuria (20-200 microg/min) were elevated HbA(1c) and diabetes duration in both types 1 and 2 diabetic patients. Other risk factors were high BMI, elevated systolic and diastolic BP in type 2 patients, and antihypertensive therapy in type 1 patients. A subsequent larger cross-sectional study in 2002 showed that established microalbuminuria was independently associated with HbA(1c), diabetes duration, systolic BP, BMI, smoking and triglycerides in types 1 and 2 diabetic patients, and also with HDL-cholesterol in type 2 patients. Relatively few types 1 and 2 patients with microalbuminuria achieved treatment targets of HbA(1c) < 6.5% (21-48%), BP < 130/85 mmHg (33-13%), cholesterol < 5 mmol/l (48-46%), triglycerides < 1.7 mmol/l (83-48%) and BMI < 25 kg/m(2) (50-18%), respectively. In conclusion, high HbA(1c), BP and BMI were independent risk factors for the development of microalbuminuria in types 1 and 2 diabetic patients. These risk factors as well as triglycerides, HDL-cholesterol and smoking were independently associated with established microalbuminuria. Treatment targets were achieved by a relatively few patients with microalbuminuria.
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| 14. |
- Eeg-Olofsson, Katarina, 1968, et al.
(författare)
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Glycemic and risk factor control in type 1 diabetes: results from 13,612 patients in a national diabetes register
- 2007
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 30:3, s. 496-502
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study was designed to investigate the clinical characteristics of a large type 1 diabetic population and to evaluate the degree of fulfillment of recently updated treatment goals. RESEARCH DESIGN AND METHODS: The Swedish National Diabetes Register was initiated in 1996 as a tool for quality assurance in diabetes care. A1C levels, treatment, and risk factors were analyzed in two cross-sectional samples of 9,424 patients in 1997 and 13,612 patients in 2004 and in a smaller longitudinal sample from 1997 to 2004. RESULTS: Mean A1C decreased from 8.2 +/- 1.3% in 1997 to 8.0 +/- 1.2% in 2004 (P < 0.001). The proportion of patients reaching A1C <7.0% increased from 17.4 to 21.2% in 2004. A slow but significant improvement in blood pressure levels was seen, but only 61.3% reached the blood pressure goal of <130/80 mmHg in 2004. Lipid control improved, and the use of lipid-lowering drugs increased. Among patients treated with lipid-lowering agents, 38% reached the goal of total cholesterol <4.5 mmol/l, and 48% reached the goal of LDL cholesterol <2.5 mmol/l. Successful long-term glycemic and blood pressure control were both independently predicted by low BMI and the absence of microalbuminuria in 1997. CONCLUSIONS: In this large cohort of type 1 diabetic patients, there was a slow improvement in glycemic and risk factor control from 1997 to 2004, although the gap between the clinical results and current Swedish and American treatment goals is still unsatisfactory. It is crucial that additional measures be taken to improve risk factor control in type 1 diabetic patients.
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| 15. |
- Eliasson, Björn, 1959, et al.
(författare)
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Antihyperglycaemic treatment of type 2 diabetes : results from a national diabetes register
- 2007
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Ingår i: Diabetes & Metabolism. - : Elsevier BV. - 1262-3636 .- 1878-1780. ; 33:4, s. 269-276
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Tidskriftsartikel (refereegranskat)abstract
- Aim To describe clinical characteristics and antihyperglycaemic treatment patterns in patients with varying duration of diabetes. Methods We performed a cross-sectional survey of 61 890 type 2 diabetic (DM2) patients from the Swedish National Diabetes Register (NDR) in 2004. We also analysed the effect of types of treatment and risk factors on glycaemic control in a longitudinal cohort study from 1996 to 2004. HbA1c, risk factors and treatments were determined locally in primary care as well as hospital outpatient clinics. Results Insulin was frequently used in DM2 patients with long duration of diabetes, although the mean HbA1c increased and only a few in this group reached HbA1c < 7.0%. Patients showing long-term improvement in HbA1c (> 1%) from 1996 to 2004 were more often treated with insulin than with oral hypoglycaemic agents (OHA). During this period, the HbA1c levels leading to additional treatment decreased. A low BMI, decreasing BMI and not smoking were predictors of good long-term metabolic control. Hypertension and hyperlipidaemia were frequent in both newly diagnosed DM2 patients and in patients with a long duration of diabetes. Conclusions Insulin treatment was frequently used, particularly in patients with a long duration of DM2. The glycaemic control, which usually deteriorates over time, did not reach the recommended goal, despite the fact that complementary treatment was added at lower HbA1c levels in 2003 than in 1996. High frequencies of hypertension, hyperlipidaemia and high 10-year risks of coronary heart disease necessitate intensified risk factor control in the future.
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| 16. |
- Eliasson, Björn, 1959, et al.
(författare)
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Behandling med perorala antidiabetika
- 2009
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Ingår i: Diabetes (fjärde upplagan). - Stockholm : Liber AB. - 9789147093311 ; , s. 162-177
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 17. |
- Eliasson, Björn, 1959, et al.
(författare)
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Diabetesvårdens mål, innehåll och kvalitet
- 2009
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Ingår i: Diabetes (fjärde upplagan). - Stockholm : Liber AB. - 9789147093311 ; , s. 463-469
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 18. |
- Eliasson, Björn, 1959, et al.
(författare)
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The gap between guidelines and reality: Type 2 diabetes in a National Diabetes Register 1996-2003
- 2005
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Ingår i: Diabet Med. - : Wiley. - 0742-3071 .- 1464-5491. ; 22:10, s. 1420-6
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Tidskriftsartikel (refereegranskat)abstract
- Guidelines for the treatment of risk factors in diabetes care have been updated recently, due to indisputable results from clinical end-point trials. This study evaluates risk factor control compared with current national and international targets during the period 1996-2003 in Type 2 diabetes (DM2). Patients were registered in primary-care and hospital outpatient clinics using computer software, or via the Internet. The clinical characteristics of the patients, treatment, HbA(1c), and risk factors were reported after screening by local methods. The numbers of cases of DM2 reported were 17547 in 1996 and 57119 in 2003. The mean HbA(1c) decreased from 7.8 to 7.2%, while blood pressure decreased from 150/82 to 143/78 mmHg during the same period. Longitudinal analysis of results was performed in 5356 patients repeatedly reported, showing slightly lower effects. The new European treatment targets of HbA(1c)< or = 6.1%, blood pressure < 130/80 mmHg and total cholesterol < 4.5 mmol/l were attained by 16, 13 and 28% of the patients in 2003, respectively. The prevalence of the metabolic syndrome in 2003 was 77%. Aspirin was prescribed in 36% of cases. Lipid-lowering, anti-hypertensive drugs, and treatment with oral hypoglycaemic agents in combination with insulin were increasingly employed during the period studied. Risk factor control in DM2 reported to the National Diabetes Register (NDR) is slowly improving, although multiple risk factors and the metabolic syndrome are found in most patients. The majority of subjects do not achieve current target levels for HbA(1c), blood pressure and blood lipids. Thus, giving up smoking and increased use of aspirin are called for, as well as more aggressive treatment of hyperglycaemia, elevated blood pressure and blood lipid levels, in accordance with updated international guidelines.
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| 19. |
- Eliasson, Björn, 1959, et al.
(författare)
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Weight loss and metabolic effects of topiramate in overweight and obese type 2 diabetic patients: randomized double-blind placebo-controlled trial
- 2007
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Ingår i: Int J Obes (Lond). - : Springer Science and Business Media LLC. - 0307-0565 .- 1476-5497. ; 31:7, s. 1140-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To examine the metabolic effects and body composition changes after topiramate treatment of obese type 2 diabetic patients (DM2) for 11 months. DESIGN AND SUBJECTS: Thirty-eight DM2 on diet or sulfonylurea treatment participated in this randomized double-blind placebo-controlled trial. Thirteen placebo-treated and nine topiramate-treated patients completed the trial. Patients were randomized to treatment with topiramate 96 mg b.i.d. or placebo (6-week run-in phase, 2-months titration phase, 9-months maintenance phase). MEASUREMENTS: Insulin sensitivity was measured with euglycaemic hyperinsulinemic clamps. Weight, HbA1c, fasting glucose, blood lipids and safety variables were measured at regular intervals. Body composition was determined with computerized tomography. Meal tests were performed to evaluate postprandial glucose and insulin levels. Three-day diet recalls were carried out to evaluate energy ingestion. RESULTS: The mean age was 58.6+/-7.1 years, body weight 98.1+/-16.1 kg, BMI 33.0+/-4.5 kg/m(2), and glycosylated hemoglobin (HbA1c) 7.3+/-0.9%. In topiramate-treated patients, there were significant reductions in HbA1c (1.1+/-0.9%), fasting plasma glucose, body weight (-6.6+/-3.3%), as well as body fat, lean body mass, postprandial glucose and free fatty acid levels but there were no significant changes in insulin sensitivity. The daily average energy intake decreased more in the topiramate group than in the placebo group. Paresthesia and central nervous system-related side effects were the main causes for the dropout rate. CONCLUSIONS: Topiramate treatment of overweight DM2 reduced body weight and body fat, and was associated with a marked improvement in glycaemic control whereas no significant improvement in insulin-stimulated glucose uptake was demonstrated. Further studies are required to clarify whether this effect might occur through changes in insulin sensitivity in the liver and/or pancreatic insulin secretion.
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| 20. |
- Fahlén, M, et al.
(författare)
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Optimization of basal insulin delivery in Type 1 diabetes: a retrospective study on the use of continuous subcutaneous insulin infusion and insulin glargine.
- 2005
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Ingår i: Diabetic medicine : a journal of the British Diabetic Association. - : Wiley. - 0742-3071. ; 22:4, s. 382-6
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To compare the effects on glycaemic control after using continuous subcutaneous insulin infusion (CSII) or insulin glargine. METHODS: Data were obtained from 17 diabetes outpatient clinics in Sweden, employing the same diabetes data management system. Type 1 diabetic patients using multiple dose injections were included prior to starting on either CSII (n = 563) or glargine (n = 513). The median duration of therapy was 25 months for CSII and 6 months for glargine. The comparison between the treatment modalities was carried out by multiple regression analysis and logistic regression analysis in an attempt at reducing the influence of confounding factors. RESULTS: The mean HbA1c decrease was 0.59 +/- 1.19% for CSII and 0.20 +/- 1.07% for glargine (P < 0.001, when assessed by logistic regression). An additional 0.1% lower HbA1c would be expected if glargine had been optimized with basal insulin 40-60% of the daily dose. The more pronounced effect of CSII was achieved with a lower daily dosage of insulin. In a multiple regression analysis with a change of HbA1c as the dependent variable, the following variables were significant: choice of treatment (P < 0.001), HbA1c prior to treatment (P < 0.001) and BMI prior to treatment (P < 0.01). CONCLUSION: Both regimes improved metabolic control, but CSII resulted in significantly higher reduction in HbA1c than after insulin glargine treatment, particularly in those individuals who had higher levels of HbA1c at baseline.
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| 21. |
- Lind, Marcus, 1976, et al.
(författare)
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A systematic review of HbA1c variables used in the study of diabetic complications
- 2008
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Ingår i: Diabetes and Metabolic Syndrome: Clinical Research and Reviews. - : Elsevier BV. - 1871-4021. ; 2:4, s. 282-293
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The predictive power of different HbA1c variables is of importance in prognosis of diabetic complications, clinical guidelines, health-economical analyses and in the design of clinical trials of antidiabetic agents. The aim was to review the literature with regard to the HbA1c variables used, and determine how the predictive power of these relates to diabetic complications. Method: We reviewed 97 full-text articles on HbA1c and diabetic complications. Results: The most commonly used HbA1c variables were: the baseline value, the mean and the "updated" mean HbA1c. Other variables used were the logarithm of the updated mean, the standard deviation, the slope (annual average change), the initial decline (change during the first year), the final value, and the change in HbA1c between baseline and the fourth year. The updated mean, logarithm of the updated mean and mean HbA1c were found to have greater predictive power than baseline HbA1c. The slope, final value, S.D., initial decline and change of HbA1c did not add any further information. The predictive power of the mean or updated mean HbA1c became stronger with longer study lengths. There was a persistent effect over several years between HbA1c values and diabetic complications. Measurements of HbA1c varied from a single value to measurements each month. Conclusions: The use of a mean or the updated mean HbA1c is recommended in the study design. HbA1c values several years old also influence the prognosis of diabetic complications. The possibility of finding a true effect of an antidiabetic agent increases with longer study length. © 2008 Diabetes India.
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| 22. |
- Lind, Marcus, 1976, et al.
(författare)
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The effect of insulin lispro on glycemic control in a large patient cohort.
- 2009
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Ingår i: Diabetes technology & therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 11:1, s. 51-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The use of rapid-acting insulin analogs and regular insulin differs considerably in countries throughout the world. We therefore studied how glycemic control has been affected by using insulin lispro in clinical practice over 5 years in 14 hospitals in Sweden. METHODS: We used a time period when most patients had not changed the basal insulin, but only the mealtime insulin. Accordingly the most recent years were not suitable since many patients had changed basal insulin from NPH to glargine or determir. We therefore analyzed the metabolic consequences on glycosylated hemoglobin (HbA1c) when changing from regular insulin to insulin lispro from 1997 and during the following 5 years. We studied 1,069 patients with diabetes taking NPH insulin as basal insulin and at least three daily injections of regular insulin, of whom 423 changed their mealtime insulin to insulin lispro and 646 controls who continued with regular insulin. RESULTS: Patients changing to insulin lispro on average decreased by 0.19% units more in HbA1c than those remaining on regular insulin. The effect was most pronounced in patients with high HbA1c even after controlling for regression to the mean. A beneficial effect of insulin lispro was also indicated since patients had the same level of HbA1c during a long period of time with regular insulin but then dropped when changing to insulin lispro. CONCLUSIONS: This study indicates that insulin lispro has had a beneficial and persisting effect on glycemic control when used in patients with diabetes on multiple daily injections of insulin in clinical practice.
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| 23. |
- Lind, Marcus, 1976, et al.
(författare)
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The true value of HbA1c as a predictor of diabetic complications: simulations of HbA1c variables
- 2009
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 4:2
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Tidskriftsartikel (refereegranskat)abstract
- Aim The updated mean HbA1c has been used in risk estimates of diabetic complications, but it does not take into account the temporal relationship between HbA1c and diabetic complications. We studied whether the updated mean HbA1c underestimated the risk of diabetic complications. Method Continuous HbA1c curves for 10,000 hypothetical diabetes patients were simulated over an average of 7 years. Simulations were based on HbA1c values encountered in clinical practice. We assumed that each short time interval of the continuous HbA1c curves had a long-lasting effect on diabetic complications, as evidenced by earlier studies. We tested several different HbA1c variables including various profiles, e.g. different duration, of such a long-lasting effect. The predictive power of these variables was compared with that of the updated mean HbA1c. Results The predictive power of the constructed HbA1c variables differed considerably compared to that of the updated mean HbA1c. The risk increase per standard deviation could be almost 100% higher for a constructed predictor than the updated mean HbA1c. Conclusions The importance of good glycemic control in preventing diabetic complications could have been underestimated in earlier hallmark studies by not taking the time-dependent effect of HbA1c into account.
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| 24. |
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| 25. |
- Nilsson, Peter, et al.
(författare)
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Predictors of successful long-term blood pressure control in type 2 diabetic patients: data from the Swedish National Diabetes Register (NDR)
- 2005
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Ingår i: J Hypertens. - 0263-6352 .- 1473-5598. ; 23:12, s. 2305-2311
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hypertension in patients with diabetes is a well recognized cardiovascular risk factor for which the benefits of treatment are strongly evidence based. Less is known about predictors for successful long-term blood pressure control in these patients, including the potential role of body mass index (BMI), glycaemic control, microalbuminuria and smoking. MATERIAL AND METHODS: We used longitudinal data on risk factor levels from repeated clinical surveys of 1759 type 2 diabetic patients in the Swedish National Diabetes Register (NDR), a nationwide annual registration of quality indicators in diabetes care. Subjects with successful blood pressure (BP) control (systolic BP < 135 mmHg and diastolic BP < 85 mmHg) at baseline in 1997, in 2001, and at follow-up in 2003, were compared to subjects with BP control >or= 135/85 mmHg. RESULTS: Logistic regression analysis disclosed that successful BP control during the study period was predicted by lower BMI (P < 0.001), a lower frequency of microalbuminuria (P = 0.002), and lower age (P < 0.001) at baseline in 1997, and was still associated with lower BMI (P < 0.001), a lower frequency of microalbuminuria (P = 0.01) and lower age (P < 0.001) at follow-up. Successful BP control was also associated at follow-up with a lower frequency of the metabolic syndrome (30 versus 75%) and lower predicted 10-year risks [United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine] of coronary heart disease (14 versus 29%) and stroke (10 versus 22%) (all P < 0.001). CONCLUSION: A lower BMI and absence of microalbuminuria were strong independent predictors of long-term successful BP control in type 2 diabetic patients, also characterized by a lower frequency of the metabolic syndrome and lower 10-year risk of cardiovascular disease. This implies the long-term benefits on BP control of lifestyle measures as well as control of microalbuminuria.
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