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Olsen MH, Almdal TP, Madsbad S, Ovesen C, Gluud C, Sneppen SB, Breum L, Hedetoft C, Krarup T, Lundby-Christensen L, Mathiesen ER, Røder ME, Vestergaard H, Wiinberg N, Jakobsen JC. Quality of life, patient satisfaction, and cardiovascular outcomes of the randomised 2 x 3 factorial Copenhagen insulin and Metformin therapy (CIMT) trial - A detailed statistical analysis plan. Contemp Clin Trials Commun 2023; 33:101095. [PMID: 36923108 PMCID: PMC10009439 DOI: 10.1016/j.conctc.2023.101095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
Background The evidence on the effects of metformin and insulin in type 2 diabetes patients on quality of life, patient satisfaction, and cardiovascular outcomes is unclear. Methods The Copenhagen Insulin and Metformin Therapy (CIMT) trial is an investigator-initiated multicentre, randomised, placebo-controlled trial with a 2 × 3 factorial design conducted at eight hospitals in Denmark. Participants with type 2 diabetes were randomised to metformin (n = 206) versus placebo (n = 206); in combination with open-label biphasic insulin aspart one to three times daily (n = 137) versus insulin aspart three times daily in combination with insulin detemir once daily (n = 138) versus insulin detemir once daily (n = 137).We present a detailed description of the methodology and statistical analysis of the clinical CIMT outcomes including a detailed description of tests of the assumptions behind the statistical analyses. The outcomes are quality of life (Short Form Health Survey (SF-36)), Diabetes Medication Satisfaction Questionnaire, and Insulin Treatment Satisfaction Questionnaire (assessed at entry and 18 months after randomisation) and cardiovascular outcomes including time to a composite of either myocardial infarction, stroke, peripheral amputation, coronary revascularisation, peripheral revascularisation, or death. Discussions This statistical analysis plan ensure the highest possible quality of the subsequent post-hoc analyses. Trial registration The protocol was approved by the Regional Committee on Biomedical Research Ethics (H-D-2007-112), the Danish Medicines Agency (EudraCT: 2007-006665-33 CIMT), and registered within ClinicalTrials.gov (NCT00657943, 8th of April 2008).
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Affiliation(s)
- Markus Harboe Olsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark.,Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thomas P Almdal
- Department of Endocrinology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Christian Ovesen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark.,Department of Neurology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Simone B Sneppen
- Section of Endocrinology, Department of Internal Medicine, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Leif Breum
- Department of Medicine and Endocrinology, Zealand University Hospital, Køge, Denmark
| | - Christoffer Hedetoft
- Department of Medicine and Endocrinology, Zealand University Hospital, Køge, Denmark
| | | | | | - Elisabeth R Mathiesen
- Department of Endocrinology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael E Røder
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Henrik Vestergaard
- Department of Medicine, Bornholms Hospital, Rønne, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Niels Wiinberg
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital - Rigshospitalet, The Capital Region, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Edens MA, van Dijk PR, Hak E, Bilo HJG. Course of body weight before and after the initiation of insulin therapy in type 2 diabetes mellitus: Retrospective inception cohort study (ZODIAC 58). Endocrinol Diabetes Metab 2021; 4:e00212. [PMID: 33855214 PMCID: PMC8029529 DOI: 10.1002/edm2.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022] Open
Abstract
Aims The aim of this study was to explore the effect of insulin treatment initiation on weight by taking weight change prior to initiation into account. Materials and methods We performed an observational retrospective inception cohort study, concerning Dutch primary care. We identified all patients that initiated insulin treatment (n = 7967) and individually matched patients with a reference patient (n = 5213 pairs). We obtained estimated mean weight changes in the five years prior to five years post insulin therapy. We applied linear regression analysis on weight change in the first year after insulin therapy (T0 to T+1), with matched group as primary determinant adjusted for pre-insulin weight change and additional covariates. Results Estimated mean weight increased in the five consecutive years prior to insulin therapy (-0.23 kg in year T-5 to T-4, 0.01 kg in year T-4 to T-3, 0.07 kg in year T-3 to T-2, 0.24 kg in year T-2 to T-1, and 0.46 kg in year T-1 to T0) and continued to increase in the first year after, that is T0 to T+1, at a slightly lower rate (0.31 ± 3.9 kg). Pre-insulin weight change had the highest explained variance and was inversely and independently associated with weight change (p < .001). Starting insulin was associated with weight increase, independent of pre-insulin weight change (β-adjusted 1.228, p < .001). Stratification revealed that despite having a more or less similar baseline BMI, patients with substantial weight increase showed higher estimated mean BMI's followed by weight loss pre-insulin. In matched references, estimated mean weight changes were negative in all years concerning the study period, indicating consistent weight loss. Conclusions Initiation of insulin therapy was independently associated with weight increase; however, overall effect on weight was small and subject to substantial variation. Pre-insulin weight change is identified as a relatively strong inverse determinant of weight change after insulin initiation.
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Affiliation(s)
- Mireille A. Edens
- Diabetes Research CenterZwollethe Netherlands
- Epidemiology UnitDepartment Innovation and ScienceIsala HospitalZwollethe Netherlands
| | - Peter R. van Dijk
- Diabetes Research CenterZwollethe Netherlands
- Department of EndocrinologyUniversity of Groningen and University Medical Center GroningenGroningenthe Netherlands
| | - Eelko Hak
- Groningen Research Institute of PharmacyUniversity of GroningenGroningenthe Netherlands
| | - Henk J. G. Bilo
- Diabetes Research CenterZwollethe Netherlands
- Department of Internal MedicineUniversity of Groningen and University Medical Center GroningenGroningenthe Netherlands
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Seguro C, Viana R, Lima G, Galvão L, Silva L, Jardim T, Jardim P, Gentil P. Improvements in health parameters of a diabetic and hypertensive patient with only 40 minutes of exercise per week: a case study. Disabil Rehabil 2019; 42:3119-3125. [PMID: 30907139 DOI: 10.1080/09638288.2019.1583780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose: The present study aimed to report the effects of 15 weeks of a minimal dose resistance training on blood glucose levels, blood pressure, heart rate, physical capacity, and quality of life of a 67 old woman with type 2 diabetes mellitus, cardiopathy and hypertension.Method: The Patient was sedentary with a family history of heart failure and coronary artery disease. She suffered a heart attack in 2013 and was submitted to six cardiac catheterizations and one angioplasty between the 2015 and 2017. On April 2017, she was initially untrained in resistance training and was followed for 15 weeks with the performance of 31 resistance training sessions. Resistance training followed a minimal dose approach with 4 exercises performed with 2 sets to muscle failure, twice a week.Results: After follow up, the Patient presented a reduction in blood glucose, systolic and diastolic blood pressure, and heart rate at rest. There were also improvements on body mass index, cardiorespiratory fitness and quality of life. These results were accompanied by a reduction in the amount of antihypertensive and anti-diabetic medications.Conclusions: These results suggest that only 40 min of resistance training per week might help to improve general health and quality of life in a patient with hypertension and type 2 diabetes mellitus.Implications for RehabilitationMinimal dose resistance training improved health parameters in a diabetic and hypertensive patient.Resistance training promoted a reduction in the drugs used to control blood pressure and blood glucose levels.
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Affiliation(s)
- Camila Seguro
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Ricardo Viana
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Gislene Lima
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Luan Galvão
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Lucas Silva
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| | - Thiago Jardim
- Hypertension League Federal University of Goiás, Goiânia, Brazil.,Brigham & Women's Hospital Division of Cardiovascular Medicine, Boston, USA.,Harvard TH Chan School of Public Health Department of Health Policy and Management, Center for Health Decision Science, Boston, USA
| | - Paulo Jardim
- Hypertension League Federal University of Goiás, Goiânia, Brazil
| | - Paulo Gentil
- Faculty of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
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Ling SY, Zhao ZY, Tao B, Zhao HY, Su TW, Jiang YR, Xie J, Sun QF, Bian LG, Sun K, He NY, Yan FH, Wang WQ, Ning G, Sun LH, Liu JM. PITUITARY STALK THICKENING IN A LARGE COHORT: TOWARD MORE ACCURATE PREDICTORS OF PITUITARY DYSFUNCTION AND ETIOLOGY. Endocr Pract 2019; 25:534-544. [PMID: 30865546 DOI: 10.4158/ep-2018-0550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: To summarize the characteristics of patients with pituitary stalk thickening, analyze the association between pituitary stalk width and hypopituitarism, and develop a diagnostic model to differentiate neoplastic and inflammatory origins. Methods: A total of 325 patients with pituitary stalk thickening in a tertiary teaching hospital between January 2012 and February 2018 were enrolled. Basic characteristics and hormonal status were evaluated. Indicators to predict etiology in patients with histologic diagnoses were analyzed. Results: Of the 325 patients, 62.5% were female. Deficiency in gonadotropin was most common, followed by corticotropin, growth hormone, and thyrotropin. The increase in pituitary stalk width was associated with a risk of central diabetes insipidus (odds ratio [OR], 3.57; P<.001) and with a combination of central diabetes insipidus and anterior pituitary deficiency (OR, 2.28; P = .029). The cut-off pituitary stalk width of 4.75 mm had a sensitivity of 69.2% and a specificity of 71.4% for the presence of central diabetes insipidus together with anterior pituitary deficiency. Six indicators (central diabetes insipidus, pattern of pituitary stalk thickening, pituitary stalk width, neutrophilic granulocyte percentage, serum sodium level, and gender) were used to develop a model having an accuracy of 95.7% to differentiate neoplastic from inflammatory causes. Conclusion: Pituitary stalk width could indicate the presence of anterior pituitary dysfunction, especially in central diabetes insipidus patients. With the use of a diagnostic model, the neoplastic and inflammatory causes of pituitary stalk thickening could be preliminarily differentiated. Abbreviations: APD = anterior pituitary dysfunction; AUC = area under the curve; CDI = central diabetes insipidus; GH = growth hormone; MRI = magnetic resonance imaging; OR = odd ratio; PHBS = posterior hypophyseal bright spots; PST = pituitary stalk thickening; PSW = pituitary stalk width.
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Cichosz SL, Johansen MD, Hejlesen O. Toward Big Data Analytics: Review of Predictive Models in Management of Diabetes and Its Complications. J Diabetes Sci Technol 2015; 10:27-34. [PMID: 26468133 PMCID: PMC4738225 DOI: 10.1177/1932296815611680] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Diabetes is one of the top priorities in medical science and health care management, and an abundance of data and information is available on these patients. Whether data stem from statistical models or complex pattern recognition models, they may be fused into predictive models that combine patient information and prognostic outcome results. Such knowledge could be used in clinical decision support, disease surveillance, and public health management to improve patient care. Our aim was to review the literature and give an introduction to predictive models in screening for and the management of prevalent short- and long-term complications in diabetes. Predictive models have been developed for management of diabetes and its complications, and the number of publications on such models has been growing over the past decade. Often multiple logistic or a similar linear regression is used for prediction model development, possibly owing to its transparent functionality. Ultimately, for prediction models to prove useful, they must demonstrate impact, namely, their use must generate better patient outcomes. Although extensive effort has been put in to building these predictive models, there is a remarkable scarcity of impact studies.
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Affiliation(s)
- Simon Lebech Cichosz
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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