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Ito C, Baune BT, Kurth T, Brinks R. Projections of anxiety disorder prevalence during and beyond the COVID-19 pandemic in Germany using the illness-death model. BJPsych Open 2024; 10:e174. [PMID: 39387195 DOI: 10.1192/bjo.2024.754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND Although there is now substantial evidence on the acute impacts of the COVID-19 pandemic on anxiety disorders, the long-term population impact of the pandemic remains largely unexplored. AIMS To quantify a possible longitudinal population-level impact of the pandemic by projecting the prevalence of anxiety disorders through 2030 among men and women aged up to 95 years in Germany under scenarios with varying impacts of the pandemic on the incidence of anxiety disorders. METHOD We used a three-state illness-death model and data from the Global Burden of Disease Study to model historical trends of the prevalence and incidence of anxiety disorders. The German population projections determined the initial values for projections. The COVID-19 incidence rate data informed an additional incidence model, which was parameterised with a wash-in period, delay, wash-out period, incidence increase level and decay constant. RESULTS When no additional increase in the incidence during the pandemic waves during 2020-2022 was assumed, it was estimated that 3.86 million women (9.96%) and 2.13 million men (5.40%) would have anxiety disorders in 2030. When increases in incidence following pandemic waves were assumed, the most extreme scenario projected 5.67 million (14.02%) women and 3.30 million (8.14%) men with the mental disorder in 2030. CONCLUSIONS Any increased incidence during the pandemic resulted in elevated prevalence over the projection period. Projection of anxiety disorder prevalence based on the illness-death model enables simulations with varying assumptions and provides insight for public health planning. These findings should be refined as trend data accumulate and become available.
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Affiliation(s)
- Chisato Ito
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany; Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; and Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralph Brinks
- Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany; and Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
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Silverman-Retana O, Brinks R, Hoyer A, Witte DR, Tönnies T. Using the illness-death model to estimate age- and sex-standardized incidence rates of diabetes in Mexico from 2003 to 2015. BMC Public Health 2024; 24:1882. [PMID: 39010051 PMCID: PMC11247887 DOI: 10.1186/s12889-024-19281-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/26/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND We aimed to estimate the age-specific and age-standardized incidence rate of diabetes for men and women in Mexico between 2003 and 2015, and to assess the relative change in incidence of diabetes between 2003 and 2015. METHODS We use a partial differential equation describing the illness-death model to estimate the incidence rate (IR) of diabetes for the years 2003, 2009 and 2015 based on prevalence data from National Health Surveys conducted in Mexico, the mortality rate of the Mexican general population and plausible input values for age-specific mortality rate ratios associated with diabetes. RESULTS The age-standardized IR of diabetes per 1000 person years (pryr) was similar among men (IRm) and women (IRw) in the year 2003 (IRm 6.1 vs. IRw 6.5 1000/pryr), 2009 (IRm: 7.0 vs. IRw: 8.4 1000/pryr), and in 2015 (IRm 8.0 vs. IRw 10.6 1000/pryr). The highest incident rates were observed among men and women in the 60-69 age group. CONCLUSIONS Overall, the incidence rate of diabetes in Mexico between the years 2003 and 2015 remained stable. However, rates were markedly higher among women in the age group 40-49 and 50-59 in the year 2015 compared with rates in 2003.
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Affiliation(s)
- Omar Silverman-Retana
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich-Heine-University Duesseldorf, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany
- Chair for Medical Biometry and Epidemiology, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Thaddäus Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich-Heine-University Duesseldorf, Auf'm Hennekamp 65, 40225, Duesseldorf, Germany.
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Dynesen AW, Pedersen SG, Lorenzen JK, Lehn SF. Nearly one in five older adults in Danish nursing homes live with type 2 diabetes. Scand J Public Health 2024; 52:397-401. [PMID: 36468770 PMCID: PMC11179306 DOI: 10.1177/14034948221139648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022]
Abstract
AIM This study aimed to investigate the prevalence of type 2 diabetes (T2D) among Danish nursing home residents (aged ⩾65 years). METHODS Individuals with T2D in the Danish population of older adults in 2018 were identified using a Danish diabetes register based on administrative and clinical register data. Data on age, sex, type of housing, educational level and place of origin were obtained from various high-quality administrative registers. We calculated frequencies of T2D among older adults living in nursing homes and in other types of housing. We performed a multiple logistic regression analysis to estimate the odds ratio (OR) of T2D among people living in nursing homes and adjusted for sex, age, educational level and place of origin. RESULTS All Danish older adults aged ⩾65 years, alive and living in Denmark on 31 December 2018 were included (N=1,170,517). Nursing home residents accounted for 37,891 older adults, and of these, 19% had T2D, whereas 14% of older adults living in other types of housing had T2D. According to the multiple logistic regression analysis, nursing home residents had a higher OR of having T2D compared to older adults living in other types of housing (OR=1.47; confidence interval 1.43-1.51) when adjusting for socio-demographic factors. CONCLUSIONS The prevalence of T2D in nursing home residents exceeds the prevalence in the background population at ⩾65 years of age. This indicates a need for increased focus on individualised interdisciplinary care plans aimed at maintaining physical function and maximising quality of life for this group of vulnerable older adults.
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Affiliation(s)
- Anja W. Dynesen
- Centre for Nutrition, Rehabilitation and Midwifery, University College Absalon, Denmark
| | | | | | - Sara F. Lehn
- Steno Diabetes Center Zealand, Denmark
- National Institute of Public Health, University of Southern Denmark, Denmark
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Liaghat B, Folkestad L, Skou ST, Koes B, Stammerjohan AF, Hartvigsen J. Prevalence and consequences of spinal pain among people with type 1 and type 2 diabetes mellitus in Denmark. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3744-3752. [PMID: 37659046 DOI: 10.1007/s00586-023-07911-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/30/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To describe 1-week and 1-year prevalence of spinal pain and its consequences in relation to leisure activity, work-life, and care-seeking in people with type 1 and 2 diabetes mellitus (DM). METHODS A cross-sectional survey including adults diagnosed with DM from two Danish secondary care centres. Using the Standardised Nordic Questionnaire, spinal pain prevalence (cervical, thoracic, lumbar) and its consequences were evaluated (proportions, 95% confidence intervals) and compared to the general population. RESULTS Among 3767 people, 1-week and 1-year spinal pain prevalence were 11.6-32.4 and 18.5-49.6%, respectively, highest for lumbar pain (24.6-49.6%). The prevalence was similar between DM types for cervical and thoracic pain, but higher in type 2 for lumbar spine. Women had higher pain prevalence across spinal regions and DM types, while cervical and thoracic pain estimates were higher for age < 60 vs. ≥ 60. Within the past year, > 50% reported pain > 30 days, high proportions had reduced their activities (leisure time, 43.7-63.9%; work, 20.7-33.3%), 13.3-28.1% reported sick-leave > 30 days, and 44.3-48.5% had sought care due to spinal pain. CONCLUSION Spinal pain is common in people with type 1 and 2 DM, resulting in considerable consequences for work/leisure activities, sick-leave, and healthcare utilisation as compared to the general population.
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Affiliation(s)
- Behnam Liaghat
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
- Centre for Evidence-Based Orthopaedics, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
| | - Amalie Frost Stammerjohan
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Skriver LKL, Nielsen MW, Walther S, Nørlev JD, Hangaard S. Factors associated with adherence or nonadherence to insulin therapy among adults with type 2 diabetes mellitus: A scoping review. J Diabetes Complications 2023; 37:108596. [PMID: 37651772 DOI: 10.1016/j.jdiacomp.2023.108596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND AIM One of the greatest barriers to the treatment of T2DM is nonadherence which particularly applies to insulin therapy. There is a need for a comprehensive overview of all factors associated with nonadherence to insulin therapy. The aim of this study was to identify factors associated with adherence or nonadherence to insulin therapy among adults with T2DM. METHODS A scoping review was conducted in accordance with the PRISMA 2020 statement. A systematic search was performed in PubMed, Cinahl, and Web of Science (January 2013 to March 2023). RESULTS A final sample of 48 studies was included in the scoping review. The synthesis revealed 30 factors associated with adherence or nonadherence. The factors were grouped into 6 themes: demographics, attitude and perceptions, management of diabetes, impact on daily living, disease and medication, and healthcare system. CONCLUSION The most prominent factors identified were age, cost of healthcare, personal beliefs towards insulin therapy, social stigma, patient education, complexity of diabetes treatment, impact of insulin therapy on daily life, and fear of side effects. The results indicate a need for further research to determine threshold values for the factors associated with adherence or nonadherence.
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Affiliation(s)
| | | | - Simone Walther
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | | | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark; Steno Diabetes Center North Jutland, 9000 Aalborg, Denmark
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Thinggaard BS, Pedersen F, Grauslund J, Stokholm L. Intravitreal Vascular Endothelial Growth Factor Inhibitor Therapy in Denmark and 5-Year Projections. JAMA Netw Open 2023; 6:e2335148. [PMID: 37738053 PMCID: PMC10517372 DOI: 10.1001/jamanetworkopen.2023.35148] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023] Open
Abstract
This cohort study examines the use of intravitreal injections of vascular endothelial growth factor inhibitor in Denmark from 2007 through 2022 and forecasts future demand for this therapy.
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Affiliation(s)
- Benjamin Sommer Thinggaard
- Department of Clinical Research, University of Southern Denmark, Odense
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Open Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Frederik Pedersen
- Department of Clinical Research, University of Southern Denmark, Odense
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense
- Open Patient Data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
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Liaghat B, Folkestad L, Skou ST, Koes B, Hartvigsen J. Prevalence and consequences of musculoskeletal pain in the upper and lower extremities: A cross-sectional analysis of patients with type 1 and type 2 diabetes in Denmark. Prim Care Diabetes 2023; 17:267-272. [PMID: 36890059 DOI: 10.1016/j.pcd.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/18/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
AIMS To describe the one-week and 12-month prevalence of musculoskeletal pain in the upper and lower extremities and consequences in relation to care seeking, leisure time activity, and work life in patients with type 1 and 2 diabetes. METHODS A cross-sectional survey including adults diagnosed with type 1 and 2 diabetes from two Danish secondary care databases. Questions covered pain prevalence (shoulder, elbow, hand, hip, knee, ankle) and its consequences based on the Standardised Nordic Questionnaire. Data was presented using proportions (95 % confidence intervals). RESULTS The analysis included 3767 patients. The one-week prevalence was 9.3-30.8 % and 12-month prevalence 13.9-41.8 %, highest for shoulder pain (30.8-41.8 %). The prevalence was similar between type 1 and 2 diabetes for the upper extremity, but higher in type 2 for the lower extremity. Women had a higher pain prevalence for any joint for both diabetes types, while estimates did not vary between age groups (<60 or ≥60 years). More than half of the patients had reduced their activities at work or leisure time, and more than one-third had sought care during the past year because of pain. CONCLUSIONS Musculoskeletal pain in the upper and lower extremities is common in patients with type 1 and 2 diabetes from Denmark, with considerable consequences for work and leisure activities.
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Affiliation(s)
- Behnam Liaghat
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Centre for Evidence-Based Orthopaedics, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
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Kvist AV, Nasser MI, Vestergaard P, Frost M, Burden AM. Site-Specific Fracture Incidence Rates Among Patients With Type 1 Diabetes, Type 2 Diabetes, or Without Diabetes in Denmark (1997-2017). Diabetes Care 2023; 46:633-642. [PMID: 36696428 PMCID: PMC10020021 DOI: 10.2337/dc22-1004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate trends in incidence rates (IRs) at various fracture sites for patients with type 1 diabetes and type 2 diabetes compared with patients without diabetes in Denmark in 1997-2017. RESEARCH DESIGN AND METHODS Patients aged ≥18 years with a vertebral, hip, humerus, forearm, foot, or ankle fracture between 1997 and 2017 were identified from Danish hospital discharge data. IRs per 10,000 person-years were calculated over the study period. Median IRs for the first (1997-2001) and the last (2013-2017) 5 years were compared. We used Poisson models to estimate age-adjusted IR ratios (IRRs) of fractures among patients with type 1 and type 2 diabetes versus patients without diabetes. RESULTS Except for foot fractures, fracture IRs were higher in patients with type 1 or type 2 diabetes compared with patients without diabetes. Hip fracture IRs declined between the first and last 5 years by 35.2%, 47.0%, and 23.4% among patients with type 1, type 2, and without diabetes, respectively. By contrast, vertebral fracture IRs increased 14.8%, 18.5%, 38.9%, respectively. While age-adjusted IRRs remained elevated in patients with type 1 diabetes compared with patients without diabetes, IRRs in patients with type 2 diabetes converged with those observed in patients without diabetes. CONCLUSIONS Unadjusted fracture rates are higher in patients with diabetes but have decreased between 1997 and 2017 except for vertebral fractures, which increased in all groups. Fracture rates change after age adjustment.
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Affiliation(s)
- Annika Vestergaard Kvist
- Department of Endocrinology and Metabolism, Molecular Endocrinology Stem Cell Research Unit (KMEB), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Swiss Federal Insititue of Technology (ETH) Zurich, Zurich, Switzerland
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Mohamad I. Nasser
- Department of Endocrinology and Metabolism, Molecular Endocrinology Stem Cell Research Unit (KMEB), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Frost
- Department of Endocrinology and Metabolism, Molecular Endocrinology Stem Cell Research Unit (KMEB), Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Andrea M. Burden
- Pharmacoepidemiology Group, Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Swiss Federal Insititue of Technology (ETH) Zurich, Zurich, Switzerland
- Corresponding author: Andrea M. Burden,
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Prætorius T, Baymler Lundberg AS, Søndergaard E, Tang Knudsen S, Sandbæk A. The effect of virtual specialist conferences between endocrinologists and general practitioners about type 2 diabetes: study protocol for a pragmatic randomized superiority trial. Trials 2022; 23:1059. [PMID: 36578024 PMCID: PMC9795951 DOI: 10.1186/s13063-022-06961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/25/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To support the primary care sector in delivering high-quality type 2 diabetes (T2D), literature reviews emphasize the need for implementing models of collaboration that in a simple and effective way facilitate clinical dialogue between general practitioners (GPs) and endocrinologists. The overall aim of the project is to evaluate if virtual specialist conferences between GPs and endocrinologists about patients living with T2D is clinically effective and improves diabetes competences and organization in general practice in comparison to usual practice. METHODS A prospective, pragmatic, and superiority RCT with two parallel arms of general practices in the Municipality of Aarhus, Denmark. All general practices are invited (n = 100). The intervention runs for 12 months and consists of four virtual conferences between endocrinologists and an individual general practice. Before the first conference, an introductory webinar teaches GPs about how to use an IT-platform to identify and manage T2D patients. The main analysis (month 12) concerns the difference between the intervention and control arm. It is expected that the virtual conferences at the patient level will improve adherence to international recommendations on diabetes medication for T2D patients and improve the risk profile with a reduction in glycated haemoglobin, blood pressure, and cholesterol. The study design allows for identifying a significant difference between the intervention (n = 15) and control group (n = 15) regarding the three primary clinical outcomes with a power of 0.8870-0.9941. At the general practice level, it is expected that general practitioners and practice staff in the intervention group will improve self-reported diabetes competence and organization. The control arm will get the intervention when the primary intervention ends (months 12-24), and the intervention arm transitions to a maintenance phase. DISCUSSION The potential of virtual conferences is yet to be fully tapped because of methodological limitations. Studies have also not yet systematically evaluated virtual conferences in the context of chronic care using a high-quality research design. Given the nature of this real-life intervention, general practitioners and endocrinologists cannot be blinded to their allocation to either the intervention or comparison arm. TRIAL REGISTRATION ClinicalTrials.gov, United States National Institutes of Health trial ID: NCT05268081. Registered on 4 March 2022.
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Affiliation(s)
- Thim Prætorius
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Anne Sofie Baymler Lundberg
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722 Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Esben Søndergaard
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Søren Tang Knudsen
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Annelli Sandbæk
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722 Department of Public Health, Aarhus University, Aarhus, Denmark
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Ito C, Kurth T, Baune BT, Brinks R. Illness-Death Model as a Framework for Chronic Disease Burden Projection: Application to Mental Health Epidemiology. FRONTIERS IN EPIDEMIOLOGY 2022; 2:903652. [PMID: 38455334 PMCID: PMC10910899 DOI: 10.3389/fepid.2022.903652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/30/2022] [Indexed: 03/09/2024]
Abstract
Introduction Estimates of future disease burden supports public health decision-making. Multistate modeling of chronic diseases is still limited despite a long history of mathematical modeling of diseases. We introduce a discrete time approach to the illness-death model and a recursion formula, which can be utilized to project chronic disease burden. We further illustrate an example of the technique applied to anxiety disorders in Germany. Materials and Equipment The illness-death model is a multistate model that relates prevalence, incidence, mortality, and remission. A basic recursion formula that considers prevalence, incidence, mortality among the susceptible, and mortality among the diseased can be applied to irreversible chronic diseases such as diabetes. Among several mental disorders, remission plays a key role and thus an extended recursion formula taking remission into account is derived. Methods Using the Global Burden of Disease Study 2019 data and population projections from the Federal Statistical Office of Germany, a total number of individuals with anxiety disorders by sex in Germany from 2019 to 2030 was projected. Regression models were fitted to historical data for prevalence and incidence. Differential mortality risks were modeled based on empirical evidence. Remission was estimated from prevalence, incidence, and mortality, applying the extended recursion formula. Sex- and age-specific prevalence of 2019 was given as the initial value to estimate the total number of individuals with anxiety disorders for each year up to 2030. Projections were also made through simple extrapolation of prevalence for comparison. Results From 2019 to 2030, we estimated a decrease of 52,114 (-1.3%) individuals with anxiety disorders among women, and an increase of 166,870 (+8.5%) cases among men, through the illness-death model approach. With prevalence extrapolation, an increase of 381,770 (+9.7%) among women and an increase of 272,446 (+13.9%) among men were estimated. Discussion Application of the illness-death model with discrete time steps is possible for both irreversible chronic diseases and diseases with possible remissions, such as anxiety disorders. The technique provides a framework for disease burden prediction. The example provided here can form a basis for running simulations under varying transition probabilities.
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Affiliation(s)
- Chisato Ito
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernhard T. Baune
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ralph Brinks
- Medical Biometry and Epidemiology, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany
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Future prevalence of type 2 diabetes—A comparative analysis of chronic disease projection methods. PLoS One 2022; 17:e0264739. [PMID: 35255104 PMCID: PMC8901066 DOI: 10.1371/journal.pone.0264739] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Accurate projections of the future number of people with chronic diseases are necessary for effective resource allocation and health care planning in response to changes in disease burden. Aim To introduce and compare different projection methods to estimate the number of people with diagnosed type 2 diabetes (T2D) in Germany in 2040. Methods We compare three methods to project the number of males with T2D in Germany in 2040. Method 1) simply combines the sex- and age-specific prevalence of T2D in 2010 with future population distributions projected by the German Federal Statistical Office (FSO). Methods 2) and 3) additionally account for the incidence of T2D and mortality rates using partial differential equations (PDEs). Method 2) models the prevalence of T2D employing a scalar PDE which incorporates incidence and mortality rates. Subsequently, the estimated prevalence is applied to the population projection of the FSO. Method 3) uses a two-dimensional system of PDEs and estimates future case numbers directly while future mortality of people with and without T2D is modelled independently from the projection of the FSO. Results Method 1) projects 3.6 million male people with diagnosed T2D in Germany in 2040. Compared to 2.8 million males in 2010, this equals an increase by 29%. Methods 2) and 3) project 5.9 million (+104% compared to 2010) and 6.0 million (+116%) male T2D patients, respectively. Conclusions The results of the three methods differ substantially. It appears that ignoring temporal trends in incidence and mortality may result in misleading projections of the future number of people with chronic diseases. Hence, it is essential to include these rates as is done by method 2) and 3).
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Lindekilde N, Scheuer SH, Rutters F, Knudsen L, Lasgaard M, Rubin KH, Henriksen JE, Kivimäki M, Andersen GS, Pouwer F. Prevalence of type 2 diabetes in psychiatric disorders: an umbrella review with meta-analysis of 245 observational studies from 32 systematic reviews. Diabetologia 2022; 65:440-456. [PMID: 34841451 DOI: 10.1007/s00125-021-05609-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/01/2021] [Indexed: 01/05/2023]
Abstract
AIMS/HYPOTHESIS Estimates of the global prevalence of type 2 diabetes vary between 6% and 9%. The prevalence of type 2 diabetes has been investigated in psychiatric populations but a critical appraisal of the existing evidence is lacking, and an overview is needed. This umbrella review summarises existing systematic reviews of observational studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder. METHODS We searched PubMed, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews from inception to 17 January 2021 and screened reference lists of included systematic reviews. On the basis of prespecified criteria, we included systematic reviews investigating the prevalence of type 2 diabetes in adults (aged ≥18 years) with a psychiatric disorder. Titles and abstracts of 5155 identified records and full texts of 431 selected studies were screened by two independent reviewers, based on predefined eligibility criteria and an a priori developed extraction form, following the PRISMA and MOOSE guidelines. Risk of bias was assessed with the ROBIS instrument. Data extracted from primary studies were synthesised using random-effects meta-analyses. RESULTS A total of 32 systematic reviews with 245 unique primary studies were identified and met inclusion criteria. Twelve had low risk of bias. They reported type 2 diabetes prevalence estimates ranging from 5% to 22% depending on the specific psychiatric disorder. We meta-analysed data for ten categories of psychiatric disorders and found the following prevalence estimates of type 2 diabetes: in people with a sleep disorder: 40%; binge eating disorder: 21%; substance use disorder: 16%; anxiety disorder: 14%; bipolar disorder: 11%; psychosis: 11%; schizophrenia: 10%; a mixed group of psychiatric disorders: 10%; depression: 9%; and in people with an intellectual disability 8%. All meta-analyses revealed high levels of heterogeneity. CONCLUSIONS/INTERPRETATION Type 2 diabetes is a common comorbidity in people with a psychiatric disorder. Future research should investigate whether routine screening for type 2 diabetes and subsequent prevention initiatives for these people are warranted. PROSPERO registration no. CRD42020159870.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | | | - Femke Rutters
- Epidemiology and Data Science, Amsterdam Public Health Institute, Amsterdam UMC, location VUMC, Amsterdam, the Netherlands
| | | | - Mathias Lasgaard
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Katrine H Rubin
- OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Erik Henriksen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University of College London, London, UK
| | | | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
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Changes in type 2 diabetes incidence and mortality associated with introduction of HbA1c as diagnostic option: A Danish 24-year population-based study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 14:100291. [PMID: 35024680 PMCID: PMC8733171 DOI: 10.1016/j.lanepe.2021.100291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background In 2011, the World Health Organization began recommending glycated haemoglobin (HbA1c) as a measure for diagnosing type 2 diabetes (T2D). This initiative may have changed basic T2D epidemiology. Consequently, we examined time changes in T2D incidence and mortality during 1995-2018. Methods In this population-based cohort study, we included 415,553 individuals with incident T2D. We calculated annual age-standardized incidence rates of T2D. We examined HbA1c testing and used Poisson-regression to investigate all-cause mortality among the T2D patients and a matched comparison cohort from the general population over successive 3-year periods. Findings From 1995 to the 2012 introduction of HbA1c testing as a diagnostic option in Denmark, the annual standardized incidence rate (SIR) of T2D doubled, from 193 to 396 per 100,000 persons (4.1% increase annually). From 2012 onwards, the T2D incidence declined by 36%, reaching 253 per 100,000 persons in 2018 (5.7% decrease annually). This was driven by fewer patients starting treatment with an HbA1c measurement of <6·5% or without prior HbA1c testing. Mortality per 1,000 person-years following a T2D diagnosis decreased by 44% between 1995-1997 and 2010-2012, from 69 deaths to 38 deaths (adjusted mortality rate ratio: 0·55 (95% CI: 0·54-0·56)). After the low level during 2010-2012, mortality increased again by 27% to 48 per 1,000 person-years (95% CI: 46-50) by 2016-2018. Interpretation Our findings suggest that introducing HbA1c as a diagnostic option may have changed basic T2D epidemiology by leaving patients undiagnosed, that previously would have been diagnosed and treated. Funding Aarhus University funded the study and had no further involvement.
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Yang HT, Liu JK, Xiu WJ, Tian TT, Yang Y, Hou XG, Xie X. Gut Microbiome-Based Diagnostic Model to Predict Diabetes Mellitus. Bioengineered 2021; 12:12521-12534. [PMID: 34927535 PMCID: PMC8810174 DOI: 10.1080/21655979.2021.2009752] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to determine the diversity of intestinal microflora and its correlation with clinical parameters in diabetic patients and healthy subjects and to assess the importance of intestinal flora in patients with diabetes. Forty-four patients with diabetes were included. The control group included 47 healthy people. Their data, biochemical indicators and results from 16S rRNA sequencing of their fecal samples were collected. Compared with the healthy population, the intestinal flora of the diabetic patients was obviously abnormal. Within the diabetes group, the abundances of the genera Faecalibacterium, Prevotella, and Roseburia were higher, and the abundances of the genera Shigella and Bifidobacterium were lower. In the correlation analysis between bacteria and clinical indicators, it was found that the genera Veillonella and unclassified_Enterobacteriaceae were negatively related to blood glucose, while the genera Phascolarctobacterium, unidentified_Bacteroidales and Prevotella were significantly positively correlated with fasting blood glucose. Twelve microbial markers were detected in the random forest model, and the area under the curve (AUC) was 84.1%. This index was greater than the diagnostic effect of fasting blood glucose. This was also supported by the joint diagnostic model of microorganisms and clinical indicators. In addition, the intestinal flora significantly improved the diagnosis of diabetes. In conclusion, it can be concluded from these results that intestinal flora is essential for the occurrence and development of diabetes, which seems to be as important as blood glucose itself. Abbreviations: PCoA: principal coordinate analysis; NMDS: non econometric multidimensional scaling analysis; LEfSe: linear discriminant analysis effect size; LDA: linear discriminant analysis; POD: probability of disease; BMI: body mass index; DCA: decision curve analysis
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Affiliation(s)
- Hai-Tao Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jing-Kun Liu
- Department of Oncology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wen-Juan Xiu
- College of Basic Medical Science, Xinjiang Medical University, Urumqi, China
| | - Ting-Ting Tian
- College of Basic Medical Science, Xinjiang Medical University, Urumqi, China
| | - Yi Yang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xian-Geng Hou
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Causes of symptom dissatisfaction in patients with generalized myasthenia gravis. J Neurol 2021; 269:3086-3093. [PMID: 34806129 DOI: 10.1007/s00415-021-10902-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patient-centered assessments have attracted increasing attention in the last decade in clinics and research. The purpose of this study was to examine the association between patients' satisfaction with symptoms and several disease-specific and generic outcome measures in 100 patients with generalized myasthenia gravis (gMG). METHODS In this cross-sectional study, patients with gMG followed at the Copenhagen Neuromuscular Center from October 2019 to June 2020 participated in one test. The patients completed commonly used MG-specific outcome measures and generic questionnaires for depression (Major Depression Inventory), comorbidities (Charlson Comorbidity Index), fatigue (Multidimensional Fatigue Inventory), overall health state (EQ-5D-3L), and satisfaction with MG treatment. The analyses were anchored in the Patient Acceptable Symptom State (PASS). RESULTS N = 190 patients were screened for the study, and 100 patients were included. One-third of the patients reported dissatisfaction (negative PASS status) with the current symptom state. Increasing MG symptoms, fatigue, depression, low MG-related quality of life, and shorter disease duration were associated with negative PASS status. Age, sex, BMI, MG treatment, and comorbidity did not influence PASS status. CONCLUSIONS This study shows that dissatisfaction with the current symptom level is high in patients with gMG and that dissatisfaction is associated with disease severity, disease length, depression, fatigue, and lower MG-related quality of life. The results emphasize the importance of a patient-centered approach to MG treatment to optimize patient satisfaction. The PASS question was useful in this study to investigate the causes of symptom dissatisfaction in gMG.
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Kosjerina V, Carstensen B, Jørgensen ME, Brock B, Christensen HR, Rungby J, Andersen GS. Discontinuation of diabetes medication in the 10 years before death in Denmark: a register-based study. THE LANCET HEALTHY LONGEVITY 2021; 2:e561-e570. [DOI: 10.1016/s2666-7568(21)00170-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023]
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Carstensen B, Rønn PF, Jørgensen ME. Lifetime risk and years lost to type 1 and type 2 diabetes in Denmark, 1996-2016. BMJ Open Diabetes Res Care 2021; 9:9/1/e001065. [PMID: 33653710 PMCID: PMC7929801 DOI: 10.1136/bmjdrc-2019-001065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 11/02/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Lifetime risk and lifetime lost to diabetes are measures of current diabetes burden in a population. We aimed at quantifying these measures in the Danish population. RESEARCH DESIGN AND METHODS We modeled incidence and mortality of type 1 diabetes (T1D) and type 2 diabetes (T2D) and non-diabetes mortality based on complete follow-up of the entire population of Denmark in 1996-2016. A multistate model with these transition rates was used to assess the lifetime risk of diabetes, as well as the difference in expected lifetime between persons with type 1 and T2D and persons without. RESULTS In 2016, the lifetime risk of T1D was 1.1% and that for T2D 24%, the latter a 50% increase from 1996. For 50-year-old persons, the lifetime lost was 6.6 years for T1D and 4.8 years for T2D. These figures have been declining over the study period.At 2016, the total foreseeable lives lost in Denmark among patients with T1D were 182 000 years, and those among patients with T2D were 766 000 years, corresponding to 6.6 and 3.0 years per person, respectively. CONCLUSION At the individual level, improvements in the disease burden for both T1D and T2D have occurred. At the population level, the increasing number of patients with T2D has contributed to a large increase in the total loss of lifetime.
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Affiliation(s)
| | | | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Clinical Epidemiology, University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
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