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van der Vaart A, Eelderink C, van Goor H, Hillebrands JL, Te Velde-Keyzer CA, Bakker SJL, Pasch A, van Dijk PR, Laverman GD, de Borst MH. Serum T 50 predicts cardiovascular mortality in individuals with type 2 diabetes: A prospective cohort study. J Intern Med 2024; 295:748-758. [PMID: 38528373 DOI: 10.1111/joim.13781] [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] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND AIMS Individuals with type 2 diabetes (T2D) have a higher risk of cardiovascular disease, compared with those without T2D. The serum T50 test captures the transformation time of calciprotein particles in serum. We aimed to assess whether serum T50 predicts cardiovascular mortality in T2D patients, independent of traditional risk factors. METHODS We analyzed 621 individuals with T2D in this prospective cohort study. Cox regression models were performed to test the association between serum T50 and cardiovascular and all-cause mortality. Causes of death were categorized according to ICD-10 codes. Risk prediction improvement was assessed by comparing Harrell's C for models without and with T50. RESULTS: The mean age was 64.2 ± 9.8 years, and 61% were male. The average serum T50 time was 323 ± 63 min. Higher age, alcohol use, high-sensitive C-reactive protein, and plasma phosphate were associated with lower serum T50 levels. Higher plasma triglycerides, venous bicarbonate, sodium, magnesium, and alanine aminotransferase were associated with higher serum T50 levels. After a follow-up of 7.5[5.4-10.7] years, each 60 min decrease in serum T50 was associated with an increased risk of cardiovascular (fully adjusted HR 1.32, 95% CI 1.08-1.50, and p = 0.01) and all-cause mortality (HR 1.15, 95%CI 1.00-1.38, and p = 0.04). Results were consistent in sensitivity analyses after exclusion of individuals with estimated glomerular filtration rate <45 or <60 mL/min/1.73 m2 and higher plasma phosphate levels. CONCLUSIONS Serum T50 improves prediction of cardiovascular and all-cause mortality risk in individuals with T2D. Serum T50 may be useful for risk stratification and to guide therapeutic strategies aiming to reduce cardiovascular mortality in T2D.
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Affiliation(s)
- Amarens van der Vaart
- Departments of Internal Medicine, Divisions of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Coby Eelderink
- Departments of Internal Medicine, Divisions of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Harry van Goor
- Pathology & Medical Biology, Division of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan-Luuk Hillebrands
- Pathology & Medical Biology, Division of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Charlotte A Te Velde-Keyzer
- Departments of Internal Medicine, Divisions of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Departments of Internal Medicine, Divisions of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andreas Pasch
- Calciscon AG, Biel, Switzerland
- Institute for Physiology and Pathophysiology, Johannes Kepler University Linz, Linz, Austria
| | - Peter R van Dijk
- Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gozewijn D Laverman
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo, Hengelo, the Netherlands
| | - Martin H de Borst
- Departments of Internal Medicine, Divisions of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Braem CIR, Yavuz US, Hermens HJ, Veltink PH. Missing Data Statistics Provide Causal Insights into Data Loss in Diabetes Health Monitoring by Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2024; 24:1526. [PMID: 38475061 DOI: 10.3390/s24051526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/14/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Data loss in wearable sensors is an inevitable problem that leads to misrepresentation during diabetes health monitoring. We systematically investigated missing wearable sensors data to get causal insight into the mechanisms leading to missing data. METHODS Two-week-long data from a continuous glucose monitor and a Fitbit activity tracker recording heart rate (HR) and step count in free-living patients with type 2 diabetes mellitus were used. The gap size distribution was fitted with a Planck distribution to test for missing not at random (MNAR) and a difference between distributions was tested with a Chi-squared test. Significant missing data dispersion over time was tested with the Kruskal-Wallis test and Dunn post hoc analysis. RESULTS Data from 77 subjects resulted in 73 cleaned glucose, 70 HR and 68 step count recordings. The glucose gap sizes followed a Planck distribution. HR and step count gap frequency differed significantly (p < 0.001), and the missing data were therefore MNAR. In glucose, more missing data were found in the night (23:00-01:00), and in step count, more at measurement days 6 and 7 (p < 0.001). In both cases, missing data were caused by insufficient frequency of data synchronization. CONCLUSIONS Our novel approach of investigating missing data statistics revealed the mechanisms for missing data in Fitbit and CGM data.
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Affiliation(s)
- Carlijn I R Braem
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
| | - Utku S Yavuz
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
| | - Hermie J Hermens
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
| | - Peter H Veltink
- Department of Biomedical Signals and Systems, University of Twente, 7522 NB Enschede, The Netherlands
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van der Vaart A, Bakker SJL, Laverman GD, van Dijk PR, de Borst MH. NT-proBNP Mediates the Association Between FGF23 and All-Cause Mortality in Individuals With Type 2 Diabetes. J Am Heart Assoc 2023; 12:e031873. [PMID: 38014662 PMCID: PMC10727346 DOI: 10.1161/jaha.123.031873] [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: 07/20/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND FGF23 (fibroblast growth factor 23) is associated with a higher mortality risk in type 2 diabetes, but the mechanism is unclear. We aimed to study whether NT-proBNP (N-terminal pro-brain natriuretic peptide) mediates the association between FGF23 and mortality. METHODS AND RESULTS We analyzed C-terminal FGF23 and NT-proBNP levels in 399 patients with type 2 diabetes. Cox regression analyses were performed, followed by mediation analyses using Structural Equation Modeling. During follow-up of 9.2 [7.6-11.3] years, 117 individuals died. FGF23 was associated with all-cause mortality, independent of potential confounders (fully adjusted hazard ratio [HR], 2.32 [95% CI, 1.21-4.43], P=0.01). The association was lost upon further adjustment for NT-proBNP (HR, 1.84; 95% CI, 0.91-3.73). NT-proBNP accounted for 26% of the mediation effect between FGF23 and all-cause mortality. CONCLUSIONS These findings suggest that a higher FGF23 level is associated with increased mortality in individuals with type 2 diabetes through an effect on volume homeostasis.
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Affiliation(s)
- Amarens van der Vaart
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Department of Internal Medicine, Division of EndocrinologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Gozewijn D. Laverman
- Division of Nephrology, Department of Internal MedicineZiekenhuisgroep TwenteHengeloThe Netherlands
| | - Peter R. van Dijk
- Department of Internal Medicine, Division of EndocrinologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Martin H. de Borst
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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4
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Chuang GT, Kremer D, Huang CH, Alkaff FF, Lin CH, Tseng TL, Laverman GD, Bakker SJL, Chuang LM. Urinary Fetuin-A Fragments Predict Progressive Estimated Glomerular Filtration Rate Decline in Two Independent Type 2 Diabetes Cohorts of Different Ethnicities. Am J Nephrol 2023; 55:106-114. [PMID: 37812932 DOI: 10.1159/000534514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION There is a great clinical need for novel markers to predict kidney function decline in patients with type 2 diabetes. We explored the potential of posttranslationally modified fetuin-A fragments in urine (uPTM-FetA) as such a marker. METHODS We included patients with type 2 diabetes from two independent, nonoverlapping prospective cohort studies. A cut-off for uPTM-FetA, measured via ELISA method, was determined using the Youden index in the primary cohort of patients with type 2 diabetes from Taiwan. Kidney endpoint was defined as an estimated glomerular filtration rate (eGFR) decline ≥30% from baseline, reaching of an eGFR <15 mL/min/1.73 m2, or a need of renal replacement therapy. Prospective associations were assessed in Cox regression models. All analyses were replicated in a cohort of patients with type 2 diabetes from the Netherlands. RESULTS In total, 294 patients with type 2 diabetes (age 61 ± 10 years, 55% male, eGFR 88 ± 16 mL/min/1.73 m2) were included in the primary cohort. During a follow-up of median 4.6 years, 42 participants (14%) experienced the kidney endpoint. Using the defined cut-off, a high uPTM-FetA was associated with a higher risk of renal function decline (Plog-rank < 0.0001). This association was similar in subgroups depending on albuminuria. This association remained, independent of age, sex, baseline eGFR, albuminuria, HbA1c, and other potential confounders (HR: 9.94; 95% CI: 2.96-33.40; p < 0.001 in the final model). Analyses in the validation cohort (376 patients with type 2 diabetes, age 64 ± 11 years, 66% male, eGFR 76 ± 24 mL/min/1.73 m2) using the same cut-off yielded similar results. CONCLUSION uPTM-FetA was independently associated with kidney function decline in patients with type 2 diabetes validated in a 2-cohort study. The significant additive predictive power of this biomarker from conventional risk factors suggests its clinical use for renal function progression in patients with type 2 diabetes.
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Affiliation(s)
- Gwo-Tsann Chuang
- Department of Pediatrics, Division of Nephrology, National Taiwan University Hospital, Taipei, Taiwan,
| | - Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Chi-Hsuan Huang
- Research and Development Division, Bio Preventive Medicine Corp., Hsinchu, Taiwan
| | - Firas F Alkaff
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
| | - Chih-Hung Lin
- Divsion of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Ling Tseng
- Research and Development Division, Bio Preventive Medicine Corp., Hsinchu, Taiwan
| | - Gozewijn D Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, The Netherlands
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lee-Ming Chuang
- Divsion of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
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Gant CM, Oosterwijk MM, Binnenmars SH, Navis GJ, Haverkate H, Bakker SJL, Laverman GD. Use of maximal dosage renin-angiotensin-aldosterone system inhibitors in a real life population of complicated type 2 diabetes - contraindications and opportunities. BMC Nephrol 2023; 24:240. [PMID: 37587437 PMCID: PMC10428595 DOI: 10.1186/s12882-023-03205-2] [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: 12/15/2021] [Accepted: 05/18/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE Pharmacological inhibition of the renin-angiotensin-aldosterone-system (RAASi) is the cornerstone of hypertension treatment, renoprotection and secondary prevention of cardiovascular disease in patients with type 2 diabetes. Although there is a dose-dependent effect of RAASi with optimum protection when using maximal dose, little is known on actual use of maximal dosage RAASi in clinical practice. Here we investigate prevalence of maximal dosage RAASi, and contraindications for, optimizing RAASi dosage, in patients with complicated type 2 diabetes in a real-life clinical setting. RESEARCH DESIGN AND METHODS We performed a retrospective analysis in 668 patients included in the DIAbetes and LifEstyle Cohort Twente (DIALECT). We grouped patients according to no RAASi, submaximal RAASi and maximal RAASi use. All potassium and creatinine measurements between January 1st 2000 and date of inclusion in DIALECT were extracted from patients files. We identified determinants of maximal RAASi use vs. submaximal RAASi use with multivariate logistic regression analysis. RESULTS Mean age was 64 ± 10 years and 61% were men. In total, 460 patients (69%) used RAASi, and 30% used maximal RAASi. Maximal RAASi use was not statistically different between different indications for RAASi (i.e. hypertension, diabetic kidney disease, coronary heart disease and cerebrovascular disease; P > 0.05). Per patient, 2 [1-4] measurements of potassium and 20 [13-31] measurements of creatinine were retrieved, retrospective follow-up time was - 3.0 [-1.4 to -5.7] years. Pre-baseline hyperkalemia > 5.0 mmol/l and acute kidney injury were found in 151 (23%) patients and 119 patients (18%), respectively. Determinants of maximal RAASi were prior acute kidney injury (OR 0.51 (0.30-0.87)), increased albuminuria (OR 1.89 (1.17-3.08)) and total number of used antihypertensives (OR 1.66 (1.33-2.06)). CONCLUSIONS Maximal dose RAASi is used in almost one third of complicated type 2 diabetes patients in a real-life setting. The prevalence of contraindications is considerable, but relative in nature, suggesting that it is worthwhile to explore strategies aimed at maximizing RAASi while circumventing the alleged contraindications.
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Affiliation(s)
- C M Gant
- Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands.
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584CX, The Netherlands.
| | - M M Oosterwijk
- Department of Internal Medicine, ZGT Hospital, Almelo, The Netherlands
| | - S H Binnenmars
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G J Navis
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Haverkate
- Hospital Pharmacy, ZGT Hospital, Almelo, The Netherlands
| | - S J L Bakker
- Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G D Laverman
- Department of Internal Medicine, ZGT Hospital, Almelo, The Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
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Yeung SMH, Oosterwijk MM, Poelstra M, Gant CM, Rotmans JI, Hoorn EJ, Vogt L, Navis G, Bakker SJL, de Borst MH, Laverman GD. Low Urinary Potassium Excretion Is Associated with Higher Risk of All-Cause Mortality in Patients with Type 2 Diabetes: Results of the Dutch Diabetes and Lifestyle Cohort Twente (DIALECT). J Nutr 2023; 152:2856-2864. [PMID: 36130237 DOI: 10.1093/jn/nxac215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/21/2022] [Accepted: 09/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Low 24-h urinary potassium excretion, reflecting low potassium intake, is associated with premature mortality in the general population. OBJECTIVES To determine whether urinary potassium excretion is associated with all-cause mortality in patients with type 2 diabetes. METHODS We performed a prospective cohort study in 654 patients with type 2 diabetes in the Diabetes and Lifestyle Cohort Twente (DIALECT). Sex-specific tertiles of 24-h urinary potassium excretion were analyzed in a multivariable Cox regression model with all-cause mortality. The outpatient program of the hospital uses a continuous surveillance system by the municipal registry of death to ensure up-to-date information on the patient's status (alive or deceased). FFQs were used to study associations between urinary potassium excretion and food products. RESULTS Urinary potassium excretion at baseline was 84 ± 25 mmol/d in males and 65 ± 22 mmol/d in females, corresponding to estimated potassium intakes of 4250 ± 1270 mg/d and 3300 ± 875 mg/d. During a median follow-up of 5.2 (IQR: 2.7-7.9] y, 96 participants died. In a fully adjusted model, patients in the lowest sex-specific tertile had a higher risk of all-cause mortality, compared with patients in the highest sex-specific tertile (HR: 2.09; 95% CI: 1.06, 4.10; P = 0.03). Patients in the lowest sex-specific tertile consumed fewer fruits and vegetables, dairy, coffee, and potato products compared with patients in the highest sex-specific tertile (all P < 0.05). CONCLUSIONS Low potassium intake is associated with a higher risk of all-cause mortality in Dutch patients with type 2 diabetes. Intervention studies are needed to determine whether potassium supplementation improves longevity in patients with type 2 diabetes. This trial was registered in the Dutch Trial Register as NTR trial code 5855.
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Affiliation(s)
- Stanley M H Yeung
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Milou M Oosterwijk
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, Almelo and Hengelo, The Netherlands
| | - Monique Poelstra
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christina M Gant
- Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liffert Vogt
- Department of Internal Medicine, Section of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gozewijn D Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, Almelo and Hengelo, The Netherlands
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Kushniruk A, Middelweerd A, van Empelen P, Preuhs K, Konijnendijk AAJ, Oude Nijeweme-d'Hollosy W, Schrijver LK, Laverman GD, Vollenbroek-Hutten MMR. A Digital Lifestyle Coach (E-Supporter 1.0) to Support People With Type 2 Diabetes: Participatory Development Study. JMIR Hum Factors 2023; 10:e40017. [PMID: 36633898 PMCID: PMC9947918 DOI: 10.2196/40017] [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: 06/01/2022] [Revised: 09/29/2022] [Accepted: 11/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A healthy lifestyle, including regular physical activity and a healthy diet, is becoming increasingly important in the treatment of chronic diseases. eHealth interventions that incorporate behavior change techniques (BCTs) and dynamic tailoring strategies could effectively support a healthy lifestyle. E-Supporter 1.0 is an eCoach designed to support physical activity and a healthy diet in people with type 2 diabetes (T2D). OBJECTIVE This paper aimed to describe the systematic development of E-Supporter 1.0. METHODS Our systematic design process consisted of 3 phases. The definition phase included the selection of the target group and formulation of intervention objectives, and the identification of behavioral determinants based on which BCTs were selected to apply in the intervention. In the development phase, intervention content was developed by specifying tailoring variables, intervention options, and decision rules. In the last phase, E-Supporter 1.0 integrated in the Diameter app was evaluated using a usability test in 9 people with T2D to assess intervention usage and acceptability. RESULTS The main intervention objectives were to stimulate light to moderate-vigorous physical activities or adherence to the Dutch dietary guidelines in people with T2D. The selection of behavioral determinants was informed by the health action process approach and theories explaining behavior maintenance. BCTs were included to address relevant behavioral determinants (eg, action control, self-efficacy, and coping planning). Development of the intervention resulted in 3 types of intervention options, consisting of motivational messages, behavioral feedback, and tailor-made supportive exercises. On the basis of IF-THEN rules, intervention options could be tailored to, among others, type of behavioral goal and (barriers to) goal achievement. Data on these variables could be collected using app data, activity tracker data, and daily ecological momentary assessments. Usability testing revealed that user experiences were predominantly positive, despite some problems in the fixed delivery of content. CONCLUSIONS The systematic development approach resulted in a theory-based and dynamically tailored eCoach. Future work should focus on expanding intervention content to other chronic diseases and lifestyle behaviors, enhancing the degree of tailoring and evaluating intervention effects on acceptability, use, and cost-effectiveness.
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Affiliation(s)
| | - Anouk Middelweerd
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | - Katharina Preuhs
- Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Leiden, Netherlands
| | | | | | - Laura K Schrijver
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Gozewijn D Laverman
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente, Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands.,Board of Directors, Medisch Spectrum Twente, Enschede, Netherlands
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Beernink JM, Oosterwijk MM, van Boven JFM, Heerspink HJL, Bakker SJL, Navis G, Nijboer RM, Gant CM, Haverkate H, Kruik-Kollöffel WJ, Laverman GD. Adherence to Statin Therapy and Attainment of LDL Cholesterol Targets in an Outpatient Population of Type 2 Diabetes Patients: Analysis in the DIAbetes and LifEstyle Cohort Twente (DIALECT). Front Pharmacol 2022; 13:888110. [PMID: 35903346 PMCID: PMC9315395 DOI: 10.3389/fphar.2022.888110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess adherence to statin therapy and its association with sociodemographic data, medical characteristics, LDLc levels, and LDLc target attainment in real-world T2D patients treated in secondary care.Research Design and Methods: Cross-sectional analyses were performed on baseline data of 393 patients in the DIAbetes and LifEstyle Cohort Twente (DIALECT). The medication possession ratio (MPR), calculated with pharmacy dispensing data, was used to determine adherence to statins for an intended period of 24 months. Statins were included in the analyses if they were used for at least six consecutive months with at least three dispenses. Adherence was defined as an MPR ≥80%. Associations with adherence were assessed using descriptive statistics and binary logistic regression.Results: Overall, 80% of the patients had a statin prescription and of those, 89% were adherent. The proportion of patients who reached LDLc targets of ≤2.5 mmol/L and <1.8 mmol/L differed significantly between the adherent, nonadherent and non-statin group (90% vs. 74% vs. 46%; p < 0.01 and 56% vs. 26% vs. 6%; p < 0.01, respectively). Serum LDLc levels were lower in the adherent versus the nonadherent and non-statin group (1.76 ± 0.60 vs. 2.23 ± 0.90 vs. 2.71 ± 0.67 mmol/L; p < 0.01). Higher HbA1c levels were independently associated with nonadherence (OR: 1.05, 95% CI 1.01–1.08; p < 0.01). Mediation adherence (OR: 2.88, 95% CI 1.04–7.97; p = 0.041) and lower BMI (OR: 0.88, 95% CI 0.81–0.96; p < 0.01) were independently associated with attaining the LDLc target of ≤2.5 mmol/L.Conclusion: In patients with T2D treated in secondary care, statin adherence was relatively high and was associated with significantly lower LDLc levels. It is important to identify nonadherence as it appeared an important determinant of failure to reach LDLc targets. The finding that many patients who failed to attain LDLc targets did not receive statin treatment offers an opportunity to improve diabetes care.
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Affiliation(s)
- Jelle M. Beernink
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, Netherlands
- *Correspondence: Jelle M. Beernink, ,
| | - Milou M. Oosterwijk
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, Netherlands
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, Netherlands
| | - Hiddo J. L. Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stephan J. L. Bakker
- Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, Netherlands
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Roos M. Nijboer
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, Netherlands
| | - Christina M. Gant
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Internal Medicine, Meander Medical Center, Amersfoort, Netherlands
| | - Heleen Haverkate
- Department of Clinical Pharmacy, Ziekenhuis Groep Twente, Almelo, Netherlands
| | | | - Gozewijn D. Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, Netherlands
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, Netherlands
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Oosterwijk MM, Navis G, Bakker SJL, Laverman GD. Personalized Nutrition in Patients with Type 2 Diabetes and Chronic Kidney Disease: The Two-Edged Sword of Dietary Protein Intake. J Pers Med 2022; 12:300. [PMID: 35207788 PMCID: PMC8878174 DOI: 10.3390/jpm12020300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
In type 2 diabetes (T2D), there is a general and strong focus on carbohydrate restriction. However, this may have unwarranted consequences for those with concomitant chronic kidney disease (CKD) since decreasing intake of carbohydrates implies a higher proportion of dietary protein, which is of critical debate in patients with CKD due to its ambiguous implications in maintaining either kidney function or nutritional status. We evaluated adherence to the protein recommendations, taking into account the nutritional status of patients with T2D with or without CKD. Patients were divided in three groups according to their estimated Glomerular Filtration Rate (eGFR): mild to no CKD (eGFR > 60 mL/min/1.73 m2), moderate CKD (eGFR 30-60 mL/min/1.73 m2), or advanced CKD (eGFR < 30 mL/min/1.73 m2). Regarding adherence to the protein recommendations, 17% of the patients without advanced CKD consumed < 0.8 g/kg/day, 29% of the patients with moderate CKD consumed > 1.3 g/kg/day, and 60% of the patients with advanced CKD consumed > 1.0 g/kg/day. In addition, patients with moderate- or advanced CKD tend to have a lower muscle mass, normalized by height, compared to patients with mild to no CKD (p < 0.001), while body mass index was not significantly different between patients with or without CKD (p = 0.44). We found that although dietary protein restriction has not been indicated in either of the CKD stages, approximately 10% had a dietary protein intake < 0.8 g/kg/day, with accompanying risks of malnourishment and sarcopenia. Our main advice is to maintain a dietary protein intake of at least 0.8 g/kg/day in order to prevent patients from becoming malnourished and sarcopenic.
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Affiliation(s)
- Milou M. Oosterwijk
- Ziekenhuis Groep Twente, Department of Internal Medicine/Nephrology, 7609 PP Almelo, The Netherlands;
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (G.N.); (S.J.L.B.)
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (G.N.); (S.J.L.B.)
| | - Gozewijn D. Laverman
- Ziekenhuis Groep Twente, Department of Internal Medicine/Nephrology, 7609 PP Almelo, The Netherlands;
- Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, 7522 NB Enschede, The Netherlands
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10
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Oosterwijk MM, Groothof D, Navis G, Bakker SJL, Laverman GD. High-Normal Protein Intake Is Not Associated With Faster Renal Function Deterioration in Patients With Type 2 Diabetes: A Prospective Analysis in the DIALECT Cohort. Diabetes Care 2022; 45:35-41. [PMID: 34711636 DOI: 10.2337/dc21-1211] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study the prospective association between dietary protein intake and renal function deterioration in patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Prospective analyses were performed in data of 382 patients of the Diabetes and Lifestyle Cohort Twente (DIALECT) study. Dietary protein intake was determined by the Maroni equation from 24-h urinary urea excretion. Renal function deterioration was defined as need for renal replacement therapy or a persistent increase of ≥50% in serum creatinine. Cox proportional hazards models were used to calculate hazard ratios (HRs) for the association between dietary protein intake and renal function deterioration. Threshold levels represent the dietary protein intake at which there was a significantly increased and reduced hazard of renal function deterioration. RESULTS Renal function deterioration occurred in 53 patients (14%), with a median follow-up duration of 6 (interquartile range 5-9) years. Mean dietary protein intake was 91 ± 27 g/day (1.22 ± 0.33 g/kg ideal body weight/day). Dietary protein intake was inversely associated with renal function deterioration (HR 0.62 [95% CI 0.44-0.90]). Patients with an intake <92 g/day had an increased hazard for renal function deterioration (HR 1.44 [95% CI 1.00-2.06]), while patients with an intake >163 g/day had a decreased hazard for renal function deterioration (HR 0.42 [95% CI 0.18-1.00]). Regarding dietary protein intake per kilogram body weight, patients with an intake <1.08 g/kg/day had an increased hazard for renal function deterioration (HR 1.63 [95% CI 1.00-2.65]). CONCLUSIONS In patients with T2D, unrestricted dietary protein intake was not associated with an increased hazard of renal function deterioration. Therefore, substituting carbohydrates with dietary protein is not contraindicated as a part of T2D management, although it may have a positive effect on body weight while minimizing loss of muscle mass.
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Affiliation(s)
- Milou M Oosterwijk
- 1Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - Dion Groothof
- 2Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- 2Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- 2Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gozewijn D Laverman
- 1Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands.,3Biomedical Signals and Systems, University of Twente, Enschede, the Netherlands
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11
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Schouten RM, Bueno MLP, Duivesteijn W, Pechenizkiy M. Mining sequences with exceptional transition behaviour of varying order using quality measures based on information-theoretic scoring functions. Data Min Knowl Discov 2021. [DOI: 10.1007/s10618-021-00808-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractDiscrete Markov chains are frequently used to analyse transition behaviour in sequential data. Here, the transition probabilities can be estimated using varying order Markov chains, where order k specifies the length of the sequence history that is used to model these probabilities. Generally, such a model is fitted to the entire dataset, but in practice it is likely that some heterogeneity in the data exists and that some sequences would be better modelled with alternative parameter values, or with a Markov chain of a different order. We use the framework of Exceptional Model Mining (EMM) to discover these exceptionally behaving sequences. In particular, we propose an EMM model class that allows for discovering subgroups with transition behaviour of varying order. To that end, we propose three new quality measures based on information-theoretic scoring functions. Our findings from controlled experiments show that all three quality measures find exceptional transition behaviour of varying order and are reasonably sensitive. The quality measure based on Akaike’s Information Criterion is most robust for the number of observations. We furthermore add to existing work by seeking for subgroups of sequences, as opposite to subgroups of transitions. Since we use sequence-level descriptive attributes, we form subgroups of entire sequences, which is practically relevant in situations where you want to identify the originators of exceptional sequences, such as patients. We show this relevance by analysing sequences of blood glucose values of adult persons with diabetes type 2. In the experiments, we find subgroups of patients based on age and glycated haemoglobin (HbA1c), a measure known to correlate with average blood glucose values. Clinicians and domain experts confirmed the transition behaviour as estimated by the fitted Markov chain models.
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12
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Clinical and Dietary Determinants of Muscle Mass in Patients with Type 2 Diabetes: Data from the Diabetes and Lifestyle Cohort Twente. J Clin Med 2021; 10:jcm10225227. [PMID: 34830509 PMCID: PMC8623198 DOI: 10.3390/jcm10225227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/29/2021] [Accepted: 11/06/2021] [Indexed: 12/25/2022] Open
Abstract
Low muscle mass in patients with type 2 diabetes is associated with a progressively higher risk of morbidity and mortality. The aim of this study was to identify modifiable targets for intervention of muscle mass in type 2 diabetes. Cross-sectional analyses were performed in 375 patients of the Diabetes and Lifestyle Cohort Twente-1 study. Muscle mass was estimated by 24 h urinary creatinine excretion rate (CER, mmol/24 h). Patients were divided in sex-stratified tertiles of CER. To study determinants of CER, multivariable linear regression analyses were performed. Protein intake was determined by Maroni formula and by a semi-quantitative Food Frequency Questionnaire. The mean CER was 16.1 ± 4.8 mmol/24 h and 10.9 ± 2.9 mmol/24 h in men and women, respectively. Lower CER was significantly associated with older age (p < 0.001) as a non-modifiable risk factor, whereas higher BMI (p = 0.015) and lower dietary protein intake (both methods p < 0.001) were identified as modifiable risk factors for lower CER. Overall body mass index (BMI) was high, even in the lowest CER tertile the mean BMI was 30.9 kg/m2, mainly driven by someone’s body weight (p = 0.004) instead of someone’s height (p = 0.58). In the total population, 28% did not achieve adequate protein intake of >0.8 g/kg/day, with the highest percentage in the lowest CER tertile (52%, p < 0.001). Among patients with type 2 diabetes treated in secondary care, higher BMI and low dietary protein intake are modifiable risk factors for lower muscle mass. Considering the risk associated with low muscle mass, intervention may be useful. To that purpose, dietary protein intake and BMI are potential targets for intervention.
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13
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den Braber N, Vollenbroek-Hutten MMR, Westerik KM, Bakker SJL, Navis G, van Beijnum BJF, Laverman GD. Glucose Regulation Beyond HbA 1c in Type 2 Diabetes Treated With Insulin: Real-World Evidence From the DIALECT-2 Cohort. Diabetes Care 2021; 44:dc202241. [PMID: 34301732 PMCID: PMC8740938 DOI: 10.2337/dc20-2241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 06/24/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate glucose variations associated with glycated hemoglobin (HbA1c) in insulin-treated patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Patients included in Diabetes and Lifestyle Cohort Twente (DIALECT)-2 (n = 79) were grouped into three HbA1c categories: low, intermediate, and high (≤53, 54-62, and ≥63 mmol/mol or ≤7, 7.1-7.8, and ≥7.9%, respectively). Blood glucose time in range (TIR), time below range (TBR), time above range (TAR), glucose variability parameters, day and night duration, and frequency of TBR and TAR episodes were determined by continuous glucose monitoring (CGM) using the FreeStyle Libre sensor and compared between HbA1c categories. RESULTS CGM was performed for a median (interquartile range) of 10 (7-12) days/patient. TIR was not different for low and intermediate HbA1c categories (76.8% [68.3-88.2] vs. 76.0% [72.5.0-80.1]), whereas in the low category, TBR was higher and TAR lower (7.7% [2.4-19.1] vs. 0.7% [0.3-6.1] and 8.2% [5.7-17.6] vs. 20.4% [11.6-27.0], respectively, P < 0.05). Patients in the highest HbA1c category had lower TIR (52.7% [40.9-67.3]) and higher TAR (44.1% [27.8-57.0]) than the other HbA1c categories (P < 0.05), but did not have less TBR during the night. All patients had more (0.06 ± 0.06/h vs. 0.03 ± 0.03/h; P = 0.002) and longer (88.0 [45.0-195.5] vs. 53.4 [34.4-82.8] minutes; P < 0.001) TBR episodes during the night than during the day. CONCLUSIONS In this study, a high HbA1c did not reduce the occurrence of nocturnal hypoglycemia, and low HbA1c was not associated with the highest TIR. Optimal personalization of glycemic control requires the use of newer tools, including CGM-derived parameters.
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Affiliation(s)
- Niala den Braber
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo and Hengelo, the Netherlands
- Biomedical Signals and Systems, University of Twente, Enschede, the Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo and Hengelo, the Netherlands
- Biomedical Signals and Systems, University of Twente, Enschede, the Netherlands
| | - Kathryn M Westerik
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo and Hengelo, the Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Gozewijn D Laverman
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo and Hengelo, the Netherlands
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Beernink JM, Oosterwijk MM, Khunti K, Gupta P, Patel P, van Boven JFM, Lambers Heerspink HJ, Bakker SJL, Navis G, Nijboer RM, Laverman GD. Biochemical Urine Testing of Medication Adherence and Its Association With Clinical Markers in an Outpatient Population of Type 2 Diabetes Patients: Analysis in the DIAbetes and LifEstyle Cohort Twente (DIALECT). Diabetes Care 2021; 44:1419-1425. [PMID: 33893164 PMCID: PMC8247497 DOI: 10.2337/dc20-2533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/25/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess adherence to the three main drug classes in real-world patients with type 2 diabetes using biochemical urine testing, and to determine the association of nonadherence with baseline demographics, treatment targets, and complications. RESEARCH DESIGN AND METHODS Analyses were performed of baseline data on 457 patients in the DIAbetes and LifEstyle Cohort Twente (DIALECT) study. Adherence to oral antidiabetics (OADs), antihypertensives, and statins was determined by analyzing baseline urine samples using liquid chromatography-tandem mass spectrometry. Primary outcomes were microvascular and macrovascular complications and treatment targets of LDL cholesterol, HbA1c, and blood pressure. These were assessed cross-sectionally at baseline. RESULTS Overall, 89.3% of patients were identified as adherent. Adherence rates to OADs, antihypertensives, and statins were 95.7%, 92.0%, and 95.5%, respectively. The prevalence of microvascular (81.6% vs. 66.2%; P = 0.029) and macrovascular complications (55.1% vs. 37.0%; P = 0.014) was significantly higher in nonadherent patients. The percentage of patients who reached an LDL cholesterol target of ≤2.5 mmol/L was lower (67.4% vs. 81.1%; P = 0.029) in nonadherent patients. Binary logistic regression indicated that higher BMI, current smoking, elevated serum LDL cholesterol, high HbA1c, presence of diabetic kidney disease, and presence of macrovascular disease were associated with nonadherence. CONCLUSIONS Although medication adherence of real-world type 2 diabetes patients managed in specialist care was relatively high, the prevalence of microvascular and macrovascular complications was significantly higher in nonadherent patients, and treatment targets were reached less frequently. This emphasizes the importance of objective detection and tailored interventions to improve adherence.
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Affiliation(s)
- Jelle M Beernink
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - Milou M Oosterwijk
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, U.K
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, U.K
| | - Pankaj Gupta
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Prashanth Patel
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, Leicester, U.K
- Department of Cardiovascular Sciences, University of Leicester, Leicester, U.K
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Medication Adherence Expertise Center of the Northern Netherlands, Groningen, the Netherlands
| | - Hiddo J Lambers Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Medication Adherence Expertise Center of the Northern Netherlands, Groningen, the Netherlands
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Roos M Nijboer
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - Gozewijn D Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
- Biomedical Signals and Systems, University of Twente, Enschede, the Netherlands
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15
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Gurgel do Amaral M, Reijneveld SA, Almansa J, Navis G, de Winter AF. Do Uncontrolled Hypertension, Diabetes, Dyslipidemia, and Obesity Mediate the Relationship Between Health Literacy and Chronic Kidney Disease Complications? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105235. [PMID: 34069095 PMCID: PMC8157126 DOI: 10.3390/ijerph18105235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/30/2022]
Abstract
Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy and chronic diseases, such as chronic kidney disease (CKD), have poor disease-management skills, which could lead to complications. We used logistic regressions and structural equational modeling to assess whether low health literacy is associated with the development of cardiovascular disease and mortality in patients with CKD, and whether this association is mediated by the presence of uncontrolled hypertension, diabetes, dyslipidemia, obesity, or albuminuria. Data from 2742 adult participants with CKD from the Lifelines study were analyzed at baseline and after approximately four years. Low health literacy was associated with cardiovascular disease and mortality in the crude models, with OR and 95%CI of 1.93 (1.46 to 2.55) and 1.59 (1.08 to 2.36), respectively. After adjustment for age and sex, low health literacy was only associated with cardiovascular disease (OR 1.76 (1.31 to 2.23)). This association was mediated by uncontrolled diabetes (27.1%) and obesity (8.0%). Low health literacy is associated with the development of cardiovascular disease after adjustment for age and sex, and this association is mediated by uncontrolled diabetes and obesity.
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Affiliation(s)
- Matheus Gurgel do Amaral
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
- Correspondence:
| | - Sijmen A. Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
| | - Josue Almansa
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
| | - Gerjan Navis
- Department of Nephrology, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands;
| | - Andrea F. de Winter
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Hanzeplein 1, 9700RB Groningen, The Netherlands; (S.A.R.); (J.A.); (A.F.d.W.)
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Determinants of Increased Serum Calprotectin in Patients with Type 2 Diabetes Mellitus. Int J Mol Sci 2020; 21:ijms21218075. [PMID: 33138021 PMCID: PMC7662274 DOI: 10.3390/ijms21218075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/19/2020] [Accepted: 10/28/2020] [Indexed: 01/21/2023] Open
Abstract
Circulating calprotectin is a potential biomarker for endovascular inflammation in type 2 diabetes mellitus (T2DM). We investigated the determinants of calprotectin and its relationship with the presence of cardiovascular disease (CVD) in 362 T2DM patients included in the Diabetes and Lifestyle Cohort Twente-1 (DIALECT-1) study. Lifestyle exposures, including nutrition, were determined by validated questionnaires. CVD was defined as coronary artery diseases, strokes, and peripheral artery diseases. Median serum calprotectin levels were 1.04 mg/L [IQR: 0.73-1.46 mg/L] and were higher in women (1.11 mg/L) than men (0.96 mg/L, p = 0.007). Current smoking was a major independent determinant of circulating calprotectin, with a 51% higher calprotectin compared to never smoking (p < 0.001). Albuminuria (p = 0.011), former smoking (p = 0.023), and intake of mono- and disaccharides (p = 0.005) also contributed independently to circulating calprotectin. Each incremental increase in calprotectin level was associated with 1.36-times higher odds for CVD (95% CI 1.04-1.77, p = 0.026). In the current study, calprotectin was the only inflammatory parameter significantly associated with CVD. The strong association of circulating calprotectin with smoking, a well-known direct cause of vascular inflammation, and also with CVD, stresses the urge for further research to define its role as a biomarker in T2DM.
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17
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Hagedoorn IJM, den Braber N, Oosterwijk MM, Gant CM, Navis G, Vollenbroek-Hutten MMR, van Beijnum BJF, Bakker SJL, Laverman GD. Low Physical Activity in Patients with Complicated Type 2 Diabetes Mellitus Is Associated with Low Muscle Mass and Low Protein Intake. J Clin Med 2020; 9:jcm9103104. [PMID: 32992990 PMCID: PMC7601707 DOI: 10.3390/jcm9103104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: In order to promote physical activity (PA) in patients with complicated type 2 diabetes, a better understanding of daily movement is required. We (1) objectively assessed PA in patients with type 2 diabetes, and (2) studied the association between muscle mass, dietary protein intake, and PA. Methods: We performed cross-sectional analyses in all patients included in the Diabetes and Lifestyle Cohort Twente (DIALECT) between November 2016 and November 2018. Patients were divided into four groups: <5000, 5000–6999, 7000–9999, ≥ 10,000 steps/day. We studied the association between muscle mass (24 h urinary creatinine excretion rate, CER) and protein intake (by Maroni formula), and the main outcome variable PA (steps/day, Fitbit Flex device) using multivariate linear regression analyses. Results: In the 217 included patients, the median steps/day were 6118 (4115–8638). Of these patients, 48 patients (22%) took 7000–9999 steps/day, 37 patients (17%) took ≥ 10,000 steps/day, and 78 patients (36%) took <5000 steps/day. Patients with <5000 steps/day had, in comparison to patients who took ≥10,000 steps/day, a higher body mass index (BMI) (33 ± 6 vs. 30 ± 5 kg/m2, p = 0.009), lower CER (11.7 ± 4.8 vs. 14.8 ± 3.8 mmol/24 h, p = 0.001), and lower protein intake (0.84 ± 0.29 vs. 1.08 ± 0.22 g/kg/day, p < 0.001). Both creatinine excretion (β = 0.26, p < 0.001) and dietary protein intake (β = 0.31, p < 0.001) were strongly associated with PA, which remained unchanged after adjustment for potential confounders. Conclusions: Prevalent insufficient protein intake and low muscle mass co-exist in obese patients with low physical activity. Dedicated intervention studies are needed to study the role of sufficient protein intake and physical activity in increasing or maintaining muscle mass in patients with type 2 diabetes.
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Affiliation(s)
- Ilse J. M. Hagedoorn
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands; (N.d.B); (M.M.O.); (M.M.R.V.-H.); (G.D.L.)
- Correspondence: ; Tel.: +31-6-44-019-033
| | - Niala den Braber
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands; (N.d.B); (M.M.O.); (M.M.R.V.-H.); (G.D.L.)
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, 7522 NB Enschede, The Netherlands;
| | - Milou M. Oosterwijk
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands; (N.d.B); (M.M.O.); (M.M.R.V.-H.); (G.D.L.)
| | - Christina M. Gant
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (C.M.G.); (G.N); (S.J.L.B.)
- Department of Internal Medicine, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (C.M.G.); (G.N); (S.J.L.B.)
| | - Miriam M. R. Vollenbroek-Hutten
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands; (N.d.B); (M.M.O.); (M.M.R.V.-H.); (G.D.L.)
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, 7522 NB Enschede, The Netherlands;
| | - Bert-Jan F. van Beijnum
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, 7522 NB Enschede, The Netherlands;
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (C.M.G.); (G.N); (S.J.L.B.)
| | - Gozewijn D. Laverman
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands; (N.d.B); (M.M.O.); (M.M.R.V.-H.); (G.D.L.)
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18
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Lifestyle-Related Exposure to Cadmium and Lead is Associated with Diabetic Kidney Disease. J Clin Med 2020; 9:jcm9082432. [PMID: 32751456 PMCID: PMC7463543 DOI: 10.3390/jcm9082432] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Environmental factors contributing to diabetic kidney disease are incompletely understood. We investigated whether blood cadmium and lead concentrations were associated with the prevalence of diabetic kidney disease, and to what extent lifestyle-related exposures (diet and smoking) contribute to blood cadmium and lead concentrations. MATERIAL AND METHODS In a cross-sectional analysis in 231 patients with type 2 diabetes included in the DIAbetes and LifEstyle Cohort Twente (DIALECT-1), blood cadmium and lead concentrations were determined using inductively coupled plasma mass spectrometry. The associations between diet (derived from food frequency questionnaire), smoking and cadmium and lead were determined using multivariate linear regression. The associations between cadmium and lead and diabetic kidney disease (albumin excretion >30 mg/24 h and/or creatinine clearance <60 mL/min/1.73 m2) were determined using multivariate logistic regression. RESULTS Median blood concentrations were 2.94 nmol/L (interquartile range (IQR): 1.78-4.98 nmol/L) for cadmium and 0.07 µmol/L (IQR: 0.04-0.09 µmol/L) for lead, i.e., below acute toxicity values. Every doubling of lead concentration was associated with a 1.75 (95% confidence interval (CI): 1.11-2.74) times higher risk for albuminuria. In addition, both cadmium (odds ratio (OR) 1.50 95% CI: 1.02-2.21) and lead (OR 1.83 95% CI: 1.07-3.15) were associated with an increased risk for reduced creatinine clearance. Both passive smoking and active smoking were positively associated with cadmium concentration. Alcohol intake was positively associated with lead concentration. No positive associations were found between dietary intake and cadmium or lead. CONCLUSIONS The association between cadmium and lead and the prevalence of diabetic kidney disease suggests cadmium and lead might contribute to the development of diabetic kidney disease. Exposure to cadmium and lead could be a so far underappreciated nephrotoxic mechanism of smoking and alcohol consumption.
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Yeung SMH, Binnenmars SH, Gant CM, Navis G, Gansevoort RT, Bakker SJL, de Borst MH, Laverman GD. Fibroblast Growth Factor 23 and Mortality in Patients With Type 2 Diabetes and Normal or Mildly Impaired Kidney Function. Diabetes Care 2019; 42:2151-2153. [PMID: 31488569 DOI: 10.2337/dc19-0528] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study whether fibroblast growth factor 23 (FGF23) is associated with adverse outcomes in patients with type 2 diabetes and normal or mildly impaired kidney function. RESEARCH DESIGN AND METHODS We analyzed C-terminal FGF23 levels in 310 patients with type 2 diabetes and estimated glomerular filtration rate ≥60 mL/min/1.73 m2. Associations of FGF23 with all-cause mortality and major adverse cardiovascular events (MACE) were studied by Cox regression. RESULTS During a follow-up of 5.8 years (3.3-6.5), 47 patients developed MACE and 28 patients died. FGF23 was associated with an increased risk of all-cause mortality (age- and sex-adjusted hazard ratio 2.78 [95% CI 1.76-4.40]) and MACE (1.67 [1.12-2.49]). Results were similar after additional adjustment for other potential confounders and were consistent upon replication in an independent cohort. CONCLUSIONS In patients with type 2 diabetes and normal or mildly impaired kidney function, FGF23 is associated with an increased risk of cardiovascular events and mortality.
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Affiliation(s)
- Stanley M H Yeung
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S Heleen Binnenmars
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, Almelo and Hengelo, the Netherlands
| | - Christina M Gant
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, Almelo and Hengelo, the Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ron T Gansevoort
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Martin H de Borst
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gozewijn D Laverman
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, Almelo and Hengelo, the Netherlands
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20
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Weber B, Bersch-Ferreira ÂC, Torreglosa CR, Marcadenti A, Lara ES, da Silva JT, Costa RP, Santos RHN, Berwanger O, Bosquetti R, Pagano R, Mota LGS, de Oliveira JD, Soares RM, Galante AP, da Silva SA, Zampieri FG, Kovacs C, Amparo FC, Moreira P, da Silva RA, Dos Santos KG, Monteiro AS, Paiva CCJ, Magnoni CD, Moreira ASB, Peçanha DO, Missias KCS, de Paula LS, Marotto D, Souza P, Martins PRT, Dos Santos EM, Santos MR, Silva LP, Torres RS, Barbosa SNAA, de Pinho PM, de Araujo SHA, Veríssimo AOL, Guterres AS, Cardoso AFR, Palmeira MM, de Ataíde BRB, Costa LPS, Marinho HA, de Araújo CBP, Carvalho HMS, Maquiné RO, Caiado AC, de Matos CH, Barretta C, Specht CM, Onofrei M, Bertacco RTA, Borges LR, Bertoldi EG, Longo A, Ribas BLP, Dobke F, Pretto ADB, Bachettini NP, Gastaud A, Necchi R, Souza GC, Zuchinali P, Fracasso BM, Bobadra S, Sangali TD, Salamoni J, Garlini LM, Shirmann GS, de Los Santos MLP, Bortonili VMS, Dos Santos CP, Bragança GCM, Ambrózio CL, E Lima SB, Schiavini J, Napparo AS, Boemo JL, Nagano FEZ, Modanese PVG, Cunha NM, Frehner C, da Silva LF, Formentini FS, Ramos MEM, Ramos SS, Lucas MCS, Machado BG, Ruschel KB, Beiersdorf JR, Nunes CE, Rech RL, Damiani M, Berbigier M, Poloni S, Vian I, Russo DS, Rodrigues JA, de Moraes MAP, da Costa LM, Boklis M, El Kik RM, Adorne EF, Teixeira JM, Trescastro EP, Chiesa FL, Telles CT, Pellegrini LA, Reis LF, Cardoso RGM, Closs VE, Feres NH, da Silva NF, Silva NE, Dutra ES, Ito MK, Lima MEP, Carvalho APPF, Taboada MIS, Machado MMA, David MM, Júnior DGS, Dourado C, Fagundes VCFO, Uehara RM, Sasso S, Vieira JSO, de Oliveira BAS, Pereira JL, Rodrigues IG, Pinho CPS, Sousa ACS, Almeida AS, de Jesus MT, da Silva GB, Alves LVS, Nascimento VOG, Vieira SA, Coura AGL, Dantas CF, Leda NMFS, Medeiros AL, Andrade ACL, Pinheiro JMF, de Lima LRM, Sabino LS, de Souza CVS, Vasconcelos SML, Costa FA, Ferreira RC, Cardoso IB, Navarro LNP, Ferreira RB, Júnior AES, Silva MBG, Almeida KMM, Penafort AM, de Queirós APO, Farias GMN, Carlos DMO, Cordeiro CGNC, Vasconcelos VB, de Araújo EMVMC, Sahade V, Ribeiro CSA, Araujo GA, Gonçalves LB, Teixeira CS, Silva LMAJ, da Costa LB, Souza TS, de Jesus SO, Luna AB, da Rocha BRS, Santos MA, Neto JAF, Dias LPP, Cantanhede RCA, Morais JM, Duarte RCL, Barbosa ECB, Barbosa JMA, de Sousa RML, Dos Santos AF, Teixeira AF, Moriguchi EH, Bruscato NM, Kesties J, Vivian L, de Carli W, Shumacher M, Izar MCO, Asoo MT, Kato JT, Martins CM, Machado VA, Bittencourt CRO, de Freitas TT, Sant'Anna VAR, Lopes JD, Fischer SCPM, Pinto SL, Silva KC, Gratão LHA, Holzbach LC, Backes LM, Rodrigues MP, Deucher KLAL, Cantarelli M, Bertoni VM, Rampazzo D, Bressan J, Hermsdorff HHM, Caldas APS, Felício MB, Honório CR, da Silva A, Souza SR, Rodrigues PA, de Meneses TMX, Kumbier MCC, Barreto AL, Cavalcanti AB. Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial. Am Heart J 2019; 215:187-197. [PMID: 31349110 DOI: 10.1016/j.ahj.2019.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. METHODS In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. RESULTS From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up. CONCLUSIONS The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.
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Affiliation(s)
| | | | - Camila R Torreglosa
- Research Institute-HCor, São Paulo, Brazil; Research Institute-HCor, São Paulo, Brazil and to PhD studant at Graduation Program in Global Health and Sustainability, University of São Paulo, São Paulo-SP, Brazil
| | - Aline Marcadenti
- Research Institute-HCor, São Paulo, Brazil; Research Institute-HCor, São Paulo, Brazil and to Graduate Program in Health Sciences (Cardiology), Institute of Cardiology of Rio Grande do Sul/University Foundation of Cardiology (IC/FUC), Porto Alegre-RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Annie S B Moreira
- Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil; Instituto Nacional de Cardiologia, Rio de Janeiro-RJ, Brazil
| | | | | | - Lais S de Paula
- Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil
| | - Deborah Marotto
- Hospital Universitário Pedro Ernesto, Rio de Janeiro-RJ, Brazil
| | - Paula Souza
- Instituto Nacional de Cardiologia, Rio de Janeiro-RJ, Brazil
| | | | | | | | - Luisa P Silva
- Instituto Nacional de Cardiologia, Rio de Janeiro-RJ, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aline Longo
- Universidade Federal de Pelotas, Pelotas-RS, Brazil
| | | | | | | | | | | | | | | | | | | | - Sara Bobadra
- Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | | | - Joyce Salamoni
- Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | - Luíza M Garlini
- Hospital de Clínicas de Porto Alegre, Porto Alegre-RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | - Paulo V G Modanese
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | - Natalia M Cunha
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | - Caroline Frehner
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | - Lannay F da Silva
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba-PR, Brazil
| | | | - Maria E M Ramos
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Salvador S Ramos
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Marilia C S Lucas
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Bruna G Machado
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Karen B Ruschel
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | | | - Cristine E Nunes
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Rafael L Rech
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Mônica Damiani
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Marina Berbigier
- Hospital Universitário Associação Educadora São Carlos, Canoas-RS, Brazil
| | - Soraia Poloni
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Izabele Vian
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Diana S Russo
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | | | | | - Laura M da Costa
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Mirena Boklis
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Raquel M El Kik
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Elaine F Adorne
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Joise M Teixeira
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Eduardo P Trescastro
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Fernanda L Chiesa
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Cristina T Telles
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Livia A Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Luisa F Reis
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Roberta G M Cardoso
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Vera E Closs
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre-RS, Brazil
| | - Naoel H Feres
- Universidade Federal do Mato Grosso, Cuiabá-MT, Brazil
| | | | - Neyla E Silva
- Universidade Federal do Mato Grosso, Cuiabá-MT, Brazil
| | | | - Marina K Ito
- Hospital Universitário de Brasília, Brasília-DF, Brazil
| | | | | | | | | | - Marta M David
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Délcio G S Júnior
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Camila Dourado
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | | | - Rose M Uehara
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Sandramara Sasso
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | | | | | - Juliana L Pereira
- Hospital Universitário Maria Aparecida Pedrossian, Campo Grande-MS, Brazil
| | - Isa G Rodrigues
- Pronto Socorro Cardiológico Universitário de Pernambuco, Recife-PE, Brazil
| | - Claudia P S Pinho
- Pronto Socorro Cardiológico Universitário de Pernambuco, Recife-PE, Brazil
| | | | | | | | | | | | | | | | - Amanda G L Coura
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | - Clenise F Dantas
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | - Neuma M F S Leda
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | | | - Ana C L Andrade
- Hospital Universitário Alcides Carneiro, Campina Grande-PB, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Viviane Sahade
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | | | - Givaldo A Araujo
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | | | | | | | - Laís B da Costa
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | - Tainah S Souza
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | - Sende O de Jesus
- Hospital Universitário Professor Edgard Santos, Salvador-BA, Brazil
| | - Adriana B Luna
- Hospital Universitário da Universidade Federal de Sergipe, Aracaju-SE, Brazil
| | | | - Maria A Santos
- Hospital Universitário da Universidade Federal de Sergipe, Aracaju-SE, Brazil
| | - José A F Neto
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Luciana P P Dias
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | | | - Jadson M Morais
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Rita C L Duarte
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Elza C B Barbosa
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | - Janaina M A Barbosa
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | | | | | - Adriana F Teixeira
- Hospital Universitário da Universidade Federal do Maranhão, São Luís-MA, Brazil
| | | | - Neide M Bruscato
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Josiele Kesties
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Lilian Vivian
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Waldemar de Carli
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | - Marina Shumacher
- Associação Veranense de Assistência em Saúde, Veranópolis-RS, Brazil
| | | | - Marina T Asoo
- Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | | | | | | | | | | | | | - Júlia D Lopes
- Universidade Federal de São Paulo, São Paulo-SP, Brazil
| | | | - Sônia L Pinto
- Universidade Federal de Tocantins, Palmas-TO, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Simone R Souza
- Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro-RJ, Brazil
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Gant CM, Mensink I, Binnenmars SH, van der Palen JAM, Bakker SJL, Navis G, Laverman GD. Body weight course in the DIAbetes and LifEstyle Cohort Twente (DIALECT-1)-A 20-year observational study. PLoS One 2019; 14:e0218400. [PMID: 31216324 PMCID: PMC6583961 DOI: 10.1371/journal.pone.0218400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/01/2019] [Indexed: 12/19/2022] Open
Abstract
Background Although weight gain increases risk of type 2 diabetes, real-life data on the weight course in patients with established type 2 diabetes are scarce. We assessed weight course in a real-life diabetes secondary care setting and analyzed its association with patient characteristics, lifestyle habits and initiation of insulin, glucagon like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 inhibitors (SGLT-2i). Methods Data on weight, insulin, GLP-1 RA and SGLT-2i use were collected retrospectively (12 years) and prospectively (8 years) from patients included in the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1, n = 450, age 63 ± 9 years, 58% men, diabetes duration [7–18] years). Lifestyle habits were assessed using validated questionnaires. The association of clinical parameters with body mass index (BMI) course was determined using linear mixed models. Patients who underwent bariatric surgery (n = 19) had a distinct BMI course and were excluded from the study. Results Baseline BMI was 31.3 (0.3) and was higher in women, patients aged <60 years and patients with unfavorable lifestyle habits. BMI increased to 32.5 (0.3) after 12 years (P<0.001), and thereafter decreased to 31.5 (0.3) after 20 years, resulting in a similar BMI as the baseline BMI (P = 0.96, compared to baseline). Clinical parameters or initiation of insulin or SGLT-2i were not associated with BMI course. Patients who initiated GLP-1 RA declined in BMI compared to non-users (Pinteraction = 0.003). Conclusions High BMI that real-life patients with type 2 diabetes gained earlier in life, remained stable in the following decades. Weight loss interventions should remain a priority, and GLP-1 RA might be considered to support weight loss.
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Affiliation(s)
- Christina M. Gant
- Department of Internal Medicine, Meander Medical Center, Amersfoort, The Netherlands
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Ijmke Mensink
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, The Netherlands
| | - S. Heleen Binnenmars
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Job A. M. van der Palen
- Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, The Netherlands and Medical School Twente, Medisch spectrum Twente, Enschede, The Netherlands
| | - Stephan J. L. Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gozewijn D. Laverman
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, The Netherlands
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Oosterwijk MM, Soedamah-Muthu SS, Geleijnse JM, Bakker SJ, Navis G, Binnenmars SH, Gant CM, Laverman GD. High Dietary Intake of Vegetable Protein Is Associated With Lower Prevalence of Renal Function Impairment: Results of the Dutch DIALECT-1 Cohort. Kidney Int Rep 2019; 4:710-719. [PMID: 31080926 PMCID: PMC6506707 DOI: 10.1016/j.ekir.2019.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Dietary protein intake may influence development of renal function impairment in diabetes mellitus type 2 (T2DM). We assessed the association between sources of protein and prevalence of renal function impairment. METHODS Cross-sectional analyses were performed in baseline data of 420 patients of the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1) study. Protein intake was assessed using a Food Frequency Questionnaire, modified for accurate assessment of protein intake, including types and sources of protein. Renal function impairment was defined as estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2 (Chronic Kidney Disease Epidemiology Collaboration formula). RESULTS Among 420 patients with T2DM, 99 renal function impairment cases were identified. Multivariate Cox proportional hazard models were used and adjusted for the main lifestyle and dietary factors. The prevalence ratios in the fully adjusted model were 1 (reference), 0.74 (95% confidence interval [CI]: 0.44-1.27; P = 0.28) and 0.47 (95% CI: 0.23-0.98; P = 0.04) according to increasing tertiles of vegetable protein intake. For animal protein intake the prevalence ratios were 1 (reference), 1.10 (95% CI: 0.64-1.88; P = 0.74) and 1.06 (95% CI: 0.56-1.99; P = 0.87) according to increasing tertiles of intake. Theoretical replacement models showed that replacing 3 energy percent from animal protein by vegetable protein lowered the prevalence ratio for the association with renal function impairment to 0.20 (95% CI: 0.06-0.63; P = 0.01). CONCLUSION In conclusion, we found that higher intake of vegetable protein was associated with a lower prevalence of renal function impairment, and theoretical replacement of animal protein with vegetable protein was inversely associated with renal function impairment among patients with T2DM.
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Affiliation(s)
- Milou M. Oosterwijk
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Sabita S. Soedamah-Muthu
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Institute for Food, Nutrition and Health, University of Reading, Reading, UK
| | | | - Stephan J.L. Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S. Heleen Binnenmars
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christina M. Gant
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gozewijn D. Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuis Groep Twente, Almelo, the Netherlands
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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den Braber N, Vollenbroek-Hutten MMR, Oosterwijk MM, Gant CM, Hagedoorn IJM, van Beijnum BJF, Hermens HJ, Laverman GD. Requirements of an Application to Monitor Diet, Physical Activity and Glucose Values in Patients with Type 2 Diabetes: The Diameter. Nutrients 2019; 11:nu11020409. [PMID: 30781348 PMCID: PMC6413029 DOI: 10.3390/nu11020409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/22/2022] Open
Abstract
Adherence to a healthy diet and regular physical activity are two important factors in sufficient type 2 diabetes mellitus management. It is recognized that the traditional treatment of outpatients does not meet the requirements for sufficient lifestyle management. It is hypothesised that a personalized diabetes management mHealth application can help. Such an application ideally measures food intake, physical activity, glucose values, and medication use, and then integrates this to provide patients and healthcare professionals insight in these factors, as well as the effect of lifestyle on glucose values in daily life. The lifestyle data can be used to give tailored coaching to improve adherence to lifestyle recommendations and medication use. This study describes the requirements for such an application: the Diameter. An iterative mixed method design approach is used that consists of a cohort study, pilot studies, literature search, and expert meetings. The requirements are defined according to the Function and events, Interactions and usability, Content and structure and Style and aesthetics (FICS) framework. This resulted in 81 requirements for the dietary (n = 37), activity and sedentary (n = 15), glycaemic (n = 12), and general (n = 17) parts. Although many applications are currently available, many of these requirements are not implemented. This stresses the need for the Diameter as a new personalized diabetes application.
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Affiliation(s)
- Niala den Braber
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
- Biomedical Signals and Systems (BSS), University of Twente, 7522 NB Enschede, The Netherlands.
| | - Miriam M R Vollenbroek-Hutten
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
- Biomedical Signals and Systems (BSS), University of Twente, 7522 NB Enschede, The Netherlands.
| | - Milou M Oosterwijk
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
| | - Christina M Gant
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
| | - Ilse J M Hagedoorn
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
| | - Bert-Jan F van Beijnum
- Biomedical Signals and Systems (BSS), University of Twente, 7522 NB Enschede, The Netherlands.
| | - Hermie J Hermens
- Biomedical Signals and Systems (BSS), University of Twente, 7522 NB Enschede, The Netherlands.
- Roessingh Research and Development (RRD), 7522 AH Enschede, The Netherlands.
| | - Gozewijn D Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), 7609 PP Almelo, The Netherlands.
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24
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Jalving AC, Gant CM, Binnenmars SH, Soedamah‐Muthu SS, Bakker SJL, Navis G, Laverman GD. Glycaemic control in the diabetes and Lifestyle Cohort Twente: A cross-sectional assessment of lifestyle and pharmacological management on Hba1c target achievement. Diabetes Obes Metab 2018; 20:2494-2499. [PMID: 29862616 PMCID: PMC6175458 DOI: 10.1111/dom.13399] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 12/18/2022]
Abstract
The majority of patients with type 2 diabetes do not reach target levels of glycated haemoglobin (HbA1c < 7%). We investigated the prevalence of HbA1c-target achievement and opportunities afforded by lifestyle and pharmacological treatment to increase target achievement. We performed cross-sectional analyses of baseline data from the Diabetes and Lifestyle Cohort Twente-1 (DIALECT-1). Patients were divided according to (1) HbA1c <53 and ≥53 mmol/mol (<7%) and (2) non-insulin treatment and tertiles of daily insulin use. We found that 161 (36%) patients achieved the target HbA1c level. Patients with HbA1c ≥53 mmol/mol had a longer duration of diabetes (13 [8-20] vs 9 [4-14] years; P < .001) and more frequently were insulin-users (76% vs 41%, P < .001). Patients in the highest tertile of insulin use had a higher body mass index than those in the lowest tertile (35.8 ± 5.5 vs 29.8 ± 5.5 kg/m2 ; P < .001). Achievement of target HbA1c is low in this type 2 diabetes population. High resistance to pharmacological treatment, paralleled with high body mass index, illustrates that increasing insulin sensitivity through lifestyle intervention is the best opportunity to improve HbA1c target achievement in this real-life population.
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Affiliation(s)
- Annis C. Jalving
- Department of Internal Medicine/NephrologyZGT HospitalAlmelo and HengeloThe Netherlands
| | - Christina M. Gant
- Department of Internal Medicine/NephrologyZGT HospitalAlmelo and HengeloThe Netherlands
- Department of Internal Medicine, Division of NephrologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - S. Heleen Binnenmars
- Department of Internal Medicine, Division of NephrologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Sabita S. Soedamah‐Muthu
- Center of Research on Psychology in Somatic Diseases (CORPS), Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
- Institute for Food, Nutrition and HealthUniversity of ReadingReadingUK
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of NephrologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of NephrologyUniversity of Groningen, University Medical Centre GroningenGroningenThe Netherlands
| | - Gozewijn D. Laverman
- Department of Internal Medicine/NephrologyZGT HospitalAlmelo and HengeloThe Netherlands
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25
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van den Berkhof YS, Gant CM, Maatman R, De Graaf A, Navis GJ, Bakker SJL, Laverman GD. Correlations between plasma strontium concentration, components of calcium and phosphate metabolism and renal function in type 2 diabetes mellitus. Eur J Clin Invest 2018; 48:e12987. [PMID: 29931675 DOI: 10.1111/eci.12987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Renal function decline in diabetic kidney disease is accompanied by calcium and phosphate metabolism alterations. Whereas strontium (Sr2+ ) has many similarities with calcium, little is known about Sr2+ in this respect. We studied the association of plasma Sr2+ concentration and parameters associated with an altered calcium and phosphate metabolism in diabetic kidney disease. MATERIALS AND METHODS Plasma Sr2+ concentration was measured in 450 patients included in the DIAbetes and LifEstyle Cohort Twente-1. Patients were classified based on chronic kidney disease (CKD) stages: stages 1-2, stage 3 and stages 4-5 (estimated glomerular filtration rate of ≥60 mL·min-1 ·1.73 m-2 , 30-59 mL·min-1 ·1.73 m-2 and ≤29 mL·min-1 ·1.73 m-2 , respectively). The associations between log-transformed plasma Sr2+ concentration and parameters of calcium and phosphate metabolism were studied using multivariate linear regression analysis. RESULTS Overall, median plasma Sr2+ concentration was in normal range, 269 nmol/L, but was progressively higher in patients with lower renal function, that is 246 nmol/L (CKD 1-2), 347 nmol/L (CKD 3) and 419 nmol/L (CKD 4-5). In multivariate analysis, independent associations were found between plasma Sr2+ concentration and both eGFR (β = -0.401, P < 0.001) and plasma fibroblast growth factor 23 (FGF23) concentration (β = 0.087, P = 0.04). CONCLUSIONS We found an independent inverse association between eGFR and plasma Sr2+ concentration and an independent association between plasma Sr2+ concentration and plasma FGF23 concentration, a marker of deranged calcium and phosphate metabolism. Further research is needed to determine the mechanisms behind these associations and the impact of an elevation in plasma Sr2+ concentration on bone mineralization and calcification.
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Affiliation(s)
| | - Christina Maria Gant
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, The Netherlands.,Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ronald Maatman
- Department of Clinical Chemistry, ZGT Hospital, Almelo and Hengelo, The Netherlands
| | - Albert De Graaf
- Department of Clinical Chemistry, ZGT Hospital, Almelo and Hengelo, The Netherlands
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gozewijn Dirk Laverman
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, The Netherlands
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26
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Detection of carnosinase-1 in urine of healthy individuals and patients with type 2 diabetes: correlation with albuminuria and renal function. Amino Acids 2018; 51:17-25. [PMID: 29961141 DOI: 10.1007/s00726-018-2602-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/09/2018] [Indexed: 01/31/2023]
Abstract
Low serum carnosinase (CN-1) concentrations are associated with low risk for development of diabetic nephropathy (DN) in patients with type 2 diabetes (T2D). Although CN-1 is expressed in the kidney, urinary CN-1 (CNU) excretion and its pathological relevance in patients with T2D have not been investigated to date. The present study therefore assessed the extent of CNU excretion in healthy subjects (n = 243) and in patients with T2D (n = 361) enrolled in the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1) in relation to functional renal parameters. CNU was detected in a high proportion of healthy individuals, 180 (74%); median CNU excretion was 0.25 mg/24 h [(IQR 0-0.65 mg/24 h]. In patients with T2D the prevalence and extent of CNU increased in parallel with albuminuria (r = 0.59, p < 0.0001; median CNU 0.1 vs 0.2 vs 1.5 mg/24 h, p < 0.0001; prevalence of CNU 61 vs. 81 vs. 97% p < 0.05 in normo- (n = 241), micro- (n = 80) and macroalbuminuria (n = 40), respectively). Patients with estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2 displayed higher median CNU excretion rates in comparison to patients with preserved eGFR (> 90 ml/min/1.73 m2) (1.36 vs 0.13 mg/24 h, p < 0.05). Backward stepwise multivariate linear regression analysis revealed albuminuria, eGFR and glycosuria to be independent factors of CNU excretion rates, all together explaining 37% of variation of CNU excretion rates (R2 = 0.37, p < 0.0001). These results show for the first time that CN-1 can be detected in urine and warrants prospective studies to assess the relevance of CNU for renal function deterioration in diabetes patients.
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27
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Gant CM, Minovic I, Binnenmars H, de Vries L, Kema I, van Beek A, Navis G, Bakker S, Laverman GD. Lower Renal Function Is Associated With Derangement of 11- β Hydroxysteroid Dehydrogenase in Type 2 Diabetes. J Endocr Soc 2018; 2:609-620. [PMID: 29942925 PMCID: PMC6007243 DOI: 10.1210/js.2018-00088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/17/2018] [Indexed: 02/08/2023] Open
Abstract
Context Derangement of 11-β hydroxysteroid dehydrogenase type 1 and type 2 (11β-HSD1 and 11β-HSD2), which regulate intracellular cortisol production, has been suggested in both type 2 diabetes (T2D) and chronic kidney disease (CKD). However, activity of 11β-HSD enzymes in patients with T2D and CKD has never been assessed. Objectives To compare 11β-HSD activities between patients with T2D and healthy controls, and assess whether in T2D, renal function is associated with 11β-HSD activities. Design Cross-sectional analysis in the Diabetes and Lifestyle Cohort Twente (DIALECT-1). Setting Referral center for T2D. Patients Patient with T2D [n = 373, age 64 ± 9 years, 58% men, 26% of patients estimated glomerular filtration rate (eGFR) <60 mL/min·1.73 m2] and healthy controls (n = 275, age 53 ± 11 years, 48% men). Mean Outcome Measure We measured cortisol, cortisone, and metabolites [tetrahydrocortisol (THF), allo-THF (aTHF), and tetrahydrocortisone (THE)] in 24-hour urine samples. Whole body 11β-HSD and 11β-HSD2 activities were calculated as the urinary (THF + aTHF)/THE and cortisol/cortisone ratios, respectively. Results Patients with T2D had a higher (THF + aTHF)/THE ratio [1.02 (0.84 to 1.27) vs 0.94 (0.79 to 1.0), P < 0.001] and cortisol/cortisone ratio [0.70 (0.58 to 0.83) vs 0.63 (0.54 to 0.74), P < 0.001] than healthy controls. In T2D, lower eGFR was associated with a higher (THF + aTHF)/THE ratio (β = −0.35, P < 0.001), and a higher cortisol/cortisone ratio (β = −0.16, P = 0.001). Conclusions In this real-life secondary care setting of patients with T2D, 11β-HSD enzymes activities were shifted to higher intracellular cortisol production in T2D, which was further aggravated in patients with CKD. Prospective analyses are warranted to investigate causality of these associations.
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Affiliation(s)
- Christina Maria Gant
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, PP Almelo and Hengelo, Netherlands.,Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Isidor Minovic
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Heleen Binnenmars
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Laura de Vries
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Ido Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - André van Beek
- Department of Endocrinology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Gerjan Navis
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Stephan Bakker
- Department of Nephrology, University of Groningen, University Medical Centre Groningen, EZ Groningen, Netherlands
| | - Gozewijn Dirk Laverman
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente Hospital, PP Almelo and Hengelo, Netherlands
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28
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Gant CM, Binnenmars SH, Harmelink M, Soedamah-Muthu SS, Bakker SJL, Navis G, Laverman GD. Real-life achievement of lipid-lowering treatment targets in the DIAbetes and LifEstyle Cohort Twente: systemic assessment of pharmacological and nutritional factors. Nutr Diabetes 2018; 8:24. [PMID: 29695715 PMCID: PMC5917033 DOI: 10.1038/s41387-018-0028-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/01/2018] [Accepted: 02/20/2018] [Indexed: 01/05/2023] Open
Abstract
Background/Objectives Lowering low-density lipoprotein cholesterol (LDLc) in type 2 diabetes mellitus is of paramount importance in preventing cardiovascular disease. However, treatment targets for LDLc are often not reached. We studied the prevalence of LDLc target achievement in a real-life population of type 2 diabetes mellitus patients in secondary care, and investigated whether in those not on target, there is room for intensifying pharmacological and lifestyle management according to current treatment guidelines. Subjects/Methods We performed a cross-sectional analysis in the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1; n = 450, age 63 ± 9 years, 58% men, diabetes duration 11 (7–18) years). At baseline, we determined plasma LDLc concentration, pharmacological treatment (i.e., statin use), and lifestyle (physical activity and dietary intake). Patients were divided according to LDLc < 1.8, LDLc 1.8–2.5, and LDLc > 2.5 mmol/l. Dietary intake was collected from a validated Food Frequency Questionnaire (177 items) and we determined guideline adherence for different food groups. Physical activity was assessed with the Short Questionnaire to ASsess Health enhancing behavior. Results LDLc data were available in 428 type 2 diabetes mellitus patients. LDLc ≤ 2.5 mmol/l was achieved in 317 patients (76%). In total, 76% of patients used statins, in those with LDLc > 2.5 mmol/l, this was 44%. Adherence to lifestyle guidelines was not different between the LDLc groups and was as follows: body mass index 6%, physical activity 59%, vegetables 7%, fruit 28%, legumes 59%, nuts 14%, dairy 19%, fish 36%, tea 8%, fats 66%, red meat 12%, processed meat 2%, alcohol 71%, sweetened beverages 34%, and sodium 12%. Conclusions In type 2 diabetes mellitus patients in secondary health care, the target LDLc is achieved by three quarters of patients. Increasing statin treatment could be a first step to improve LDLc. In addition, there are ample opportunities for lifestyle management through increasing adherence to lifestyle guidelines.
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Affiliation(s)
- Christina M Gant
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, Hengelo, The Netherlands. .,Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - S Heleen Binnenmars
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, Hengelo, The Netherlands.,Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Manon Harmelink
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, Hengelo, The Netherlands
| | - Sabita S Soedamah-Muthu
- Centre of Research on Psychology in Somatic Diseases (CORPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.,Institute for Food, Nutrition and Health, University of Reading, Reading, UK
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gozewijn D Laverman
- Department of Internal Medicine/Nephrology, ZGT Hospital, Almelo and Hengelo, Hengelo, The Netherlands.,Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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29
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Oosterom N, Gant CM, Ruiterkamp N, van Beijnum BJF, Hermens H, Bakker SJL, Navis G, Vollenbroek-Hutten MMR, Laverman GD. Physical Activity in Patients With Type 2 Diabetes: The Case for Objective Measurement in Routine Clinical Care. Diabetes Care 2018; 41:e50-e51. [PMID: 29432126 DOI: 10.2337/dc17-2041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/14/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Nicole Oosterom
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Christina M Gant
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo, the Netherlands.,Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Niels Ruiterkamp
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
| | - Bert-Jan F van Beijnum
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
| | - Hermie Hermens
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo, the Netherlands.,Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, the Netherlands
| | - Gozewijn D Laverman
- Division of Nephrology, Department of Internal Medicine, Ziekenhuisgroep Twente, Almelo, the Netherlands
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30
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Gant CM, Soedamah-Muthu SS, Binnenmars SH, Bakker SJL, Navis G, Laverman GD. Higher Dietary Magnesium Intake and Higher Magnesium Status Are Associated with Lower Prevalence of Coronary Heart Disease in Patients with Type 2 Diabetes. Nutrients 2018; 10:E307. [PMID: 29510564 PMCID: PMC5872725 DOI: 10.3390/nu10030307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/24/2018] [Accepted: 03/01/2018] [Indexed: 02/07/2023] Open
Abstract
In type 2 diabetes mellitus (T2D), the handling of magnesium is disturbed. Magnesium deficiency may be associated with a higher risk of coronary heart disease (CHD). We investigated the associations between (1) dietary magnesium intake; (2) 24 h urinary magnesium excretion; and (3) plasma magnesium concentration with prevalent CHD in T2D patients. This cross-sectional analysis was performed on baseline data from the DIAbetes and LifEstyle Cohort Twente-1 (DIALECT-1, n = 450, age 63 ± 9 years, 57% men, and diabetes duration of 11 (7-18) years). Prevalence ratios (95% CI) of CHD by sex-specific quartiles of magnesium indicators, as well as by magnesium intake per dietary source, were determined using multivariable Cox proportional hazard models. CHD was present in 100 (22%) subjects. Adjusted CHD prevalence ratios for the highest compared to the lowest quartiles were 0.40 (0.20, 0.79) for magnesium intake, 0.63 (0.32, 1.26) for 24 h urinary magnesium excretion, and 0.62 (0.32, 1.20) for plasma magnesium concentration. For every 10 mg increase of magnesium intake from vegetables, the prevalence of CHD was, statistically non-significantly, lower (0.75 (0.52, 1.08)). In this T2D cohort, higher magnesium intake, higher 24 h urinary magnesium excretion, and higher plasma magnesium concentration are associated with a lower prevalence of CHD.
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Affiliation(s)
- Christina M Gant
- Department of Internal Medicine/Nephrology, ZGT Hospital, 7609 PP Almelo, The Netherlands.
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, 9713EZ Groningen, The Netherlands.
| | - Sabita S Soedamah-Muthu
- Centre of Research on Psychology in Somatic Diseases (CORPS), Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands.
- Institute for Food, Nutrition and Health, University of Reading, Reading RG1 5EX, UK.
| | - S Heleen Binnenmars
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, 9713EZ Groningen, The Netherlands.
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, 9713EZ Groningen, The Netherlands.
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, 9713EZ Groningen, The Netherlands.
| | - Gozewijn D Laverman
- Department of Internal Medicine/Nephrology, ZGT Hospital, 7609 PP Almelo, The Netherlands.
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31
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Szokol M, Priksz D, Bombicz M, Varga B, Kovacs A, Fulop GA, Csipo T, Posa A, Toth A, Papp Z, Szilvassy Z, Juhasz B. Long Term Osmotic Mini Pump Treatment with Alpha-MSH Improves Myocardial Function in Zucker Diabetic Fatty Rats. Molecules 2017; 22:molecules22101702. [PMID: 29023410 PMCID: PMC6151765 DOI: 10.3390/molecules22101702] [Citation(s) in RCA: 2] [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: 09/07/2017] [Accepted: 10/03/2017] [Indexed: 01/20/2023] Open
Abstract
The present investigation evaluates the cardiovascular effects of the anorexigenic mediator alpha-melanocyte stimulating hormone (MSH), in a rat model of type 2 diabetes. Osmotic mini pumps delivering MSH or vehicle, for 6 weeks, were surgically implanted in Zucker Diabetic Fatty (ZDF) rats. Serum parameters, blood pressure, and weight gain were monitored along with oral glucose tolerance (OGTT). Echocardiography was conducted and, following sacrifice, the effects of treatment on ischemia/reperfusion cardiac injury were assessed using the isolated working heart method. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity was measured to evaluate levels of oxidative stress, and force measurements were performed on isolated cardiomyocytes to determine calcium sensitivity, active tension and myofilament co-operation. Vascular status was also evaluated on isolated arterioles using a contractile force measurement setup. The echocardiographic parameters ejection fraction (EF), fractional shortening (FS), isovolumetric relaxation time (IVRT), mitral annular plane systolic excursion (MAPSE), and Tei-index were significantly better in the MSH-treated group compared to ZDF controls. Isolated working heart aortic and coronary flow was increased in treated rats, and higher Hill coefficient indicated better myofilament co-operation in the MSH-treated group. We conclude that MSH improves global heart functions in ZDF rats, but these effects are not related to the vascular status.
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Affiliation(s)
- Miklos Szokol
- Department of Cardiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Daniel Priksz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Mariann Bombicz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Balazs Varga
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Arpad Kovacs
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Gabor Aron Fulop
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Tamas Csipo
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Aniko Posa
- Department of Physiology, Anatomy and Neuroscience, Faculty of Science and Informatics, University of Szeged, H-6720 Szeged, Hungary.
| | - Attila Toth
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Zoltan Papp
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Zoltan Szilvassy
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
| | - Bela Juhasz
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
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