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Jakobsen SG, Andersen PT, Lauritsen J, Larsen CP, Stenager E, Christiansen E. Opening the black box of registration practice for self-harm and suicide attempts in emergency departments: a qualitative study. BMC Prim Care 2024; 25:139. [PMID: 38678191 PMCID: PMC11055235 DOI: 10.1186/s12875-024-02393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/17/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The World Health Organization has called for improved surveillance of self-harm and suicide attempts worldwide to benefit suicide prevention programs. International comparisons of registrations are lacking, however, and there is a need for systematically collected, high-quality data across countries. The current study investigated healthcare professionals' perceptions of registration practices and their suggestions for ensuring high-quality registration of self-harm and suicide attempts. METHODS Qualitative interviews (N = 20) were conducted among medical secretaries, medical doctors, nurses, and registration advisers from psychiatric and somatic emergency departments in all regions of Denmark between September 2022 and March 2023. Content analysis was performed using NVivo. RESULTS Despite great efforts to standardize and assure the quality of registration in Denmark, almost all the healthcare professionals perceived registration practice as inconsistent and unreliable. Codes are often misclassified or unused due to insufficient time, non-standardized training, or insufficient information. The interview informants suggested that coding guidelines should be simplified and made more visible, alongside technical solutions in the electronic health record system. CONCLUSION The study findings resulted in eight overall recommendations for clinical practice that aim at improving the registration of patients presenting with self-harm or suicide attempts. This would be expected to help improve surveillance and prevention programs.
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Affiliation(s)
- Sarah Grube Jakobsen
- Department of Regional Health Research, University of Southern Denmark, Unit of Mental Health Services, Aabenraa, Denmark.
- Centre for Suicide Research, Bangs Boder 28-30, st. th, Odense, 5000, Denmark.
| | - Pernille Tanggaard Andersen
- Department of Public Health, Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Lauritsen
- Department of Clinical Medicine, Unit of Orthopaedic Surgery, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Christina Petrea Larsen
- Department of Regional Health Research, University of Southern Denmark, Unit of Mental Health Services, Aabenraa, Denmark
- Centre for Suicide Research, Bangs Boder 28-30, st. th, Odense, 5000, Denmark
| | - Elsebeth Stenager
- Department of Regional Health Research, University of Southern Denmark, Unit of Mental Health Services, Aabenraa, Denmark
| | - Erik Christiansen
- Department of Regional Health Research, University of Southern Denmark, Unit of Mental Health Services, Aabenraa, Denmark
- Centre for Suicide Research, Bangs Boder 28-30, st. th, Odense, 5000, Denmark
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Singh G, Hansen JP, Hulgaard D, Damkjær M, Christiansen E. Impact of COVID-19 restrictions on self-poisoning behaviour with mild analgesics in Danish youth. Nord J Psychiatry 2024:1-9. [PMID: 38625374 DOI: 10.1080/08039488.2024.2339433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/20/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The COVID-19 pandemic prompted the implementation of precautions to contain the disease, including lockdowns and social isolation. Previous studies have investigated suicide rates among children and adolescents during the pandemic and have found varying results. We speculated how the two lockdowns influenced suicidal behaviour in children and adolescents in Denmark. OBJECTIVE This study aimed to investigate the effect of lockdowns during the COVID-19 pandemic on suicide attempts, as measured by the incidence rate in all self-poisonings with mild analgesics among children and adolescents. METHODS This national Danish registry-based study on children and adolescents used Poisson regression and interrupted time series analysis to examine the incidence rates and trends of self-poisonings with mild analgesics from 2019 to mid-2021. RESULTS For the period of this study, 1655 self-poisonings were registered. During the first lockdown, there was a slight, not statistically significant, decrease in self-poisoning rates (incidence rate ratio [IRR]) 0.98) compared to no lockdown. During the second lockdown, there was a significant increase in self-poisonings for the whole Danish population (IRR 1.85) with girls being slightly higher at risk (IRR 1.87). Being a girl or between the ages of 13-17 years old were risk factors for self-poisoning. CONCLUSION These findings indicate that the restrictions enforced during the second lockdown greatly impacted youth mental health, especially girls, leading to an 85% increase in self-poisonings. We hope for increased awareness of mental health in children and adolescents during possible future lockdowns.
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Affiliation(s)
- Gurbhej Singh
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jonathan Pommer Hansen
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ditte Hulgaard
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Research Unit Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mads Damkjær
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Erik Christiansen
- Research Unit Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Centre for Suicide Research, Odense, Denmark
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Christiansen E, Reilev M, Larsen CP, Bilenberg N, Agerbo E. The joint effect of mental illness and parental suicide attempt on offspring suicide attempt and death: A Danish nationwide, registry-based study using multistate modeling. Psychiatry Res 2024; 334:115824. [PMID: 38447460 DOI: 10.1016/j.psychres.2024.115824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
AIM The aim of this study was to analyse the joint impact of moderate-to-severe mental illness and parental suicidal attempts on suicidal attempt and premature death. METHODS Using the Danish, nationwide health registries, a cohort study was conducted including the birth cohorts 1983-1989. Cox regression and multistate models were used to estimate relative and absolute risks of suicide attempt and premature death. OUTCOME We included 384,569 individuals and 7,218 individuals experienced their first suicide attempt during follow-up, while 2,762 individuals died of all causes. Joined exposure to parental suicide attempt and own mental illness increased the relative risk of suicide attempt (HR 22.57) and premature death all causes (HR 3.17). The absolute risk of suicide attempt before the age of 35 years was 20 % for offspring exposed to both parental suicide attempts and own mental illness (23 % for women vs. 15 % for men), while the risk of death was 4 % (0.6 % for women vs. 7 % for men). CONCLUSION Exposure to both parental suicide attempt and own mental illness increases the relative and absolute risks of suicide attempt and premature death with considerable differences across sex. These findings are important in the clinical assessment of individuals with suicidal behavior.
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Affiliation(s)
- Erik Christiansen
- Centre for Suicide Research, Odense, Denmark; The Research Unit in Psychiatry - child and adults, Psychiatry in the Region of Southern Denmark, Aabenraa, Denmark; Department of Regional Health Research, Odense, University of Southern Denmark, Denmark.
| | - Mette Reilev
- Centre for Suicide Research, Odense, Denmark; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark; The Research Unit in Psychiatry - child and adults, Psychiatry in the Region of Southern Denmark, Aabenraa, Denmark
| | - Christina Petrea Larsen
- Centre for Suicide Research, Odense, Denmark; Department of Regional Health Research, Odense, University of Southern Denmark, Denmark
| | - Niels Bilenberg
- Child and Adolescent Psychiatry Odense, Mental Health Services in the Region of Southern Denmark, Denmark
| | - Esben Agerbo
- CIRRAU - Centre for Integrated Register-based Research, BSS - School of Business and Social Sciences, Aarhus University, Denmark; NCRR - National Centre for Register-based Research, BSS - School of Business and Social Sciences, Aarhus University, Denmark
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Konieczna A, Larsen CP, Jakobsen SG, Okuda T, Moriyama K, Mere WS, Christiansen E. Suicide trends in Denmark-An ecological study exploring suicide methods from 1995 to 2019. PLoS One 2023; 18:e0296324. [PMID: 38157350 PMCID: PMC10756527 DOI: 10.1371/journal.pone.0296324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
Suicide is a major public health problem and complex phenomenon, affecting many people around the world. However, the incidence of suicide varies by sex and age, which includes differences in the means used. Therefore, to implement effective preventative interventions, it is important to study these differences to design effective, preventative interventions. This study investigates the trends in suicide rates in Denmark from 1995 to 2019 by analysing changes based on sex, age, and the means used for suicide. Data on all suicide deaths in the study period were extracted from the Danish Register of Causes of Death, and data on the background population were obtained from Statistics Denmark. We used negative binomial regression models to analyse the data, and the obtained estimates as a logarithm of the rate ratios allowed us to compare the results across groups and years. An overall decline in Danish suicide rates was observed during the study period, with the exception of young females aged 15-29 years. The demographic composition did not change significantly, and suicide rates are still highest for males and the elderly aged 60+. Hanging, self-poisoning and firearms remain the most prevalent means of suicide. Suicide prevention initiatives are required, especially interventions targeting males and the elderly. Restricting access to the means of suicide for these groups with high fatality rates may help reduce the overall suicide rate. Moreover, more research is needed to understand the factors that lead to suicide and affect the choice of means, which should also include studying the effects of different suicide prevention strategies on males and females from different age groups.
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Affiliation(s)
- Agnieszka Konieczna
- Centre for Suicide Research, Odense, Denmark
- Research Unit of Health Promotion, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christina Petrea Larsen
- Centre for Suicide Research, Odense, Denmark
- Research Unit Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sarah Grube Jakobsen
- Centre for Suicide Research, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Taro Okuda
- Faculty of Humanities and Director of Institute for Social Ethics, Nanzan University, Nagoya, Japan
| | - Karin Moriyama
- Faculty of Law and Institute for Social Ethics, Nanzan University, Nagoya, Japan
| | | | - Erik Christiansen
- Centre for Suicide Research, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Jakobsen SG, Larsen CP, Stenager E, Christiansen E. Risk of repeated suicide attempt after redeeming prescriptions for antidepressants: a register-based study in Denmark. Psychol Med 2023; 53:5510-5517. [PMID: 36043363 DOI: 10.1017/s0033291722002719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It remains unclear how SSRIs and other antidepressants are associated with the risk of repeated suicide attempts. We aimed to analyse the association between redeemed antidepressant prescriptions and the risk of repeated suicide attempts, hypothesising that antidepressant treatment is associated with increased risk of repeated suicide attempts. METHODS The study was based on Danish register data and a validated cohort of 1842 suicide attempts. We used three Cox regression models (crude, adjusted and propensity score matched) to analyse the data; these models included both static and dynamic time-dependent factors. RESULTS 1842 individuals attempted suicide in the study period, with a total of 210 repeated attempts. Individuals redeeming antidepressant prescriptions were more likely to repeat a suicide attempt. All crude models showed all antidepressants to be significant risk factors (HR around 1.39), whereas all adjusted models showed all antidepressants to be insignificant risk factors. CONCLUSION We found no significant increased risk of repeated suicide attempts in individuals redeeming a prescription for any antidepressant (or only SSRIs) when considering the individuals' baseline risk of repetition. This study is based on validated suicide attempts, register data, and strong epidemiology designs, but it still has some limitations, and the results should be replicated and confirmed in other studies.
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Affiliation(s)
- Sarah Grube Jakobsen
- Centre for Suicide Research, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Elsebeth Stenager
- Unit for Psychiatric Research, Department of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
| | - Erik Christiansen
- Centre for Suicide Research, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Unit for Psychiatric Research, Department of Regional Health Services Research, University of Southern Denmark, Aabenraa, Denmark
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Aroda VR, Aberle J, Bardtrum L, Christiansen E, Knop FK, Gabery S, Pedersen SD, Buse JB. Efficacy and safety of once-daily oral semaglutide 25 mg and 50 mg compared with 14 mg in adults with type 2 diabetes (PIONEER PLUS): a multicentre, randomised, phase 3b trial. Lancet 2023; 402:693-704. [PMID: 37385279 DOI: 10.1016/s0140-6736(23)01127-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Once-daily oral semaglutide is an effective type 2 diabetes treatment. We aimed to investigate a new formulation of oral semaglutide at higher investigational doses versus the approved 14 mg dose in adults with inadequately controlled type 2 diabetes. METHODS This global, multicentre, randomised, double-blind, phase 3b trial, carried out at 177 sites in 14 countries, enrolled adults with type 2 diabetes, glycated haemoglobin (HbA1c) 8·0-10·5% (64-91 mmol/mol), a BMI of 25·0 kg/m2 or greater, receiving stable daily doses of one to three oral glucose-lowering drugs. Participants were randomly assigned (1:1:1), by means of an interactive web response system, to once-daily oral semaglutide 14 mg, 25 mg, or 50 mg for 68 weeks. Investigators, site personnel, trial participants, and trial sponsor staff were masked to dose assignment throughout the trial. The primary endpoint was change in HbA1c from baseline to week 52, evaluated with a treatment policy estimand in the intention-to-treat population. Safety was assessed in all participants who received at least one dose of trial drug. This trial is registered with ClinicalTrials.gov, NCT04707469, and the European Clinical Trials register, EudraCT 2020-000299-39, and is complete. FINDINGS Between Jan 15 and Sept 29, 2021, of 2294 people screened, 1606 (n=936 [58·3%] male; n=670 [41·7%] female; mean [SD] age 58·2 [10·8] years) received oral semaglutide 14 mg (n=536), 25 mg (n=535), or 50 mg (n=535). At baseline, mean (SD) HbA1c was 9·0% (0·8; 74·4 mmol/L [SD 8·3]) and mean bodyweight was 96·4 kg (21·6). Mean changes (SE) in HbA1c at week 52 were -1·5 percentage points (SE 0·05) with oral semaglutide 14 mg, -1·8 percentage points (0·06) with 25 mg (estimated treatment difference [ETD] -0·27, 95% CI -0·42 to -0·12; p=0·0006), and -2·0 percentage points (0·06) with 50 mg (ETD -0·53, -0·68 to -0·38; p<0·0001). Adverse events were reported by 404 (76%) participants in the oral semaglutide 14 mg group, 422 (79%) in the 25 mg group, and 428 (80%) in the 50 mg group. Gastrointestinal disorders, which were mostly mild to moderate, occurred more frequently with oral semaglutide 25 mg and 50 mg than with 14 mg. Ten deaths occurred during the trial; none were judged to be treatment related. INTERPRETATION Oral semaglutide 25 mg and 50 mg were superior to 14 mg in reducing HbA1c and bodyweight in adults with inadequately controlled type 2 diabetes. No new safety concerns were identified. FUNDING Novo Nordisk.
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Affiliation(s)
- Vanita R Aroda
- Department of Medicine, Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jens Aberle
- Department of Endocrinology and Diabetes, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | | | | | - Filip K Knop
- Center for Clinical Metabolic Research, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Department of Clinical Medicine and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Sue D Pedersen
- C-ENDO Diabetes & Endocrinology Clinic Calgary, Calgary, AB, Canada
| | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Dungan KM, Bardtrum L, Christiansen E, Eliasson J, Mellbin L, Woo VC, Vilsbøll T. Greater Combined Reductions of HbA 1c ≥ 1.0% and Body Weight Loss ≥ 5.0% or ≥ 10.0% with Orally Administered Semaglutide Versus Comparators. Diabetes Ther 2023:10.1007/s13300-023-01413-5. [PMID: 37256503 PMCID: PMC10299987 DOI: 10.1007/s13300-023-01413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION A post hoc analysis of the PIONEER 1-5 and 8 trials assessed the clinically relevant composite endpoints of HbA1c (glycated haemoglobin) reduction ≥ 1% and body weight loss of ≥ 5% or ≥ 10% with orally administered semaglutide versus comparators. METHODS In the PIONEER trials, people with type 2 diabetes were randomised to orally administered semaglutide versus placebo (PIONEER 1, 4, 5 and 8), empagliflozin (PIONEER 2), sitagliptin (PIONEER 3) and liraglutide (PIONEER 4) for 26-78 weeks. This analysis assessed the proportion of people achieving an HbA1c reduction of ≥ 1% and body weight loss of ≥ 5% at week 26 and at end of treatment, and the proportion of people achieving an HbA1c reduction of ≥ 1% and body weight loss of ≥ 10% at end of treatment. RESULTS Overall, 3506 people in PIONEER 1-5 and 8 were included. At week 26 and at end of treatment, odds of achieving the composite endpoint of an HbA1c reduction of ≥ 1% and body weight loss of ≥ 5% were significantly greater with orally administered semaglutide 14 mg than with placebo (PIONEER 1, 4, 5 and 8; all p < 0.0001), empagliflozin 25 mg (PIONEER 2, p < 0.0001), sitagliptin 100 mg (PIONEER 3, p < 0.0001) and liraglutide 1.8 mg (PIONEER 4, p < 0.0001). Odds of achieving the composite endpoint of HbA1c reduction of ≥ 1% and body weight loss of ≥ 10% at end of treatment were also significantly greater with orally administered semaglutide versus comparators. CONCLUSION In PIONEER 1-5 and 8, odds of achieving clinically relevant reductions in both HbA1c and body weight were significantly greater with orally administered semaglutide versus comparators.
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Affiliation(s)
- Kathleen M Dungan
- Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, 1581 Dodd Drive, Columbus, OH 43210, USA.
| | | | | | | | - Linda Mellbin
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Vincent C Woo
- Section of Endocrinology and Metabolism, University of Manitoba, Winnipeg, MB, Canada
| | - Tina Vilsbøll
- Clinical Research, Steno Diabetes Center Copenhagen, University of Copenhagen, Herlev, Denmark
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8
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Jakobsen SG, Nielsen T, Larsen CP, Andersen PT, Lauritsen J, Stenager E, Christiansen E. Definitions and incidence rates of self-harm and suicide attempts in Europe: A scoping review. J Psychiatr Res 2023; 164:28-36. [PMID: 37311401 DOI: 10.1016/j.jpsychires.2023.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION European countries use various terminologies for self-harm and attempted suicide, which are sometimes used interchangeably. This complicates cross-country comparisons of incidence rates. This scoping review aimed to examine the definitions used and the possibilities to identify and compare incidence rates of self-harm and attempted suicide in Europe. METHODS A literature search was conducted in Embase, Medline and PsycINFO for studies published from 1990 to 2021, followed by grey literature searches. Data were collected for total populations originating from health care institutions or registries. Results were presented in tabular form supplemented by a qualitative summary by area. RESULTS A total of 3160 articles were screened, resulting in 43 studies included from databases and further 29 studies from other sources. Most studies used the term 'suicide attempt' rather than 'self-harm' and reported person-based rates with annual incidence rates from age 15+. None of the rates were considered comparable due to different reporting traditions related to classification codes and statistical approaches. CONCLUSION The present extensive literature on self-harm and attempted suicide cannot be used to compare findings between countries because of the high degree of heterogeneity among studies. International agreement on definitions and registration practices is needed to improve knowledge and understanding of suicidal behaviour.
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Affiliation(s)
- Sarah Grube Jakobsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark.
| | - Torben Nielsen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Christina Petrea Larsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Lauritsen
- Accident Analysis Group, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Erik Christiansen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
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Hojstrup S, Hansen K, Talleruphuus U, Marner L, Galatius S, Rauf M, Bjerking L, Jakobsen L, Christiansen E, Bouchelouche K, Prescott E. Coronary microvascular disease assessed by 82Rb-PET-CT is an independent prognostic marker of all-cause mortality. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary microvascular disease (CMD) is a major contributor to e.g. heart failure and angina pectoris, as well as being associated with an increased risk of adverse events. CMD is diagnosed by reduced myocardial blood flow reserve (MBFR), preferably by Positron emission tomography myocardial perfusion CT (PET-CT).
Purpose
We aim to determine whether reduced MBFR is associated with an increased hazard of all-cause mortality independently of the extent of perfusion defects in patients suspected of obstructive coronary artery disease.
Method
We conducted a multicenter study of all patients referred for 82Rubidium PET-CT imaging between January 2018 and August 2020. Rest and stress examinations were performed using standard imaging protocols. Percentage of perfusion defects were calculated based on summed rest- and difference score. CMD was defined as MBFR ≤2. Patients were followed for all-cause mortality through national registries with no loss to follow-up.
Results
Among the 7156 patients studied, 61.8% were men, median age was 69 [61–76 IQR] years, 14.1% had LVEF ≤40%, 58.4% had a previous diagnosis of ischemic heart disease (IHD), 20.1% had atrial fibrillation and 38.9% had MBFR ≤2.
A total of 571 (7.8) deaths were observed, more frequently in MBFR ≤2 compared to MBFR >2 (4.2% vs 13.2%, p<0.001). MBFR was significantly associated with reversible hypoperfusion (r2=−0.33, p<0.0001). In Kaplan-Meier estimation MBFR ≤2 was significantly associated to all-cause mortality in the overall population as well as in clinically relevant subgroups defined by the extent of reversible and/or irreversible perfusion defects (p<0.05 for all, fig. 1). In multivariate Cox-analysis adjusting for age, sex, Charlson's Co-morbidity index, eGFR, LVEF and LVEF-reserve and stratifying by diabetes, MBFR ≤2 remained a robust predictor of all-cause mortality with a HR 1.73, 95% CI: 1.62–2.19, p<0.0001 (fig. 2). No interaction was found between MBFR and reversible hypoperfusion. In subgroup analysis including only patients with no reversible perfusion defects (n=3095), MBFR ≤2 was still strongly associated with a HR of 2.00, 95% CI: 1.29–3.11, p<0.001 for all-cause mortality.
Conclusion
MBFR ≤2 is a robust predictor of all-cause mortality independently of the extent of reversible- and/or irreversible perfusion defects. Information of MBFR should be incorporated in the clinical risk stratification of patients being investigated for ischemia.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Research Committee, Bispebjerg & Frederiksberg University Hospital, scientific scholarship
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Affiliation(s)
- S Hojstrup
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - K Hansen
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - U Talleruphuus
- Bispebjerg and Frederiksberg University Hospital, Clinical physiology and nuclear medicine , Copenhagen , Denmark
| | - L Marner
- Bispebjerg and Frederiksberg University Hospital, Clinical physiology and nuclear medicine , Copenhagen , Denmark
| | - S Galatius
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - M Rauf
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - L Bjerking
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - L Jakobsen
- Aarhus University Hospital, Clinical medicine, heart diseases , Aarhus , Denmark
| | - E Christiansen
- Aarhus University Hospital, Clinical medicine, heart diseases , Aarhus , Denmark
| | - K Bouchelouche
- Aarhus University Hospital, Clinical medcine, nuclear medicine , Aarhus , Denmark
| | - E Prescott
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
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Dahl J, Rasmussen LD, Ding D, Westra J, Wijns W, Tu S, Christiansen E, Eftekhari A, Li G, Winther S, Bottcher M. Diagnostic performance of on-site computation of quantitative flow ratio by a coronary computed tomography angiography based algorithm: comparison of distal and lesion-specific measurements. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Guidelines recommend secondary ischemia assessment following a coronary computed tomography angiography (CTA) with suspected obstructive coronary artery disease (CAD). Coronary CTA-derived quantitative flow ratio (CT-QFR) is an on-site technique performed on acquired CTA images that estimates the functional severity of a coronary stenosis. However, CT-QFR measurements are available throughout the coronary vessel with no clear recommendations as to which specific values should be used for identifying obstructive CAD, e.g. most distal or lesion-specific values.
Purpose
First, to investigate the feasibility of CT-QFR and the correlation and agreement with invasive fractional flow reserve (FFR). Secondly, to compare the diagnostic performance of distal versus lesion-specific CT-QFR for identifying obstructive CAD defined by invasive coronary angiography (ICA) with FFR.
Methods
A total of 1732 prospectively included patients with symptoms suggestive of CAD referred for CTA were included. All patients with ≥50% diameter stenosis (DS) on CTA were subsequently referred for ICA with conditional FFR in lesions with 30–89%DS. Obstructive CAD was defined by ICA as FFR ≤0.80 or high-grade stenosis by visual assessment (≥90%DS). A blinded analysis of CT-QFR was performed in patients referred to ICA with measurements at the distal end of a vessel (distal CT-QFR) and 1 cm distal to stenotic lesions on CTA (lesion-specific). CT-QFR ≤0.80 was defined as abnormal. For correlation analyses to invasive FFR, CT-QFR was assessed corresponding to the position of the invasive pressure sensor.
Results
In total, 445/1732 (25%) patients had suspected obstructive CAD at CTA and underwent subsequent ICA. CT-QFR analysis was feasible in 423/445 (95%) patients. CT-QFR correlated (Pearson's rho 0.54, p<0.001) and agreed (mean difference –0.02±0.09) to FFR with CT-QFR overestimating FFR (Fig. 1). Obstructive CAD was identified in 190/423 (44%) patients by ICA. Distal and lesion-specific CT-QFR classified 196 (46%) and 171 (40%) patients as abnormal, respectively. Areas under the receiver-operating characteristic curves for distal versus lesion-specific CT-QFR were similar (0.86 (95% CI: 0.82–0.89) vs. 0.86 (0.82–0.90), p=0.80). Sensitivities for distal and lesion-specific CT-QFR were 78% (95% CI: 71–84) vs. 74% (67–80), p=0.01, respectively, and specificities 79% (95% CI: 74–84) vs. 87% (82–91), p<0.01, respectively. Distal and lesion-specific CT-QFR had similar diagnostic accuracy (79 (95% CI: 75–83), vs. 81 (77–85), p=0.07) (Fig. 2).
Conclusion
In patients with suspected obstructive CAD on CTA, non-invasive estimation of FFR using CT-QFR is feasible with moderate correlation and good agreement with invasive FFR. Overall diagnostic performance of distal and lesion-specific values for discriminating obstructive CAD by invasive FFR are similar. The use of CT-QFR could therefore potentially reduce the need for referral to invasive angiography after CTA.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Aarhus UniversityRegion Mid Jutland
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Affiliation(s)
- J Dahl
- Goedstrup Hospital , Herning , Denmark
| | | | - D Ding
- National University of Ireland, The Lambe Institute for translational Medicine and Curam , Galway , Ireland
| | - J Westra
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - W Wijns
- National University of Ireland, The Lambe Institute for translational Medicine and Curam , Galway , Ireland
| | - S Tu
- Shanghai Jiao Tong University, Biomedical Instrument Institute, School of Biomedical Engineering , Shanghai , China
| | - E Christiansen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - A Eftekhari
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - G Li
- Shanghai Jiao Tong University, Biomedical Instrument Institute, School of Biomedical Engineering , Shanghai , China
| | - S Winther
- Goedstrup Hospital , Herning , Denmark
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Dahl J, Ramussen LD, Ding D, Westra J, Wijns W, Tu S, Christiansen E, Eftekhari A, Gormsen LC, Ejlersen JA, Winther S, Bottcher M. Comparison of second-line on-site computed quantitative flow ratio from coronary computed tomography angiography to PET perfusion imaging for detecting obstructive coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In patients with suspected obstructive coronary artery disease (CAD) on coronary computed tomography (CTA), guidelines endorse second-line selective testing for hemodynamic evaluation of suspected CAD. A variety of non-invasive modalities are available, and myocardial perfusion imaging with Rubidium-82 positron emission tomography (PET) is an established method with high diagnostic performance. Recently, an on-site method estimating computed tomography-derived quantitative flow ratio (CT-QFR) showed promising results for discriminating obstructive CAD. However, no study has compared the diagnostic performances of PET and CT-QFR.
Purpose
To assess a possible non-inferiority of CT-QFR compared to PET in patients with suspected obstructive CAD at CTA using invasive coronary angiography (ICA) with fractional flow reserve (FFR) as reference.
Methods
Patients (n=1732, 57% males, age 59±9.5) referred on a clinical indication with symptoms suggestive of obstructive CAD underwent routine CTA. Patients with ≥50% diameter stenosis (DS) on CTA were referred for PET and subsequent ICA with FFR. CT-QFR was analyzed post-hoc blinded to PET and ICA results.
Abnormal CT-QFR was defined as CT-QFR ≤0.80 in any vessel with a diameter ≥1.5mm. An independent core-lab evaluated PET scans as abnormal/normal with optional analyst-dependent application of pre-specified criteria; summed stress score of ≥4 in ≥2 contiguous segments, vessel-specific myocardial blood flow (MBF) <2.00 ml/g/min, global myocardial blood flow reserve ≤1.8, and/or transient ischemic dilatation ratio >1.13. Obstructive CAD was defined as ICA with FFR ≤0.80 or high-grade stenosis (≥90% DS).
Results
In total, 445/1732 patients (25%) had suspected obstructive CAD on CTA of whom 400/445 patients (90%) underwent subsequent PET and ICA. CT-QFR was successfully analysed in 383/400 (96%) patients classifying 174/383 (45%) patients as having disease. In comparison, PET classified 130/383 (34%) patients as having disease. In total, obstructive CAD by ICA with FFR was identified in 162 (42%) patients.
There was no significant difference in area under the receiver-operating characteristic curves for CT-QFR compared to the best performing PET metric (lowest vessel-specific MBF); 0.84 (95% CI 0.80–0.89) vs. 0.81 (0.77–0.85), p=0.19)) (Fig. 1). Overall diagnostic accuracy of CT-QFR versus PET was similar (78% (95% CI 74–82) vs. 77% (72–81), p=0.70. Sensitivities for CT-QFR and PET were 78% (71–84) and 63% (55–70), p<0.01, respectively, and specificities 78% (72–84) and 87% (82–91), p=0.01, respectively (Fig. 2). Three-vessel or left main disease on ICA was correctly identified in 30/31 patients by both CT-QFR and PET.
Conclusion
In patients with suspected obstructive CAD by CTA, second-line CT-QFR was non-inferior to PET for discriminating obstructive CAD by invasive FFR; Although diagnostic accuracy was similar, CT-QFR demonstrated higher sensitivity while PET showed higher specificity
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Aarhus University PhD fellowshipRegion Mid Health Research Foundation
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Affiliation(s)
- J Dahl
- Goedstrup Hospital , Herning , Denmark
| | | | - D Ding
- National University of Ireland, The Lambe Institute for translational Medicine and Curam , Galway , Ireland
| | - J Westra
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - W Wijns
- National University of Ireland, The Lambe Institute for translational Medicine and Curam , Galway , Ireland
| | - S Tu
- Shanghai Jiao Tong University, Biomedical Instrument Institute, School of Biomedical Engineering , Shanghai , China
| | - E Christiansen
- Aarhus University Hospital, Department of Cardiology , Aarhus , Denmark
| | - A Eftekhari
- Aalborg University Hospital, Department of Cardiology , Aalborg , Denmark
| | - L C Gormsen
- Aarhus University Hospital, Department of Nuclear Medicine and PET , Aarhus , Denmark
| | - J A Ejlersen
- Viborg Hospital, Department of Clinical Physiology , Viborg , Denmark
| | - S Winther
- Goedstrup Hospital , Herning , Denmark
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12
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Hojstrup S, Hansen K, Talleruphuus U, Marner L, Galatius S, Rauf M, Bjerking L, Jakobsen L, Christiansen E, Bouchelouche K, Christensen H, Prescott E. Myocardial blood flow reserve assessed by 82Rb-PET-CT is associated with small-vessel disease in the kidney and brain. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary microvascular dysfunction (CMD) may be linked to small-vessel disease in other vascular beds as a part of multisystem disorder. However, there are limited data in support of this.
Purpose
We aim to determine whether reduced myocardial blood flow reserve (MBFR) is associated with an increased hazard of small-vessel disease in the kidneys and brain.
Method
We conducted a multicenter study of all patients consecutively referred for 82Rubidium-Positron emission tomography (82Rb-PET) myocardial perfusion CT imaging between January 2018 and August 2020. CMD was defined as MBFR ≤2. Patients were followed through national registries using ICD-10 codes with no loss to follow-up for microvascular events (ME) defined as chronic kidney disease, stroke, affective disorders, and dementia. Despite the heterogeneity of outcomes, they all play a crucial role in ME, with vascular dementia, affective disorders, and both ischemic and hemorrhagic strokes being major contributors to cerebral ME.
Results
Among the 7156 patients studied, 61.8% were men, median age was 69 [61–76 IQR] years, 14.1% had LVEF ≤40%, 58.4% had a previous diagnosis of ischemic heart disease (IHD) and 20.1% had atrial fibrillation. 38.9% had MBFR ≤2. MBFR was significantly associated with eGFR at baseline (r2=0.22, p<0.0001). After multivariable adjustment for demographics, cardiovascular risk factors, LVEF and reversible perfusion defects, MBFR remained significantly associated with eGFR, also in patients with no perfusion defects (β=0.039, 95% Cl 0.03–0.05, p<0.001 in all patients and β=0.039, 95% Cl 0.02–0.05, p<0.001, in patients with ≤5% reversible- and ≤5% irreversible hypoperfusion). During follow-up, a total of 677 (9.5%) ME were observed (480 (6.7%) cerebral ME and 197 (2.7%) renal ME). ME was more frequent in patients with MBFR ≤2 compared to MBFR >2 (11.2% vs. 5.5%, p<0.001).
In crude analysis MBFR ≤2 was significantly associated with ME (p<0.0001, Fig. 1) as well as renal- and cerebral ME (both p<0.001). Similar results were found in subgroup analysis of patients with diabetes, normal kidney function (eGFR ≥60) or no perfusion defects, respectively (Fig. 1). After multivariate adjusting for demographics, IHD, cardiovascular risk factors, Charlson's Comorbidity index, atrial fibrillation and stratifying by chronic kidney disease stages, MBFR remained a significant predictor of ME (HR 1.43, 95% CI 1.15–1.78, p<0.001, fig. 2). In subgroup analysis including only patients with no reversible perfusion defects, MBFR ≤2 was associated with a HR of 2.04, 95% CI 1.43–2.91, p<0.0001 for ME.
Conclusion
This is the first larger cohort study relating CMD to microvascular outcome in the kidneys and brain. We conclude that CMD is an independent predictor of cerebral and renal ME. Data support the hypothesis that CMD is part of a systemic vascular disorder.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Research Committee, Bispebjerg & Frederiksberg University Hospital, scientific scholarship
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Affiliation(s)
- S Hojstrup
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - K Hansen
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - U Talleruphuus
- Bispebjerg and Frederiksberg University Hospital, Clinical Physiology and Nuclear Medicine , Copenhagen , Denmark
| | - L Marner
- Bispebjerg and Frederiksberg University Hospital, Clinical Physiology and Nuclear Medicine , Copenhagen , Denmark
| | - S Galatius
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - M Rauf
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - L Bjerking
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
| | - L Jakobsen
- Aarhus University Hospital, Clinical Medicine, Heart Diseases , Aarhus , Denmark
| | - E Christiansen
- Aarhus University Hospital, Clinical Medicine, Heart Diseases , Aarhus , Denmark
| | - K Bouchelouche
- Aarhus University Hospital, Clinical medcine, Nuclear Medicine , Aarhus , Denmark
| | - H Christensen
- Bispebjerg and Frederiksberg University Hospital, Neurology , Copenhagen , Denmark
| | - E Prescott
- Bispebjerg and Frederiksberg University Hospital, Cardiology , Copenhagen , Denmark
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13
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Aroda VR, Bauer R, Christiansen E, Haluzík M, Kallenbach K, Montanya E, Rosenstock J, Meier JJ. Efficacy and safety of oral semaglutide by subgroups of patient characteristics in the PIONEER phase 3 programme. Diabetes Obes Metab 2022; 24:1338-1350. [PMID: 35373893 PMCID: PMC9321749 DOI: 10.1111/dom.14710] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the efficacy and safety of oral semaglutide versus comparators by patient characteristic subgroups in patients with type 2 diabetes. MATERIALS AND METHODS Change from baseline in glycated haemoglobin (HbA1c) and body weight, and achievement of HbA1c <7.0% with oral semaglutide 7 mg, oral semaglutide 14 mg, flexibly dosed oral semaglutide (flex) and comparators were assessed across baseline subgroups (age, race, ethnicity, diabetes duration, body mass index and HbA1c) from the PIONEER programme. Treatment differences were analysed using a mixed model for repeated measurements for continuous variables and a logistic regression model for the binary endpoint. Pooled safety data were analysed descriptively. RESULTS Changes from baseline in HbA1c and body weight, and the odds of achieving HbA1c <7.0%, were greater with oral semaglutide 14 mg/flex (n = 1934) and higher or similar with oral semaglutide 7 mg (n = 823) versus comparators (n = 2077) across most subgroups. Changes in HbA1c with oral semaglutide 14 mg/flex were greater for patients with higher baseline HbA1c (HbA1c >9.0%: -1.7% to -2.6%; HbA1c <8.0%: -0.7% to -1.2%). In some trials, Asian patients experienced greater HbA1c reductions with oral semaglutide 14 mg/flex (-1.5% to -1.8%) than other racial groups (-0.6% to -1.6%). The overall incidence of adverse events (AEs) with oral semaglutide was similar to that with comparators and was consistent across subgroups. More gastrointestinal AEs were observed with oral semaglutide, versus comparators, across subgroups. CONCLUSIONS Oral semaglutide demonstrated consistently greater HbA1c and body weight reductions across a range of patient characteristics, with greater HbA1c reductions seen at higher baseline HbA1c levels.
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Affiliation(s)
- Vanita R. Aroda
- Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | | | | | - Martin Haluzík
- Diabetes CentreInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | | | - Eduard Montanya
- Hospital Universitari Bellvitge‐IDIBELLCIBERDEM and University of BarcelonaBarcelonaSpain
| | | | - Juris J. Meier
- Department of Internal Medicine, Gastroenterology and DiabetologyAugusta ClinicBochumGermany
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14
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Christiansen E, Hansen CR. P006 Nephrolithiasis and nephrocalcinosis in infants with cystic fibrosis: a case presentation of 2 Swedish infants. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Jakobsen S, Christiansen E, Andersen P, Lauritsen J, Stenager E. Incidence rates of suicide attempts and self-harm in Europe. What can we learn? A systematic review and meta-analysis. Eur Psychiatry 2022. [PMCID: PMC9567207 DOI: 10.1192/j.eurpsy.2022.2179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Definitions used for suicide attempts and self-harm have been discussed for many years and is used differently in European countries, sometimes even interchangeably. Therefore, it is difficult to compare relevant rates across nations.
Objectives
This study aims at estimating the rate of suicide attempts and self-harm in chosen European countries in the more recent years when distinguishing between applied definitions.
Methods
A systematic search for relevant articles published between 2010-2020 will be performed in databases such as PubMed, Embase, PsycINFO, and Web of Science. Only articles in English or Danish will be included. Data will be collected for all age groups above 15 years of age. The prevalence of suicide attempts and self-harm will be calculated by a random effect model. Subgroup analyses will be performed to compare the rates according to age.
Results
from the performed systematic review and meta-study will be presented at the conference.
Conclusions
The conclusion will be presented when results have been analysed.
Disclosure
No significant relationships.
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Bjerre K, Clemmensen T, Poulsen S, Christiansen E, Neghabat O, Holm N, Hvas A, Grove E, Kristensen S, Eiskjær H. Long-Term Changes in the Coronary Artery Structure After Heart Transplantation: A Prospective Optical Coherence Tomography Study. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Araki E, Terauchi Y, Watada H, Deenadayalan S, Christiansen E, Horio H, Kadowaki T. Efficacy and safety of oral semaglutide in Japanese patients with type 2 diabetes: A post hoc subgroup analysis of the PIONEER 1, 3, 4 and 8 trials. Diabetes Obes Metab 2021; 23:2785-2794. [PMID: 34472698 PMCID: PMC9293331 DOI: 10.1111/dom.14536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
AIMS To evaluate, through exploratory post hoc subgroup analyses, the efficacy and safety of oral semaglutide versus comparators in Japanese patients enrolled in the global PIONEER 1, 3, 4 and 8 clinical trials. MATERIALS AND METHODS Patients were randomized to once-daily oral semaglutide 3, 7 or 14 mg or comparator (placebo, sitagliptin 100 mg or liraglutide 1.8 mg). Change from baseline in glycated haemoglobin (HbA1c) and body weight, and proportions of patients attaining HbA1c <7.0% (53 mmol/mol) and body weight loss ≥5%, were analysed at week 26 for all Japanese patients in each trial separately using the treatment policy estimand (regardless of treatment discontinuation or rescue medication use). Adverse events (AEs) were analysed descriptively. RESULTS Reductions in HbA1c from baseline in Japanese patients were 1.0% to 1.2% (11.3 mmol/mol to 13.3 mmol/mol) and 1.4% to 1.7% (15.7 mmol/mol to 18.3 mmol/mol) for oral semaglutide 7 mg and 14 mg, respectively. HbA1c reductions were similar or greater than with comparators. Body weight reductions were 1.0% to 2.7% and 3.7% to 4.7% for oral semaglutide 7 mg and 14 mg, respectively, and were generally greater with oral semaglutide than comparators. As expected, the main class of AEs was gastrointestinal, and these AEs comprised most commonly mild-to-moderate constipation, nausea and diarrhoea. CONCLUSIONS Oral semaglutide appears efficacious and well tolerated in Japanese patients across the type 2 diabetes spectrum.
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Affiliation(s)
- Eiichi Araki
- Department of Metabolic Medicine, Faculty of Life SciencesKumamoto UniversityKumamotoJapan
| | | | - Hirotaka Watada
- Department of Metabolism and EndocrinologyJuntendo University Graduate School of MedicineTokyoJapan
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18
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Dejgaard TF, von Scholten BJ, Christiansen E, Kreiner FF, Bardtrum L, von Herrath M, Mathieu C, Madsbad S. Efficacy and safety of liraglutide in type 1 diabetes by baseline characteristics in the ADJUNCT ONE and ADJUNCT TWO randomized controlled trials. Diabetes Obes Metab 2021; 23:2752-2762. [PMID: 34463425 PMCID: PMC9292057 DOI: 10.1111/dom.14532] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 12/21/2022]
Abstract
AIM To evaluate 26 weeks of liraglutide treatment in type 1 diabetes (T1D) by subgroups in the ADJUNCT ONE and ADJUNCT TWO trials. MATERIALS AND METHODS ADJUNCT ONE and ADJUNCT TWO were randomized controlled phase 3 trials in 1398 and 835 participants with T1D treated with liraglutide (1.8, 1.2, or 0.6 mg) or placebo (adjuncts to insulin). This post hoc analysis evaluated treatment effects by subgroups: HbA1c (< or ≥8.5%), body mass index (BMI; < or ≥27 kg/m2 ), and insulin regimen (basal bolus or continuous subcutaneous insulin infusion). RESULTS In both trials at week 26, reductions in HbA1c, body weight, and daily insulin dose did not differ significantly (P > .05) by baseline HbA1c or BMI. Risk of clinically significant hypoglycaemia or hyperglycaemia with ketosis did not differ significantly (P > .05) by baseline HbA1c, BMI, or insulin regimen. At week 26 in ADJUNCT ONE, these risks did not differ (P > .05) between treatment groups. Placebo-adjusted reductions in HbA1c, body weight, and insulin dose (-0.30%-points, -5.0 kg, and -12%, respectively, with liraglutide 1.8 mg), were significant (P < .05), greater than at week 52, and similar to those in ADJUNCT TWO (-0.35%, -4.8 kg, and -10%, respectively, with liraglutide 1.8 mg). CONCLUSIONS In ADJUNCT ONE and ADJUNCT TWO, the efficacy and glycaemic safety of liraglutide did not depend on subgroups, leaving residual beta-cell function as the only identified variable impacting the effect of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in T1D. These findings support a role for GLP-1 RAs as adjuncts to insulin in T1D, warranting further study.
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Affiliation(s)
| | | | | | | | | | | | | | - Sten Madsbad
- Hvidovre University Hospital, University of CopenhagenHvidovreDenmark
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19
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Trinacty J, Rosenstock J, Cariou B, Christiansen E, Hertz C, Montanya E, Nielsen A, Knop F. Time Spent in Glycemic Control After Initiating Treatment With Oral Semaglutide Versus Empagliflozin: An Exploratory Analysis of the PIONEER 2 Trial. Can J Diabetes 2021. [DOI: 10.1016/j.jcjd.2021.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Konieczna A, Jakobsen SG, Larsen CP, Christiansen E. Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study. Scand J Public Health 2021; 50:584-592. [PMID: 34011213 DOI: 10.1177/14034948211013270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men. METHOD This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis. RESULTS The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders' suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased. DISCUSSION The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals. CONCLUSIONS We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.
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Affiliation(s)
| | | | | | - Erik Christiansen
- Centre for Suicide Research, Odense, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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21
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Davidsen KA, Christiansen E, Haubek D, Asmussen J, Ranning A, Thorup AAE, Nordentoft M, Harder S, Bilenberg N. Parental mental illness, attendance at preventive child healthcare and dental caries in the offspring: a nation-wide population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:583-592. [PMID: 32812086 DOI: 10.1007/s00127-020-01936-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/07/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Severe mental illness (SMI) may interfere with parental caregiving practices and offspring development. Adhering to preventive well-child visits and maintaining good oral hygiene during early childhood requires parental involvement. Whether these activities are affected by parental SMI is unclear. The purpose of the present study was to determine whether children exposed to parental SMI are at increased risk of non-attendance to preventive well-child visits and vaccinations at age 0-5 years and of child dental caries experience at age 5 years. Furthermore, interactions between maternal psychiatric and sociodemographic variables in relation to an adverse child outcome were assessed. METHODS Data were obtained from national Danish health registers. All children born in Denmark between January 1997 and December 2010 were followed from birth until their 6th birthday. RESULTS 679,339 children were included in the study (51% male). Of these, 49,059 children (7.8%) had at least one parent with a lifetime SMI diagnosis. Children of parents with SMI had elevated odds of missing well-child visits and vaccinations (OR 1.41; 95% CI 1.39-1.44, p < 0.0001), and of child dental caries (OR 1.58; 95% CI 1.55-1.62, p < 0.0001). In the presence of maternal SMI, low socioeconomic classification and single-mother status added more to the elevated risk than specific maternal diagnosis or timing of last psychiatric contact. CONCLUSION Parents with SMI are less compliant with preventive child healthcare activities than parents without SMI. This indicates a need for practical support to these families in order to prevent inequality in health among their offspring.
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Affiliation(s)
- Kirstine A Davidsen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark. .,Child and Adolescent Mental Health Services, Odense, Research Unit, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.
| | - Erik Christiansen
- Child and Adolescent Mental Health Services, Odense, Research Unit, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Dorte Haubek
- Section for Paediatric Dentistry, Department of Dentistry and Oral Health, Health, Aarhus University, Aarhus, Denmark
| | - Jette Asmussen
- Child and Adolescent Mental Health Services, Odense, Research Unit, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Ranning
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne A E Thorup
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark.,Child and Adolescent Mental Health Centre, University of Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Niels Bilenberg
- Child and Adolescent Mental Health Services, Odense, Research Unit, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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22
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Jordy AB, Albayaty M, Breitschaft A, Anderson TW, Christiansen E, Houshmand-Øregaard A, Manigandan E, Bækdal TA. Effect of Oral Semaglutide on the Pharmacokinetics of Levonorgestrel and Ethinylestradiol in Healthy Postmenopausal Women and Furosemide and Rosuvastatin in Healthy Subjects. Clin Pharmacokinet 2021; 60:1171-1185. [PMID: 33782832 PMCID: PMC8416862 DOI: 10.1007/s40262-020-00976-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The first oral glucagon-like peptide-1 receptor agonist (GLP-1RA) comprises semaglutide co-formulated with the absorption enhancer, sodium N-(8-[2-hydroxybenzoyl] amino) caprylate (SNAC). Oral semaglutide may alter the pharmacokinetics of co-administered drugs via effects of semaglutide or SNAC. Two separate one-sequence crossover trials investigated the effects of oral semaglutide and SNAC on the pharmacokinetics of ethinylestradiol, levonorgestrel, furosemide and rosuvastatin. Methods Healthy, postmenopausal women (n = 25) received once-daily combined ethinylestradiol and levonorgestrel (Trial 1) and healthy male and female subjects (n = 41) received single doses of furosemide and rosuvastatin (Trial 2), either alone, with SNAC alone or with oral semaglutide. Lack of drug–drug interaction was concluded if 90% confidence intervals (CIs) for the ratio of area under the plasma concentration–time curve (AUC) or maximum concentration (Cmax), with/without oral semaglutide, were within a pre-specified interval (0.80–1.25). Results The AUC values of ethinylestradiol and levonorgestrel were not affected by oral semaglutide co-administration (estimated ratios [90% CI] 1.06 [1.01–1.10] and 1.06 [0.97–1.17], respectively); Cmax was not affected. The no-effect criterion was not met for furosemide or rosuvastatin for the AUC (1.28 [1.16–1.42] and 1.41 [1.24–1.60], respectively) or Cmax. SNAC alone did not affect the AUC or Cmax of ethinylestradiol, levonorgestrel or rosuvastatin; the Cmax of furosemide was slightly decreased. Adverse events were similar to those previously observed for GLP-1RAs (both trials). Conclusion Co-administration with oral semaglutide did not affect the pharmacokinetics of ethinylestradiol or levonorgestrel. There was a small increase in exposure of furosemide and rosuvastatin; however, these increases are not expected to be of clinical relevance. Clinical Trial Registration Numbers NCT02845219 and NCT03010475. Supplementary Information The online version contains supplementary material available at (10.1007/s40262-020-00976-x).
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Affiliation(s)
- Andreas B Jordy
- Novo Nordisk A/S, Vandtårnsvej 108-110, 2860, Søborg, Denmark
| | - Muna Albayaty
- Parexel Early Phase Clinical Unit, Northwick Park Hospital, Parexel International, Watford Road, Harrow, HA1 3UJ, UK
| | - Astrid Breitschaft
- Parexel International GmbH, Klinikum Westend, Haus 18, Spandauer Damm 130, 14050, Berlin, Germany
| | | | | | | | - Easwaran Manigandan
- Novo Nordisk Service Centre India Private Ltd., Plot No. 148, 2nd Floor, Prestige Featherlite Tech Park, 2nd Phase, EPIP Area, Whitefield, Bangalore, 560 066, India
| | - Tine A Bækdal
- Novo Nordisk A/S, Vandtårnsvej 108-110, 2860, Søborg, Denmark.
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23
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Buse JB, Bode BW, Mertens A, Cho YM, Christiansen E, Hertz CL, Nielsen MA, Pieber TR. Long-term efficacy and safety of oral semaglutide and the effect of switching from sitagliptin to oral semaglutide in patients with type 2 diabetes: a 52-week, randomized, open-label extension of the PIONEER 7 trial. BMJ Open Diabetes Res Care 2020; 8:8/2/e001649. [PMID: 33318068 PMCID: PMC7737050 DOI: 10.1136/bmjdrc-2020-001649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The PIONEER 7 trial demonstrated superior glycemic control and weight loss with once-daily oral semaglutide with flexible dose adjustment versus sitagliptin 100 mg in type 2 diabetes. This 52-week extension evaluated long-term oral semaglutide treatment and switching from sitagliptin to oral semaglutide. RESEARCH DESIGN AND METHODS A 52-week, open-label extension commenced after the 52-week main phase. Patients on oral semaglutide in the main phase continued treatment (n=184; durability part); those on sitagliptin were rerandomized to continued sitagliptin (n=98) or oral semaglutide (n=100; initiated at 3 mg) (switch part). Oral semaglutide was dose-adjusted (3, 7, or 14 mg) every 8 weeks based on glycated hemoglobin (HbA1c) (target <7.0% (<53 mmol/mol)) and tolerability. Secondary endpoints (no primary) included changes in HbA1c and body weight. RESULTS In the durability part, mean (SD) changes in HbA1c and body weight from week 0 were -1.5% (0.8) and -1.3% (1.0) and -2.8 kg (3.8) and -3.7 kg (5.2) at weeks 52 and 104, respectively. In the switch part, mean changes in HbA1c from week 52 to week 104 were -0.2% for oral semaglutide and 0.1% for sitagliptin (difference -0.3% (95% CI -0.6 to 0.0); p=0.0791 (superiority not confirmed)). More patients achieved HbA1c <7.0% with oral semaglutide (52.6%) than sitagliptin (28.6%; p=0.0011) and fewer received rescue medication (9% vs 23.5%). Respective mean changes in body weight were -2.4 kg and -0.9 kg (difference -1.5 kg (95% CI -2.8 to -0.1); p=0.0321). Gastrointestinal adverse events were the most commonly reported with oral semaglutide. CONCLUSIONS Long-term oral semaglutide with flexible dose adjustment maintained HbA1c reductions, with additional body weight reductions, and was well tolerated. Switching from sitagliptin to flexibly dosed oral semaglutide maintained HbA1c reductions, helped more patients achieve HbA1c targets with less use of additional glucose-lowering medication, and offers the potential for additional reductions in body weight. TRIAL REGISTRATION NUMBER NCT02849080.
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Affiliation(s)
- John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Bruce W Bode
- Atlanta Diabetes Associates, Atlanta, Georgia, USA
| | - Ann Mertens
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | | | | | | | - Thomas R Pieber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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24
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Mageroy MH, Christiansen E, Långström B, Borg-Karlson AK, Solheim H, Björklund N, Zhao T, Schmidt A, Fossdal CG, Krokene P. Priming of inducible defenses protects Norway spruce against tree-killing bark beetles. Plant Cell Environ 2020; 43:420-430. [PMID: 31677172 DOI: 10.1111/pce.13661] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/23/2019] [Accepted: 10/07/2019] [Indexed: 06/10/2023]
Abstract
Plants can form an immunological memory known as defense priming, whereby exposure to a priming stimulus enables quicker or stronger response to subsequent attack by pests and pathogens. Such priming of inducible defenses provides increased protection and reduces allocation costs of defense. Defense priming has been widely studied for short-lived model plants such as Arabidopsis, but little is known about this phenomenon in long-lived plants like spruce. We compared the effects of pretreatment with sublethal fungal inoculations or application of the phytohormone methyl jasmonate (MeJA) on the resistance of 48-year-old Norway spruce (Picea abies) trees to mass attack by a tree-killing bark beetle beginning 35 days later. Bark beetles heavily infested and killed untreated trees but largely avoided fungus-inoculated trees and MeJA-treated trees. Quantification of defensive terpenes at the time of bark beetle attack showed fungal inoculation induced 91-fold higher terpene concentrations compared with untreated trees, whereas application of MeJA did not significantly increase terpenes. These results indicate that resistance in fungus-inoculated trees is a result of direct induction of defenses, whereas resistance in MeJA-treated trees is due to defense priming. This work extends our knowledge of defense priming from model plants to an ecologically important tree species.
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Affiliation(s)
- Melissa H Mageroy
- Department of Molecular Plant Biology, Norwegian Institute of Bioeconomy Research, Ås, 1431, Norway
| | - Erik Christiansen
- Department of Molecular Plant Biology, Norwegian Institute of Bioeconomy Research, Ås, 1431, Norway
| | - Bo Långström
- Department of Ecology, Swedish University of Agricultural Sciences, Uppsala, 750 07, Sweden
| | - Anna-Karin Borg-Karlson
- Ecological Chemistry Group, Department of Chemistry, Royal Institute of Technology, Stockholm, SE-100 44, Sweden
| | - Halvor Solheim
- Department of Molecular Plant Biology, Norwegian Institute of Bioeconomy Research, Ås, 1431, Norway
| | - Niklas Björklund
- Department of Ecology, Swedish University of Agricultural Sciences, Uppsala, 750 07, Sweden
| | - Tao Zhao
- School of Science and Technology, Örebro University, Örebro, SE-701 82, Sweden
| | - Axel Schmidt
- Department of Biochemistry, Max Planck Institute for Chemical Ecology, Jena, D-07745, Germany
| | - Carl Gunnar Fossdal
- Department of Molecular Plant Biology, Norwegian Institute of Bioeconomy Research, Ås, 1431, Norway
| | - Paal Krokene
- Department of Molecular Plant Biology, Norwegian Institute of Bioeconomy Research, Ås, 1431, Norway
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25
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Aroda VR, Rosenstock J, Terauchi Y, Altuntas Y, Lalic NM, Morales Villegas EC, Jeppesen OK, Christiansen E, Hertz CL, Haluzík M. PIONEER 1: Randomized Clinical Trial of the Efficacy and Safety of Oral Semaglutide Monotherapy in Comparison With Placebo in Patients With Type 2 Diabetes. Diabetes Care 2019; 42:1724-1732. [PMID: 31186300 DOI: 10.2337/dc19-0749] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This trial compared the efficacy and safety of the first oral glucagon-like peptide 1 (GLP-1) receptor agonist, oral semaglutide, as monotherapy with placebo in patients with type 2 diabetes managed by diet and exercise alone. Two estimands addressed two efficacy-related questions: a treatment policy estimand (regardless of trial product discontinuation or rescue medication use) and a trial product estimand (on trial product without rescue medication use) in all randomized patients. RESEARCH DESIGN AND METHODS This was a 26-week, phase 3a, randomized, double-blind, placebo-controlled, parallel-group trial conducted in 93 sites in nine countries. Adults with type 2 diabetes insufficiently controlled with diet and exercise were randomized (1:1:1:1) to once-daily oral semaglutide 3 mg, 7 mg, 14 mg, or placebo. The primary end point was change from baseline to week 26 in HbA1c. The confirmatory secondary end point was change from baseline to week 26 in body weight. RESULTS In the 703 patients randomized (mean age 55 years, 50.8% male, and mean baseline HbA1c 8.0% [64 mmol/mol]), oral semaglutide reduced HbA1c (placebo-adjusted treatment differences at week 26: treatment policy estimand, -0.6% [3 mg], -0.9% [7 mg], and -1.1% [14 mg]; trial product estimand, -0.7% [3 mg], -1.2% [7 mg], and -1.4% [14 mg]; P < 0.001 for all) and body weight (treatment policy, -0.1 kg [3 mg], -0.9 kg [7 mg], and -2.3 kg [14 mg, P < 0.001]; trial product, -0.2 kg [3 mg], -1.0 kg [7 mg, P = 0.01], and -2.6 kg [14 mg, P < 0.001]). Mild-to-moderate transient gastrointestinal events were the most common adverse events with oral semaglutide. Trial product discontinuations occurred in 2.3-7.4% with oral semaglutide and 2.2% with placebo. CONCLUSIONS In patients with type 2 diabetes, oral semaglutide monotherapy demonstrated superior and clinically relevant improvements in HbA1c (all doses) and body weight loss (14 mg dose) versus placebo, with a safety profile consistent with other GLP-1 receptor agonists.
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Affiliation(s)
- Vanita R Aroda
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA .,MedStar Health Research Institute, Hyattsville, MD
| | | | | | - Yuksel Altuntas
- Division of Endocrinology Metabolism Diabetes, Department of Internal Medicine, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nebojsa M Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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26
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Pieber TR, Bode B, Mertens A, Cho YM, Christiansen E, Hertz CL, Wallenstein SOR, Buse JB. Efficacy and safety of oral semaglutide with flexible dose adjustment versus sitagliptin in type 2 diabetes (PIONEER 7): a multicentre, open-label, randomised, phase 3a trial. Lancet Diabetes Endocrinol 2019; 7:528-539. [PMID: 31189520 DOI: 10.1016/s2213-8587(19)30194-9] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Oral semaglutide is the first oral formulation of a glucagon-like peptide-1 (GLP-1) receptor agonist developed for the treatment of type 2 diabetes. We aimed to compare the efficacy and safety of flexible dose adjustments of oral semaglutide with sitagliptin 100 mg. METHODS In this 52-week, multicentre, randomised, open-label, phase 3a trial, we recruited patients with type 2 diabetes from 81 sites in ten countries. Patients were eligible if they were aged 18 years or older (19 years or older in South Korea), had type 2 diabetes (diagnosed ≥90 days before screening), HbA1c of 7·5-9·5% (58-80 mmol/mol), and were inadequately controlled on stable daily doses of one or two oral glucose-lowering drugs (for 90 days or more before screening). Participants were randomly assigned (1:1) by use of an interactive web-response system, stratified by background glucose-lowering medication at screening, to oral semaglutide with flexible dose adjustments to 3, 7, or 14 mg once daily or sitagliptin 100 mg once daily. To approximate treatment individualisation in clinical practice, oral semaglutide dose could be adjusted on the basis of prespecified HbA1c and tolerability criteria. Two efficacy-related estimands were prespecified: treatment policy (regardless of treatment discontinuation or use of rescue medication) and trial product (on treatment and without use of rescue medication) for participants randomly assigned to treatment. The primary endpoint was achievement of HbA1c of less than 7% (53 mmol/mol) at week 52 and the confirmatory secondary efficacy endpoint was change in bodyweight from baseline to week 52. Safety was assessed in all participants who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT02849080, and European Clinical Trials Database, EudraCT number 2015-005593-38, and an open-label extension is ongoing. FINDINGS Between Sept 20, 2016, and Feb 7, 2017, of 804 patients assessed for eligibility, 504 were eligible and randomly assigned to oral semaglutide (n=253) or sitagliptin (n=251). Most participants were male (285 [57%] of 504) with a mean age of 57·4 years (SD 9·9). All participants were given at least one dose of their allocated study drug except for one participant in the sitagliptin group. From a mean baseline HbA1c of 8·3% (SD 0·6%; 67 mmol/mol [SD 6·4]), a greater proportion of participants achieved an HbA1c of less than 7% with oral semaglutide than did with sitagliptin (treatment policy estimand: 58% [134 of 230] vs 25% [60 of 238]; and trial product estimand: 63% [123 of 196] vs 28% [52 of 184]). The odds of achieving an HbA1c of less than 7% was significantly better with oral semaglutide than sitagliptin (treatment policy estimand: odds ratio [OR] 4·40, 95% CI 2·89-6·70, p<0·0001; and trial product estimand: 5·54, 3·54-8·68, p<0·0001). The odds of decreasing mean bodyweight from baseline to week 52 were higher with oral semaglutide than with sitagliptin (estimated mean change in bodyweight, treatment policy estimand: -2·6 kg [SE 0·3] vs -0·7 kg [SE 0·2], estimated treatment difference [ETD] -1·9 kg, 95% CI -2·6 to -1·2; p<0·0001; and trial product estimand: -2·9 kg [SE 0·3] vs -0·8 kg [SE 0·3], ETD -2·2 kg, -2·9 to -1·5; p<0·0001). Adverse events occurred in 197 (78%) of 253 participants in the oral semaglutide group versus 172 (69%) of 250 in the sitagliptin group, and nausea was the most common adverse event with oral semaglutide (53 [21%]). Two deaths occurred in the sitagliptin group during the trial. INTERPRETATION Oral semaglutide, with flexible dose adjustment, based on efficacy and tolerability, provided superior glycaemic control and weight loss compared with sitagliptin, and with a safety profile consistent with subcutaneous GLP-1 receptor agonists. FUNDING Novo Nordisk A/S.
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Affiliation(s)
- Thomas R Pieber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
| | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA, USA
| | - Ann Mertens
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Aging (CHROMETA), KU Leuven, Leuven, Belgium
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | - John B Buse
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Triolo TM, Fouts A, Pyle L, Yu L, Gottlieb PA, Steck AK, Greenbaum CJ, Atkinson M, Baidal D, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Clements M, Colman P, DiMeglio L, Gitelman S, Goland R, Gottlieb P, Herold K, Knip M, Krischer J, Lernmark A, Moore W, Moran A, Muir A, Palmer J, Peakman M, Philipson L, Raskin P, Redondo M, Rodriguez H, Russell W, Spain L, Schatz D, Sosenko J, Wentworth J, Wherrett D, Wilson D, Winter W, Ziegler A, Anderson M, Antinozzi P, Benoist C, Blum J, Bourcier K, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Insel R, Kaufman F, Kay T, Leschek E, Mahon J, Marks J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Pugliese A, Roep B, Roncarolo M, Savage P, Simell O, Sherwin R, Siegelman M, Skyler J, Steck A, Thomas J, Trucco M, Wagner J, Krischer JP, Leschek E, Rafkin L, Bourcier K, Cowie C, Foulkes M, Insel R, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Rafkin L, Sosenko JM, Kenyon NS, Santiago I, Krischer JP, Bundy B, Abbondondolo M, Dixit S, Pasha M, King K, Adcock H, Atterberry L, Fox K, Englert N, Mauras J, Permuy K, Sikes T, Adams T, Berhe B, Guendling L, McLennan L, Paganessi C, Murphy M, Draznin M, Kamboj S, Sheppard V, Lewis L, Coates W, Amado D, Moore G, Babar J, Bedard D, Brenson-Hughes J, Cernich M, Clements R, Duprau S, Goodman L, Hester L, Huerta-Saenz A, Asif I, Karmazin T, Letjen S, Raman D, Morin W, Bestermann E, Morawski J, White A, Brockmyer R, Bays S, Campbell A, Boonstra M, Stapleton N, Stone A, Donoho H, Everett H, Hensley M, Johnson C, Marshall N, Skirvin P, Taylor R, Williams L, Burroughs C, Ray C, Wolverton D, Nickels C, Dothard P, Speiser M, Pellizzari L, Bokor K, Izuora S, Abdelnour P, Cummings S, Cuthbertson D, Paynor M, Leahy M, Riedl S, Shockley R, Saad T, Briones S, Casella C, Herz K, Walsh J, Greening F, Deemer M, Hay S, Hunt N, Sikotra L, Simons D, Karounos R, Oremus L, Dye L, Myers D, Ballard W, Miers R, Eberhard C, Sparks K, Thraikill K, Edwards J, Fowlkes S, Kemp A, Morales L, Holland L, Johnson P, Paul A, Ghatak K, Fiske S, Phelen H, Leyland T, Henderson D, Brenner E, Oppenheimer I, Mamkin C, Moniz C, Clarson M, Lovell A, Peters V, Ford J, Ruelas D, Borut D, Burt M, Jordan S, Castilla P, Flores M, Ruiz L, Hanson J, Green-Blair R, Sheridan K, Garmeson J, Wintergerst G, Pierce A, Omoruyi M, Foster S, Kingery A, Lunsford I, Cervantes T, Parker P, Price J, Urben I, Guillette H, Doughty H, Haydock V, Parker P, Bergman S, Duncum C, Rodda A, Perelman R, Calendo C, Barrera E, Arce-Nunez Y, Geyer S, Martinez M, De la Portilla I, Cardenas L, Garrido M, Villar R, Lorini E, Calandra G, D’Annuzio K, Perri N, Minuto C, Hays B, Rebora R, Callegari O, Ali J, Kramer B, Auble S, Cabrera P, Donohoue R, Fiallo-Scharer M, Hessner P, Wolfgram A, Henderson C, Kansra N, Bettin R, McCuller A, Miller S, Accacha J, Corrigan E, Fiore R, Levine T, Mahoney C, Polychronakos V, Henry M, Gagne H, Starkman M, Fox D, Chin F, Melchionne L, Silverman I, Marshall L, Cerracchio J, Cruz A, Viswanathan J, Heyman K, Wilson S, Chalew S, Valley S, Layburn A, Lala P, Clesi M, Genet G, Uwaifo A, Charron T, Allerton W, Hsiao B, Cefalu L, Melendez-Ramirez R, Richards C, Alleyn E, Gustafson M, Lizanna J, Wahlen S, Aleiwe M, Hansen H, Wahlen C, Karges C, Levy A, Bonaccorso R, Rapaport Y, Tomer D, Chia M, Goldis L, Iazzetti M, Klein C, Levister L, Waldman E, Keaton N, Wallach M, Regelmann Z, Antal M, Aranda C, Reynholds A, Vinik P, Barlow M, Bourcier M, Nevoret J, Couper S, Kinderman A, Beresford N, Thalagne H, Roper J, Gibbons J, Hill S, Balleaut C, Brennan J, Ellis-Gage L, Fear T, Gray L, Law P, Jones C, McNerney L, Pointer N, Price K, Few D, Tomlinson N, Leech D, Wake C, Owens M, Burns J, Leinbach A, Wotherspoon A, Murray K, Short G, Curry S, Kelsey J, Lawson J, Porter S, Stevens E, Thomson S, Winship L, Liu S, Wynn E, Wiltshire J, Krebs P, Cresswell H, Faherty C, Ross L, Denvir J, Drew T, Randell P, Mansell S, Lloyd J, Bell S, Butler Y, Hooton H, Navarra A, Roper G, Babington L, Crate H, Cripps A, Ledlie C, Moulds R, Malloy J, Norton B, Petrova O, Silkstone C, Smith K, Ghai M, Murray V, Viswanathan M, Henegan O, Kawadry J, Olson L, Maddox K, Patterson T, Ahmad B, Flores D, Domek S, Domek K, Copeland M, George J, Less T, Davis M, Short A, Martin J, Dwarakanathan P, O’Donnell B, Boerner L, Larson M, Phillips M, Rendell K, Larson C, Smith K, Zebrowski L, Kuechenmeister M, Miller J, Thevarayapillai M, Daniels H, Speer N, Forghani R, Quintana C, Reh A, Bhangoo P, Desrosiers L, Ireland T, Misla C, Milliot E, Torres S, Wells J, Villar M, Yu D, Berry D, Cook J, Soder A, Powell M, Ng M, Morrison Z, Moore M, Haslam M, Lawson B, Bradley J, Courtney C, Richardson C, Watson E, Keely D, DeCurtis M, Vaccarcello-Cruz Z, Torres K, Muller S, Sandberg H, Hsiang B, Joy D, McCormick A, Powell H, Jones J, Bell S, Hargadon S, Hudson M, Kummer S, Nguyen T, Sauder E, Sutton K, Gensel R, Aguirre-Castaneda V, Benavides, Lopez D, Hemp S, Allen J, Stear E, Davis T, O’Donnell R, Jones A, Roberts J, Dart N, Paramalingam L, Levitt Katz N, Chaudhary K, Murphy S, Willi B, Schwartzman C, Kapadia D, Roberts A, Larson D, McClellan G, Shaibai L, Kelley G, Villa C, Kelley R, Diamond M, Kabbani T, Dajani F, Hoekstra M, Sadler K, Magorno J, Holst V, Chauhan N, Wilson P, Bononi M, Sperl A, Millward M, Eaton L, Dean J, Olshan H, Stavros T, Renna C, Milliard, Brodksy L, Bacon J, Quintos L, Topor S, Bialo B, Bancroft A, Soto W, Lagarde H, Tamura R, Lockemer T, Vanderploeg M, Ibrahim M, Huie V, Sanchez R, Edelen R, Marchiando J, Palmer T, Repas M, Wasson P, Wood K, Auker J, Culbertson T, Kieffer D, Voorhees T, Borgwardt L, DeRaad K, Eckert E, Isaacson H, Kuhn A, Carroll M, Xu P, Schubert G, Francis S, Hagan T, Le M, Penn E, Wickham C, Leyva K, Rivera J, Padilla I, Rodriguez N, Young K, Jospe J, Czyzyk B, Johnson U, Nadgir N, Marlen G, Prakasam C, Rieger N, Glaser E, Heiser B, Harris C, 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Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler 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Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | 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Helledie G, Vinkel J, Christiansen E, Hyldegaard O. [Medical screening of persons with diabetes mellitus before allowing recreative diving activity]. Ugeskr Laeger 2019; 181:V12170903. [PMID: 30686284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diabetes mellitus (DM) was previously considered a contraindication to recreational diving by means of self-contained underwater breathing apparatus (SCUBA), the main concern being the risk of the divers developing underwater hypoglycaemia. However, an increasing body of scientific evidence including epidemiologic surveys and controlled case studies have shown, that some patients with DM can dive safely under the right circumstances. In this review, we summarise the Danish national guidelines based on existing literature and guidelines as well as patient instructions on how to improve safety when diving with DM.
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Zinman B, Marso SP, Christiansen E, Calanna S, Rasmussen S, Buse JB. Hypoglycemia, Cardiovascular Outcomes, and Death: The LEADER Experience. Diabetes Care 2018; 41:1783-1791. [PMID: 29903847 DOI: 10.2337/dc17-2677] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/23/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) cardiovascular (CV) outcomes trial (NCT01179048), liraglutide significantly reduced the risk of CV events (by 13%) and hypoglycemia versus placebo. This post hoc analysis examines the associations between hypoglycemia and CV outcomes and death. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes and high risk for CV disease (n = 9,340) were randomized 1:1 to liraglutide or placebo, both in addition to standard treatment, and followed for 3.5-5 years. The primary end point was time to first major adverse cardiovascular event (MACE) (1,302 first events recorded), and secondary end points included incidence of hypoglycemia. We used Cox regression to analyze time to first MACE, CV death, non-CV death, or all-cause death with hypoglycemia as a factor or time-dependent covariate. RESULTS A total of 267 patients experienced severe hypoglycemia (liraglutide n = 114, placebo n = 153; rate ratio 0.69; 95% CI 0.51, 0.93). These patients had longer diabetes duration, higher incidence of heart failure and kidney disease, and used insulin more frequently at baseline than those without severe hypoglycemia. In combined analysis (liraglutide and placebo), patients with severe hypoglycemia were more likely to experience MACE, CV death, and all-cause death, with higher risk shortly after hypoglycemia. The impact of liraglutide on risk of MACE was similar in patients with and without severe hypoglycemia (P-interaction = 0.90). CONCLUSIONS Patients experiencing severe hypoglycemia were at greater risk of CV events and death, particularly shortly after the hypoglycemic episode. While causality remains unclear, reducing hypoglycemia remains an important goal in diabetes management.
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Affiliation(s)
- Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | | | | | | | | | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
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Abstract
Extragastric leiomyoblastomas are extremely rare. This is the sixth reported case of leiomyoblastoma of the greater omentum, and the only one with acute major bleeding which required an emergency operation. Leiomyoblastomas are low-grade malignant tumors, and especially the gastric ones have an excellent prognosis after surgical removal. Extragastric leiomyoblastomas have a higher rate of dissemination. However, none of the previously reported omental leiomyoblastomas showed signs of metastatic spread at the time of operation. The present patient is alive and well 18 months postoperatively.
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Affiliation(s)
- B A Rye
- Department of Surgical Gastroenterology, Herlev University Hospital, Denmark
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Zinman B, Marso SP, Christiansen E, Calanna S, Rasmussen S, Buse JB, Jacob S. Schwere Hypoglykämien, kardiovaskuläre Ergebnisse und Tod – Erfahrungen aus der LEADER Studie. DIABETOL STOFFWECHS 2018. [DOI: 10.1055/s-0038-1641880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- B Zinman
- Mt. Sinai Hospital, University of Toronto, Toronto, Canada
| | - SP Marso
- Research Medical Center, Kansas City, United States
| | | | | | | | - JB Buse
- University of North Carolina School of Medicine, Chapel Hill, United States
| | - S Jacob
- Internist, Endokrinologe und Diabetologe, Kardio-Metabolisches Institut, Villingen-Schwenningen, Germany
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Christiansen E, Muir B, Belec J, Vandervoort E. Small composite field correction factors for the CyberKnife radiosurgery system: clinical and PCSR plans. Phys Med Biol 2017; 62:9240-9259. [PMID: 29058682 DOI: 10.1088/1361-6560/aa954c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A formalism has been proposed for small and non-standard photon fields in which [Formula: see text] correction factors are used to correct dosimeter response in small fields (indiviual or composite) relative to that in a larger machine-specific reference (MSR) field. For clinical plans consisting of several fields, a plan-class specific reference (PCSR) plan can also be defined, serving as an intermediate calibration field between the MSR and clinical plans within a certain plan-class. In this work, the formalism was applied in the calculation of [Formula: see text] for 21 clinical plans delivered by the [Formula: see text] radiosurgery system, each plan employing one or two of the smallest diameter collimators: 5 mm, 7.5 mm, and 10 mm. Three detectors were considered: the Exradin A16 and A26 micro chambers, and the W1 plastic scintillator. The clinical plans were grouped into 7 plan-classes according to commonly shared characteristics. The suitability of using a PCSR plan to represent the detector response of each plan within the plan-class was investigated. Total and intermediate correction factors were calculated using the [Formula: see text] Monte Carlo user code. The corrections for the micro chambers were large, primarily due to the presence of the low-density air cavity and the volume averaging effect. The correction for the scintillator was found to be close to unity for most plans, indicating that this detector may be used to measure small clinical plan correction factors in any plan except for those using the 5 mm collimator. The PCSR plan was shown to be applicable to plan-classes comprising isocentric plans only, with plan-classes divided according to collimator size. For non-isocentric plans, the variation of [Formula: see text] as a function of the point of measurement within a single plan, as well as the high inter-plan-class variability of the correction factor, precludes the use of a PCSR plan.
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Mader JK, Jensen L, Ingwersen SH, Christiansen E, Heller S, Pieber TR. Pharmacokinetic Properties of Liraglutide as Adjunct to Insulin in Subjects with Type 1 Diabetes Mellitus. Clin Pharmacokinet 2017; 55:1457-1463. [PMID: 27282158 PMCID: PMC5069309 DOI: 10.1007/s40262-016-0413-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The pharmacokinetic properties of liraglutide, a glucagon-like peptide-1 receptor agonist approved for the treatment of type 2 diabetes mellitus (T2D), have been established in healthy individuals and subjects with T2D. Liraglutide has been under investigation as adjunct treatment to insulin in type 1 diabetes mellitus (T1D). This single-center, double-blind, placebo-controlled, crossover, clinical pharmacology trial is the first to analyze the pharmacokinetic properties of liraglutide as add-on to insulin in T1D. Methods Subjects (18–64 years; body mass index 20.0–28.0 kg/m2; glycated hemoglobin ≤9.5 %) were randomized 1:1:1 to 0.6, 1.2, or 1.8 mg liraglutide/placebo. Each group underwent two 4-week treatment periods (liraglutide then placebo or placebo then liraglutide) separated by a 2- to 3-week washout. Both trial drugs were administered subcutaneously, once daily, as adjunct to insulin. A stepwise hypoglycemic clamp was performed at the end of each treatment period (data reported previously). Pharmacokinetic endpoints were derived from liraglutide concentration–time curves after the final dose and exposure was compared with data from previous trials in healthy volunteers and subjects with T2D. Results The pharmacokinetic properties of liraglutide in T1D were comparable with those observed in healthy volunteers and subjects with T2D. Area under the steady-state concentration–time curve (AUC) and maximum plasma concentration data were consistent with dose proportionality of liraglutide. Comparison of dose-normalized liraglutide AUC suggested that exposure in T1D, when administered with insulin, is comparable with that observed in T2D. Conclusions Liraglutide, administered as adjunct to insulin in subjects with T1D, shows comparable pharmacokinetics to those in subjects with T2D. ClinicalTrials.gov Identifier: NCT01536665.
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Affiliation(s)
- Julia K Mader
- Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Lene Jensen
- Division of Medicine and Science, Novo Nordisk A/S, Søborg, Denmark
| | | | | | - Simon Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Treftz C, Benedict J, Joakimson D, Christiansen E. A Print Media Campaign to Reduce the Intake of Sugary Drinks Among Children From Low-Income Households. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ahrén B, Hirsch IB, Pieber TR, Mathieu C, Gómez-Peralta F, Hansen TK, Philotheou A, Birch S, Christiansen E, Jensen TJ, Buse JB. Efficacy and Safety of Liraglutide Added to Capped Insulin Treatment in Subjects With Type 1 Diabetes: The ADJUNCT TWO Randomized Trial. Diabetes Care 2016; 39:1693-701. [PMID: 27493132 DOI: 10.2337/dc16-0690] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/26/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of liraglutide added to capped insulin doses in subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS A 26-week, placebo-controlled, double-blind, parallel-group trial enrolling 835 subjects randomized 3:1 receiving once-daily subcutaneous liraglutide (1.8, 1.2, and 0.6 mg) or placebo added to an individually capped total daily dose of insulin. RESULTS Mean baseline glycated hemoglobin (HbA1c) (8.1% [65.0 mmol/mol]) was significantly decreased with liraglutide versus placebo at week 26 (1.8 mg: -0.33% [3.6 mmol/mol]; 1.2 mg: -0.22% [2.4 mmol/mol]; 0.6 mg: -0.23% [2.5 mmol/mol]; placebo: 0.01% [0.1 mmol/mol]). Liraglutide significantly reduced mean body weight (-5.1, -4.0, and -2.5 kg for 1.8, 1.2, and 0.6 mg, respectively) versus placebo (-0.2 kg). Significant reductions in daily insulin dose and increases in quality of life were seen with liraglutide versus placebo. There were higher rates of symptomatic hypoglycemia (21.3 vs. 16.6 events/patient/year; P = 0.03) with liraglutide 1.2 mg vs. placebo and of hyperglycemia with ketosis >1.5 mmol/L with liraglutide 1.8 mg vs. placebo (0.5 vs. 0.1 events/patient/year; P = 0.01). CONCLUSIONS In a broad population of subjects with long-standing type 1 diabetes, liraglutide added to capped insulin reduced HbA1c, body weight, and insulin requirements but with higher rates of hypoglycemia for liraglutide 1.2 mg and hyperglycemia with ketosis for liraglutide 1.8 mg.
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Affiliation(s)
| | | | | | | | | | | | - Areti Philotheou
- University of Cape Town Private Academic Hospital, Cape Town, South Africa
| | | | | | | | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
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Mathieu C, Zinman B, Hemmingsson JU, Woo V, Colman P, Christiansen E, Linder M, Bode B. Efficacy and Safety of Liraglutide Added to Insulin Treatment in Type 1 Diabetes: The ADJUNCT ONE Treat-To-Target Randomized Trial. Diabetes Care 2016; 39:1702-10. [PMID: 27506222 DOI: 10.2337/dc16-0691] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/16/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether liraglutide added to treat-to-target insulin improves glycemic control and reduces insulin requirements and body weight in subjects with type 1 diabetes. RESEARCH DESIGN AND METHODS A 52-week, double-blind, treat-to-target trial involving 1,398 adults randomized 3:1 to receive once-daily subcutaneous injections of liraglutide (1.8, 1.2, or 0.6 mg) or placebo added to insulin. RESULTS HbA1c level was reduced 0.34-0.54% (3.7-5.9 mmol/mol) from a mean baseline of 8.2% (66 mmol/mol), and significantly more for liraglutide 1.8 and 1.2 mg compared with placebo (estimated treatment differences [ETDs]: 1.8 mg liraglutide -0.20% [95% CI -0.32; -0.07]; 1.2 mg liraglutide -0.15% [95% CI -0.27; -0.03]; 0.6 mg liraglutide -0.09% [95% CI -0.21; 0.03]). Insulin doses were reduced by the addition of liraglutide 1.8 and 1.2 mg versus placebo (estimated treatment ratios: 1.8 mg liraglutide 0.92 [95% CI 0.88; 0.96]; 1.2 mg liraglutide 0.95 [95% CI 0.91; 0.99]; 0.6 mg liraglutide 1.00 [95% CI 0.96; 1.04]). Mean body weight was significantly reduced in all liraglutide groups compared with placebo ETDs (1.8 mg liraglutide -4.9 kg [95% CI -5.7; -4.2]; 1.2 mg liraglutide -3.6 kg [95% CI -4.3; -2.8]; 0.6 mg liraglutide -2.2 kg [95% CI -2.9; -1.5]). The rate of symptomatic hypoglycemia increased in all liraglutide groups (estimated rate ratios: 1.8 mg liraglutide 1.31 [95% CI 1.07; 1.59]; 1.2 mg liraglutide 1.27 [95% CI 1.03; 1.55]; 0.6 mg liraglutide 1.17 [95% CI 0.97; 1.43]), and hyperglycemia with ketosis increased significantly for liraglutide 1.8 mg only (event rate ratio 2.22 [95% CI 1.13; 4.34]). CONCLUSIONS Liraglutide added to insulin therapy reduced HbA1c levels, total insulin dose, and body weight in a population that was generally representative of subjects with type 1 diabetes, accompanied by increased rates of symptomatic hypoglycemia and hyperglycemia with ketosis, thereby limiting clinical use in this group.
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Affiliation(s)
- Chantal Mathieu
- Gasthuisberg Hospital, University of Leuven, Leuven, Belgium
| | - Bernard Zinman
- Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Vincent Woo
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Peter Colman
- Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | | | - Bruce Bode
- Atlanta Diabetes Associates, Atlanta, GA
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Muir B, McEwen M, Belec J, Christiansen E, Vandervoort E. SU-F-T-577: Comparison of Small Field Dosimetry Measurements in Fields Shaped with Conical Applicators On Two Different Accelerating Systems. Med Phys 2016. [DOI: 10.1118/1.4956762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Hurley-Sanders J, Harms C, Christiansen E, Clarke E, Law J. Exuberant granulation tissue response associated with Neobenedenia sp. (Monogenea: Capsalidae) infestation in two cobia, Rachycentron canadum (Linnaeus). J Fish Dis 2016; 39:277-283. [PMID: 25864868 DOI: 10.1111/jfd.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 06/04/2023]
Abstract
Monogenean parasite infestations are common in captive marine teleosts, and are generally found on the skin and gills. This report describes an unusual pathological presentation of exuberant granulation tissue of the gills, suspected to be related to Neobenedenia infestation in two cobia housed together at a North Carolina aquarium.
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Affiliation(s)
- J Hurley-Sanders
- Environmental Medicine Consortium, North Carolina State University, Raleigh, NC, USA
| | - C Harms
- Environmental Medicine Consortium, North Carolina State University, Raleigh, NC, USA
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
- Center for Marine Sciences and Technology, Morehead City, NC, USA
| | - E Christiansen
- Environmental Medicine Consortium, North Carolina State University, Raleigh, NC, USA
- Center for Marine Sciences and Technology, Morehead City, NC, USA
- North Carolina Aquariums, Raleigh, NC, USA
| | - E Clarke
- Environmental Medicine Consortium, North Carolina State University, Raleigh, NC, USA
- Center for Marine Sciences and Technology, Morehead City, NC, USA
- Audubon Nature Institute, New Orleans, LA, USA
| | - J Law
- Environmental Medicine Consortium, North Carolina State University, Raleigh, NC, USA
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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Christiansen E, Agerbo E, Bilenberg N, Stenager E. SSRIs and risk of suicide attempts in young people - A Danish observational register-based historical cohort study, using propensity score. Nord J Psychiatry 2016; 70:167-75. [PMID: 26251067 DOI: 10.3109/08039488.2015.1065291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND SSRIs are widely used in the treatment of mental illness for both children and adults. Studies have found a slightly increased risk of suicidal thoughts and suicide attempts in young people using SSRIs but SSRIs' impact on risk for suicides in youth is not well-established. AIM Is there indication that SSRIs might raise risk for suicide attempts in young people? METHODS We used an observational register-based historical cohort design, a large cohort of all Danish individuals born in 1983-1989 (n = 392,458) and a propensity score approach to analyse the impact from SSRIs on risk for suicide attempts. Every suicide attempt and redeemed prescription of SSRIs was analysed by Cox regression. RESULTS We found a significant overlap between redeeming a prescription on SSRIs and subsequent suicide attempt. The risk for suicide attempt was highest in the first 3 months after redeeming the first prescription. The hazard ratio for suicide attempts after redeeming a prescription was estimated to 5.23, 95% CI 4.82-5.68. CONCLUSION We conclude that the risk of suicide attempt is higher for young people in the first months after redeeming their first prescription for SSRIs, compared to non-users. For SSRI users with lower propensity score (fewer risk factors for SSRIs) the risk of suicide attempt is estimated to be highest. Although the design may miss some explicit reason for prescription of SSRIs and SSRIs might be a marker for those in high risk rather than a causal risk factor, we would recommend systematic risk assessment in the period after redeeming the first prescription.
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Affiliation(s)
- Erik Christiansen
- a Erik Christiansen, Department of Child and Adolescent Mental Health Odense and Institute of Regional Health Services Research , University of Southern Denmark , Odense , Denmark
| | - Esben Agerbo
- b Esben Agerbo, Centre for Integrated Register-based Research, National Centre for Register-based Research, Business and Social Sciences, Aarhus University , Denmark
| | - Niels Bilenberg
- c Niels Bilenberg, Department of Child and Adolescent Mental Health Odense , University of Southern Denmark , Odense , Denmark
| | - Elsebeth Stenager
- d Elsebeth Stenager, Department of Psychiatry , Odense and Institute of Regional Health Services Research, University of Southern Denmark , Odense , Denmark
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Bjørnholt K, Christiansen E, Atterman Stokholm K, Hvolby A. The effect of daily small text message reminders for medicine compliance amongst young people connected with the outpatient department for child and adolescent psychiatry. A controlled and randomized investigation. Nord J Psychiatry 2016; 70:285-9. [PMID: 26588214 DOI: 10.3109/08039488.2015.1106580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Many patients with psychiatric illnesses have difficulty maintaining medication over time. Many take their medicine irregularly and studies show that it is the most vulnerable patients who have the greatest problems adhering to treatment. Often only 50% are still under medical treatment after 6 months. AIM In this study we investigated whether text message reminders could improve medicine compliance amongst vulnerable young people with psychiatric disorders who were being treated in the outpatient department for child and adolescent psychiatry and who either are under or were to commence medicinal treatment. METHODS This study was conducted as a randomized controlled trial including all non-acute referrals to an outpatient department for adolescent psychiatry within a group aged 15-20 years starting medical treatment. The patients were followed until the end of their treatment, for a minimum of 3 months. To enhance medicine compliance, text messages were sent daily to one group. No message was sent to the other group. RESULTS Compliance was not associated with text message intervention in any of the drug interventions. The effect size was calculated to 0.3013, which is low and therefore indicates a weak association between text message and compliance. The power in this study was calculated to 0.3539, which is also low and therefore the likelihood of finding significant association is low. CONCLUSION This study does not show increased medicine compliance from the text message intervention group. The conclusion of this study is that it is essential that significant resources are spent preparing and testing a text message strategy.
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Affiliation(s)
- Karsten Bjørnholt
- a Child and Adolescent Psychiatric Department , Region of Southern Denmark , Esbjerg , Denmark
| | - Erik Christiansen
- b Child and Adolescent Psychiatric Department , Region of Southern Denmark, University Hospital , Odense , Denmark
| | | | - Allan Hvolby
- a Child and Adolescent Psychiatric Department , Region of Southern Denmark , Esbjerg , Denmark
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Christiansen E, Agerbo E, Larsen KJ, Bilenberg N, Stenager E. Youth, suicide attempts and low level of education: A Danish historical register-based cohort study of the outcome of suicide attempt. Int J Soc Psychiatry 2015; 61:802-10. [PMID: 26253120 DOI: 10.1177/0020764015597460] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In Denmark, it is a political goal that 95% of all young people should complete an upper secondary education. For some young people, this goal can be difficult to achieve. An association has been established between suicidal behaviour and school performance. AIM We hypothesise that young people who have attempted suicide have a lower chance of finishing secondary education. METHODS We used Danish historical population registers to perform a longitudinal cohort design and extended Cox regression modelling to estimate crude and adjusted estimates of the effect of suicide attempt on secondary education. We used the birth cohorts 1983-1989, and all subjects were followed from birth until the end of 2011 (n = 355,725). RESULTS For suicide attempters, the likelihood of completing secondary education was one-third of non-attempters (crude hazard ratio = 0.38). A part of the impact can be explained by confounding factors. Individuals with a suicide attempt at age 16-20 years or with multiple suicide attempts were most likely not to complete secondary education. Compared to mentally ill non-attempters, suicide attempters with mental illness were more likely not to finish secondary education. CONCLUSION A suicide attempt is not necessarily causal for not finishing secondary education, but it is a marker, and it predicts an increased likelihood of not finishing secondary education. We need to identify individuals at risk for suicide attempts and subsequently provide the necessary support. Completing secondary education is important, as it provides better chances of employment, higher wages and more opportunities for individuals in the future.
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Affiliation(s)
- Erik Christiansen
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark Research Unit, Department of Child and Adolescent Mental Health Odense, University Hospital, Odense, Denmark
| | - Esben Agerbo
- Centre for Integrated Register-based Research, National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Kim Juul Larsen
- Centre for Suicide Prevention, Department of Child and Adolescent Mental Health Odense, University of Southern Denmark, Odense, Denmark
| | - Niels Bilenberg
- Research Unit, Department of Child and Adolescent Mental Health Odense, University Hospital, Odense, Denmark
| | - Elsebeth Stenager
- Department of Psychiatry, Odense and Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Benedict J, Pitts R, Christiansen E. The Impact of a Community-Based Effort to Promote Healthful Beverage Choices among Households Enrolled in the Supplemental Nutrition Assistance Program. J Acad Nutr Diet 2015. [DOI: 10.1016/j.jand.2015.06.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pieber TR, Deller S, Korsatko S, Jensen L, Christiansen E, Madsen J, Heller SR. Counter-regulatory hormone responses to hypoglycaemia in people with type 1 diabetes after 4 weeks of treatment with liraglutide adjunct to insulin: a randomized, placebo-controlled, double-blind, crossover trial. Diabetes Obes Metab 2015; 17:742-50. [PMID: 25855340 DOI: 10.1111/dom.12473] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/20/2015] [Accepted: 04/03/2015] [Indexed: 12/25/2022]
Abstract
AIMS To investigate the effect of glucagon-like peptide 1 receptor agonist liraglutide on the counter-regulatory hormone response to hypoglycaemia in type 1 diabetes. METHODS We conducted a randomized, double-blind, placebo-controlled, single-centre trial, in which a total of 45 adults with type 1 diabetes [mean ± standard deviation age 34.5 ± 11.2 years, BMI 23.9 ± 2.4 kg/m(2) , glycated haemoglobin (HbA1c) 7.6 ± 0.8%, diabetes duration 16.6 ± 9.4 years] underwent a hypoglycaemic clamp after 4 weeks' crossover treatment with once-daily liraglutide/placebo added to insulin in one of three liraglutide dose groups: 0.6 mg (n = 15); 1.2 mg (n = 14); and 1.8 mg (n = 16). The main outcome measure was glucagon concentration at nadir plasma glucose (2.5 mmol/l). Clinical outcomes were also evaluated. Five participants were withdrawn from the trial; three because of adverse events. All participants were included in the analysis. RESULTS Glucagon concentration at nadir plasma glucose was modest, trending towards lower concentrations at increasing liraglutide dose versus placebo: 34.7 versus 38.1 pg/ml, p = 0.555 (0.6 mg); 28.8 versus 37.2 pg/ml, p = 0.126 (1.2 mg); and 28.4 versus 37.5 pg/ml, p = 0.092 (1.8 mg). There was no difference, however, between liraglutide and placebo in incremental change in glucagon during hypoglycaemia. Other counter-regulatory hormone levels increased during hypoglycaemia with no systematic differences between groups. Glucose infusion rates were significantly lower with liraglutide versus placebo during the clamp. After 4 weeks' treatment, HbA1c remained unchanged in the liraglutide and placebo groups. Greater reductions in insulin dose and body weight were seen with liraglutide versus placebo. CONCLUSIONS Liraglutide did not compromise hypoglycaemic responses in type 1 diabetes after 4 weeks' treatment.
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Affiliation(s)
- T R Pieber
- Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - S Deller
- Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - S Korsatko
- Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - L Jensen
- Novo Nordisk A/S, Søborg, Denmark
| | | | - J Madsen
- Novo Nordisk A/S, Søborg, Denmark
| | - S R Heller
- Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
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Christiansen E, Belec J, Muir B, Vandervoort E. SU-C-304-06: Determination of Intermediate Correction Factors for Three Dosimeters in Small Composite Photon Fields Used in Robotic Radiosurgery. Med Phys 2015. [DOI: 10.1118/1.4923794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Christiansen E, Larsen KJ, Agerbo E, Bilenberg N, Stenager E. Risk factors and study designs used in research of youths' suicide behaviour-an epidemiological discussion with focus on level of evidence. Nord J Psychiatry 2014; 68:513-23. [PMID: 24754467 DOI: 10.3109/08039488.2014.898092] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Introduction: Many different epidemiology study designs have been used to analyse risk factors for suicide behaviour. The purpose of this study was to obtain an insight into the current study design used in research on youths' risk factors for suicide behaviour and to rank the studies according to level of evidence (LoE). METHODS We searched PubMed and psycINFO in order to identify relevant individual studies. RESULTS We included 36 studies of children and youth on suicidal behaviour and ideation-many rank low on LoE. For suicide, cohort design was often used, and mental illness (depression, substance abuse and severity of mental illness) was the most common risk factor. Cohort studies are ranked 2b, which is high according to LoE. For suicide attempts, survey was often used, and psychopathology, substance abuse and being exposed to suicidal behaviour were the most common risk factors. For suicidal ideation, survey was the only design used, and substance abuse and psychopathology the most common risk factors. Surveys are ranked 4, which are low according to LoE. Many risk factors were broad and unspecific, and standard definitions of outcome and exposure were rarely used. CONCLUSION A good study of risk factors for suicidal behaviour would need a high LoE, as a high-powered longitudinal epidemiological study (cohort or case-control) of very specific risk factors. The factors would have high prevention potential, compared with more broad and unspecific risk factors, to which many people are exposed. We would recommend a cohort design (in high-risk populations) or a case-control design to identify risk factors, using clinical and/or register data instead of self-reported information, reporting adjusted estimates and using standard definition of suicidal outcome and risk factors.
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Affiliation(s)
- Erik Christiansen
- Erik Christiansen, M.Sc., Child and Adolescent Psychiatric Department and Institute of Regional Health Services Research, University of Southern Denmark , Odense , Denmark
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Vandervoort E, Christiansen E, Szanto J. Sci-Sat AM: Stereo - 07: Suitability of a plastic scintillator dosimeter for composite clinical fields delivered using the Cyberknife robotic radiosurgery system. Med Phys 2014. [DOI: 10.1118/1.4894968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Rasmussen CS, Nielsen LG, Petersen DJ, Christiansen E, Bilenberg N. Adverse life events as risk factors for behavioural and emotional problems in a 7-year follow-up of a population-based child cohort. Nord J Psychiatry 2014; 68:189-95. [PMID: 23692285 DOI: 10.3109/08039488.2013.794473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND AIM The aim of the study was to identify risk factors for significant changes in emotional and behavioural problem load in a community-based cohort of Danish children aged 9-16 years, the risk factors being seven parental and two child-related adverse life events. METHODS Data on emotional and behavioural problems was obtained from parents filling in the Child Behavior Checklist (CBCL) when the child was 8-9 and again when 15 years old. Data on risk factors was drawn from Danish registers. Analysis used was logistic regression for crude and adjusted change. RESULTS Parental divorce significantly raised the odds ratio of an increase in emotional and behavioural problems; furthermore, the risk of deterioration in problem behaviour rose significantly with increasing number of adverse life events. By dividing the children into four groups based on the pathway in problem load (increasers, decreasers, high persisters and low persisters), we found that children with a consistently high level of behavioural problems also had the highest number of adverse life events compared with any other group. CONCLUSIONS Family break-up was found to be a significant risk factor. This supports findings in previous studies. The fact that no other risk factor proved to be of significance might be due to lack of power in the study. Children experiencing high levels of adverse life events are at high risk of chronic problem behaviour. Thus these risk factors should be assessed in daily clinical practice.
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Affiliation(s)
- Cathrine Skovmand Rasmussen
- Child and Adolescent Psychiatric Department, Mental Health Hospital and University Clinic, Region of Southern Denmark, University of Southern Denmark , Sdr. Boulevard 29, DK-5000 Odense C , Denmark
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Abdelmalak B, Knittel J, Abdelmalak J, Dalton J, Christiansen E, Foss J, Argalious M, Zimmerman R, Van den Berghe G. Preoperative blood glucose concentrations and postoperative outcomes after elective non-cardiac surgery: an observational study. Br J Anaesth 2014; 112:79-88. [DOI: 10.1093/bja/aet297] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Urban C, Hamacher A, Partke HJ, Roden M, Schinner S, Christiansen E, Due-Hansen ME, Ulven T, Gohlke H, Kassack MU. In vitro and mouse in vivo characterization of the potent free fatty acid 1 receptor agonist TUG-469. Naunyn Schmiedebergs Arch Pharmacol 2013; 386:1021-30. [PMID: 23861168 DOI: 10.1007/s00210-013-0899-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
Activation of the G protein-coupled free fatty acid receptor 1 (FFA1; formerly known as GPR40) leads to an enhancement of glucose-stimulated insulin secretion from pancreatic β-cells. TUG-469 has previously been reported as a potent FFA1 agonist. This study was performed to confirm the higher in vitro potency of TUG-469 compared to the reference FFA1 agonist GW9508 and to prove in vivo activity in a pre-diabetic mouse model. The in vitro pharmacology of TUG-469 was studied using Ca(2+)-, cAMP-, and impedance-based assays at recombinant FFA1 and free fatty acid receptor 4, formerly known as GPR120 (FFA4) expressing 1321N1 cells and the rat insulinoma cell line INS-1. Furthermore, we investigated the systemic effect of TUG-469 on glucose tolerance in pre-diabetic New Zealand obese (NZO) mice performing a glucose tolerance test after intraperitoneal administration of 5 mg/kg TUG-469. In comparison to GW9508, TUG-469 showed a 1.7- to 3.0-times higher potency in vitro at 1321N1 cells recombinantly expressing FFA1. Both compounds increased insulin secretion from rat insulinoma INS-1 cells. TUG-469 is > 200-fold selective for FFA1 over FFA4. Finally, a single dose of 5 mg/kg TUG-469 significantly improved glucose tolerance in pre-diabetic NZO mice. TUG-469 turned out as a promising candidate for further drug development of FFA1 agonists for treatment of type 2 diabetes mellitus.
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Affiliation(s)
- C Urban
- Pharmaceutical and Medicinal Chemistry, Heinrich-Heine-University, Universitätsstr. 1, 40225, Düsseldorf, Germany
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