1
|
Busch CBE, Meiring S, van Baar ACG, Holleman F, Nieuwdorp M, Bergman JJGHM. Re-Cellularization via Electroporation Therapy of the duodenum combined with GPL-1 receptor agonist to replace insulin therapy in patients with type 2 diabetes; 12 months results of a first-in-human study. Gastrointest Endosc 2024:S0016-5107(24)03163-8. [PMID: 38692517 DOI: 10.1016/j.gie.2024.04.2904] [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: 02/23/2024] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND AIMS Studies have shown that hydrothermal duodenal mucosal ablation results in improved glycemic control. Re-Cellularization via Electroporation Therapy (ReCET) is a novel endoscopic procedure that uses electroporation to induce cellular apoptosis and subsequent reepithelization. In this study, we aimed to eliminate exogenous insulin treatment in T2D patients through a single ReCET procedure combined with a GLP-1 receptor agonist (GLP-1RA). Feasibility, safety, and (dose) efficacy of ReCET were assessed. METHODS First-in-human study including patients with T2D on basal insulin (28-75years; BMI 24-40kg/m2, HbA1c ≤64mmol/mol; C-peptide ≥0.2nmol/L). The electroporation dose was optimized during the study, starting with single 600V and ending with double 750V treatments. All patients underwent ReCET, after which insulin was discontinued and semaglutide (GLP-1RA) was initiated. Primary endpoints were: feasibility (procedure time [catheter in-out], technical success rate), safety, and efficacy (patients off insulin at 6 months; HbA1c ≤58mmol/mol). RESULTS Fourteen patients underwent endoscopic ReCET. Median procedure time was 58 (IQR 49-73) minutes. ReCET demonstrated a technical success rate of 100%. No device related SAEs or severe hypoglycemic events were observed. At 12 months follow up, 12 (86%) patients remained off exogenous insulin therapy with significant improvements in glycemic control, metabolic parameters. The 2 patients in whom insulin therapy was reintroduced both received ReCET at the lowest voltage (single 600V). CONCLUSION These results suggest that ReCET is feasible and safe. In combination with semaglutide, ReCET may be a promising therapeutic option to replace insulin therapy in selected T2D patients, while improving glycemic control and metabolic health.
Collapse
Affiliation(s)
- Celine B E Busch
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Suzanne Meiring
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Annieke C G van Baar
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
| | - Frits Holleman
- Department of Internal Medicine, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centers, Amsterdam Gastroenterology Endocrinology Metabolism, University of Amsterdam, the Netherlands
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
2
|
Nabrdalik K, Drożdż K, Kwiendacz H, Skonieczna-Żydecka K, Łoniewski I, Kaczmarczyk M, Wijata AM, Nalepa J, Holleman F, Nieuwdorp M, Gumprecht J. Clinical Trial: Probiotics in Metformin Intolerant Patients with Type 2 Diabetes (ProGasMet). Biomed Pharmacother 2023; 168:115650. [PMID: 37812890 DOI: 10.1016/j.biopha.2023.115650] [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] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND For decades, metformin has been the drug of first choice in the management of type 2 diabetes. However, approximately 2-13% of patients do not tolerate metformin due to gastrointestinal (GI) side effects. Since metformin influences the gut microbiota, we hypothesized that a multi-strain probiotics supplementation would mitigate the gastrointestinal symptoms associated with metformin usage. METHODS AND ANALYSIS This randomized, double-blind, placebo-controlled, single-center, cross-over trial (ProGasMet study) assessed the efficacy of a multi-strain probiotic in 37 patients with metformin intolerance. Patients were randomly allocated (1:1) to receive probiotic (PRO-PLA) or placebo (PLA-PRO) at baseline and, after 12 weeks (period 1), they crossed-over to the other treatment arm (period 2). The primary outcome was the reduction of GI adverse events of metformin. RESULTS 37 out of 82 eligible patients were enrolled in the final analysis of whom 35 completed the 32 weeks study period and 2 patients resigned at visit 5. Regardless of the treatment arm allocation, while on probiotic supplementation, there was a significant reduction of incidence (for the probiotic period in PRO-PLA/PLA-PRO: P = 0.017/P = 0.054), quantity and severity of nausea (P = 0.016/P = 0.024), frequency (P = 0.009/P = 0.015) and severity (P = 0.019/P = 0.005) of abdominal bloating/pain as well as significant improvement in self-assessed tolerability of metformin (P < 0.01/P = 0.005). Moreover, there was significant reduction of incidence of diarrhea while on probiotic supplementation in PRO-PLA treatment arm (P = 0.036). CONCLUSION A multi-strain probiotic diminishes the incidence of gastrointestinal adverse effects in patients with type 2 diabetes and metformin intolerance.
Collapse
Affiliation(s)
- Katarzyna Nabrdalik
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland.
| | - Karolina Drożdż
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland.
| | - Hanna Kwiendacz
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland.
| | | | - Igor Łoniewski
- Department of Biochemical Sciences, Pomeranian Medical University, 71-460 Szczecin, Poland; Sanprobi sp. z o. o. sp. k, Szczecin, Poland.
| | - Mariusz Kaczmarczyk
- Department of Biochemical Sciences, Pomeranian Medical University, 71-460 Szczecin, Poland; Sanprobi sp. z o. o. sp. k, Szczecin, Poland.
| | - Agata M Wijata
- Faculty of Biomedical Engineering, Silesian University of Technology, Roosevelta 40, 41-800 Zabrze, Poland.
| | - Jakub Nalepa
- Faculty of Automatic Control, Electronics and Computer Science, Department of Algorithmics and Software, Silesian University of Technology, Akademicka 16, 44-100 Gliwice, Poland.
| | - Frits Holleman
- Department of Department of Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Max Nieuwdorp
- Internal and Vascular Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland.
| |
Collapse
|
3
|
Fuhri Snethlage CM, McDonald TJ, Oram RD, de Groen P, Rampanelli E, Schimmel AWM, Holleman F, Siegelaar S, Hoekstra J, Brouwer CB, Knop FK, Verchere CB, van Raalte DH, Roep BO, Nieuwdorp M, Hanssen NMJ. Residual β-Cell Function Is Associated With Longer Time in Range in Individuals With Type 1 Diabetes. Diabetes Care 2023:dc230776. [PMID: 37535870 DOI: 10.2337/dc23-0776] [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] [Received: 04/30/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Little is known about the influence of residual islet function on glycemic control in type 1 diabetes (T1D). We investigated the associations between residual β-cell function and metrics of continuous glucose monitoring (CGM) in individuals with T1D. RESEARCH DESIGN AND METHODS In this cross-sectional cohort comprising 489 individuals (64% female, age 41.0 ± 14.0 years), T1D duration was 15.0 (interquartile range [IQR] 6.0-29.0) years. Individuals had a time in range (TIR) of 66% (IQR 52-80%) and a urinary C-peptide-to-creatinine ratio (UCPCR) of 0.01 (IQR 0.00-0.41) nmol/mmol. To assess β-cell function, we measured UCPCR (detectable >0.01 nmol/mmol), and to assess α-cell function, fasting plasma glucagon/glucose ratios were measured. CGM was used to record TIR (3.9-10 mmol/L), time below range (TBR) (<3.9 mmol/L), time above range (TAR) (>10 mmol/L), and glucose coefficient of variance (CV). For CGM, 74.7% used FreeStyle Libre 2, 13.8% Medtronic Guardian, and 11.5% Dexcom G6 as their device. RESULTS The percentage of patients with T1D who had a detectable UCPCR was 49.4%. A higher UCPCR correlated with higher TIR (r = 0.330, P < 0.05), lower TBR (r = -0.237, P < 0.05), lower TAR (r = -0.302, P < 0.05), and lower glucose CV (r = -0.356, P < 0.05). A higher UCPCR correlated negatively with HbA1c levels (r = -0.183, P < 0.05) and total daily insulin dose (r = -0.183, P < 0.05). Glucagon/glucose ratios correlated with longer TIR (r = 0.234, P < 0.05). CONCLUSIONS Significantly longer TIR, shorter TBR and TAR, and lower CV were observed in individuals with greater UCPCR-assessed β-cell function. Therefore, better CGM-derived metrics in individuals with preserved β-cell function may be a contributor to a lower risk of developing long-term complications.
Collapse
Affiliation(s)
- Coco M Fuhri Snethlage
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Timothy J McDonald
- Peninsula College of Medicine and Dentistry, Peninsula National Institute for Health and Care Research Clinical Research Facility, Exeter, Devon, United Kingdom
| | - Richard D Oram
- Peninsula College of Medicine and Dentistry, Peninsula National Institute for Health and Care Research Clinical Research Facility, Exeter, Devon, United Kingdom
| | - Pleun de Groen
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Elena Rampanelli
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Alinda W M Schimmel
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Frits Holleman
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sarah Siegelaar
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost Hoekstra
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Filip K Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C Bruce Verchere
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Daniël H van Raalte
- Department of Endocrinology and Metabolism, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Bart O Roep
- Internal Medicine, Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - Max Nieuwdorp
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nordin M J Hanssen
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Bavalia R, Stals MAM, Mulder FI, Bistervels IM, Coppens M, Faber LM, Hendriks SV, Hofstee HMA, Huisman MV, van der Hulle T, Mairuhu ATA, Kruip MJHA, Middeldorp S, Klok FA, Hutten BA, Holleman F. Use of the National Early Warning Score for predicting deterioration of patients with acute pulmonary embolism: a post-hoc analysis of the YEARS Study. J Accid Emerg Med 2023; 40:61-66. [PMID: 36344240 DOI: 10.1136/emermed-2021-211506] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI) are validated scores for mortality prediction in patients with pulmonary embolism (PE). National Early Warning Score (NEWS) is a general prognostic risk score for multiple clinical settings. We investigated whether the NEWS had a comparable performance with the PESI and sPESI, for predicting intensive care unit (ICU) admission and death in patients with acute PE. METHODS In haemodynamically stable patients with confirmed PE from the YEARS Study (2013-2015), we evaluated the performance of the NEWS, PESI and sPESI for predicting 7-day ICU admission and 30-day mortality. Receiver operating characteristic curves were plotted and the area under the curve (AUC) was calculated. RESULTS Of 352 patients, 12 (3.4%) were admitted to the ICU and 5 (1.4%) died. The AUC of the NEWS for ICU admission was 0.80 (95% CI 0.66 to 0.94) and 0.92 (95% CI 0.82 to 1.00) for 30-day mortality. At a threshold of 3 points, NEWS yielded a sensitivity and specificity of 92% and 53% for ICU admission and 100% and 52% for 30-day mortality. The AUC of the PESI was 0.64 (95% CI 0.48 to 0.79) for ICU admission and 0.94 (95% CI 0.87 to 1.00) for mortality. At a threshold of 66 points, PESI yielded a sensitivity of 75% and a specificity of 38% for ICU admission. For mortality, these were 100% and 37%, respectively. The performance of the sPESI was similar to that of PESI. CONCLUSION In comparison with PESI and sPESI, NEWS adequately predicted 7-day ICU admission as well as 30-day mortality, supporting its potential relevance for clinical practice.
Collapse
Affiliation(s)
- Roisin Bavalia
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Frits I Mulder
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Ingrid M Bistervels
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Michiel Coppens
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Laura M Faber
- Internal Medicine, Red Cross Hospital, Beverwijk, The Netherlands
| | - Stephan V Hendriks
- Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands.,Internal Medicine, Haga Hospital, Den Haag, The Netherlands
| | | | | | | | | | | | - Saskia Middeldorp
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Internal Medicine & Radboud Institute of Health Sciences, Radboud University Nijmegen Faculty of Medical Sciences, Nijmegen, The Netherlands
| | | | - Barbara A Hutten
- Epidemiology and Data Science, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Schinkel M, Holleman F. In reply to: 'Use TRIPOD when validating clinical prediction models'. J Accid Emerg Med 2023; 40:81-82. [PMID: 36396346 DOI: 10.1136/emermed-2022-212701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Michiel Schinkel
- Center for Experimental and Molecular Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Schinkel M, Holleman F, Vleghels R, Brugman K, Ridderikhof ML, Dzelili M, Nanayakkara PWB, Wiersinga WJ. The impact of a sepsis performance improvement program in the emergency department: a before–after intervention study. Infection 2022:10.1007/s15010-022-01957-x. [DOI: 10.1007/s15010-022-01957-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Purpose
The latest Surviving Sepsis Campaign guidelines advocate that all hospitals use sepsis performance improvement programs. However, there is a limited evidence about how to structure such programs and what their potential impact is on sepsis management and outcomes in the emergency department (ED). In this study, we evaluated the implementation of a sepsis performance improvement program in the ED including a dedicated sepsis response team and analyzed the management and outcomes of sepsis patients before and after.
Methods
We conducted a before–after interventional study in the ED of the Amsterdam University Medical Centers, the Netherlands. The sepsis performance improvement program included regular educational meetings, daily audits and weekly feedback, a screening tool, and a dedicated multidisciplinary sepsis response team. We studied all adult patients who presented to the ED with a suspected infection and a Modified Early Warning Score (MEWS) ≥ 3 during their stay. In the postintervention phase, these patients were seen by the sepsis team. Process-related and patient-related outcomes were measured between November 2019 and February 2020 (preintervention) and December 2021–May 2022 (postintervention).
Results
A total of 265 patients were included in the primary study, 132 patients preintervention and 133 patients postintervention. The postintervention phase was associated with improvements in nearly all process-related outcomes, such as a shorter time to antibiotics (66 vs. 143 min; p < 0.001), increased number of lactate measurements (72.9 vs. 46.2%; p < 0.001), and improved completeness of documented MEWS scores (85.0 vs. 62.9%; p < 0.001). Except for an improvement in the number of immediate versus delayed ICU admissions (100% immediate vs. 64.3% immediate; p = 0.012), there was no improvement in the other patient-related outcomes such as 28 days mortality (14.3 vs. 9.1%; p = 0.261), during the postintervention phase.
Conclusion
Our program stimulated physicians to make timely decisions regarding diagnostics and treatment of sepsis in the ED. Implementing the sepsis performance improvement program was associated with significant improvements in most process-related outcomes but with minimal improvements in patient-related outcomes in our cohort.
Collapse
|
7
|
Gresnigt FMJ, Ghaem Maghami P, van Exter P, Noordhoff A, van Dijk T, van Litsenburg R, Holleman F, Kramer MHH, Nanayakkara PWB. Recreational Drug Use During the Amsterdam Dance Event: Impact on Emergency Services. Subst Abuse 2022; 16:11782218221114965. [PMID: 36312590 PMCID: PMC9597048 DOI: 10.1177/11782218221114965] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recreational drug use is common at large-scale dance events such as the Amsterdam Dance Event (ADE) and severe drug-related complications and deaths occur. Increasing concentrations of cocaine, amphetamine and MDMA have been observed in samples from dance events. Therefore, large dance events are expected to cause an increasing amount of recreational drug related complaints (RDRC) and an increased demand on emergency medical services. AIM To evaluate the impact of recreational drug related complaints (RDRC) during ADE 2016, compared to regular weeks, and to evaluate the requirement for additional medical personnel. METHODS For this prospective, observational cohort study, patients >12 years old presenting with RDRC at first aid stations (FAS), ambulance service (AA) and ED during ADE, between October 19th and October 24th 2016 were included. From 2 EDs and AA, the RDRC 2 weeks before and after ADE were also collected. RESULTS An estimated 375.000 people attended ADE. The number of patients with RDRC was 459 at the FAS, 113 at AA and 81 at the ED, and increased significantly during ADE with 225% at AA and with 236% at OLVG ED. Eight patients were admitted. A higher percentage of poly-drug use among ED patients (58%) was found, compared to FAS patients (25%). Also, the proportion of tourists in ED's (51%) was higher compared to FAS (30%). CONCLUSIONS During ADE 2016, the number of intoxicated patients increased significantly. Eight patients were admitted to the hospital, without any deaths. The absolute number of patients stayed within normal range of emergency medical services capacity.
Collapse
Affiliation(s)
- Femke MJ Gresnigt
- Emergency Department, OLVG Amsterdam,
Amsterdam, The Netherlands,Femke MJ Gresnigt, Emergency physician,
Emergency department OLVG hospital, Oosterpark 9, Amsterdam 1091AC, The
Netherlands.
| | - Pedram Ghaem Maghami
- Section General and Acute Internal
Medicine, Department of Internal Medicine, VU University Medical Center, Amsterdam,
and The Institute for Cardiovascular Research (ICAR-VU), Vrije Universiteit,
Amsterdam, The Netherlands
| | | | - Annelieke Noordhoff
- Emergency Department, VU University
Medical Center, Amsterdam, The Netherlands
| | - Tobias van Dijk
- Department of Epidemiology & Health
Promotion, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | | | - Frits Holleman
- Section Acute Medicine, Department of
Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark HH Kramer
- Section General and Acute Internal
Medicine, Department of Internal Medicine, VU University Medical Center, Amsterdam,
and The Institute for Cardiovascular Research (ICAR-VU), Vrije Universiteit,
Amsterdam, The Netherlands
| | - Prabath WB Nanayakkara
- Section General and Acute Internal
Medicine, Department of Internal Medicine, VU University Medical Center, Amsterdam,
and The Institute for Cardiovascular Research (ICAR-VU), Vrije Universiteit,
Amsterdam, The Netherlands
| |
Collapse
|
8
|
Meiring S, Busch CBE, van Baar ACG, Hemke R, Holleman F, Nieuwdorp M, Bergman JJGHM. Eliminating exogenous insulin therapy in patients with type 2 diabetes by duodenal ablation and GLP-1RA decreases risk scores for cardiovascular events. Cardiovasc Diabetol 2022; 21:191. [PMID: 36138441 PMCID: PMC9503196 DOI: 10.1186/s12933-022-01628-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/31/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Duodenal Mucosal Resurfacing (DMR) is an endoscopic ablation technique aimed at improving glycaemia and metabolic health in patients with type 2 diabetes mellitus (T2DM). DMR has an insulin sensitizing effect in patients with T2DM. Reducing hyperinsulinemia can improve cardiovascular health. In the INSPIRE trial, we combined a single DMR with a glucagon-like-peptide-1 receptor agonist (GLP-1RA) and demonstrated elimination of insulin treatment in 69% of patients at 6 months and 53% of patients at 18 months while improving glycaemic control and metabolic health. We hypothesized that this treatment approach is associated with improved cardiovascular health, by reducing hyperinsulinemia. Methods Before and 6 months after starting the combination treatment to replace insulin, the following assessments were performed to evaluate cardiovascular health: magnetic resonance imaging (MRI) to measure abdominal visceral adipose tissue volume, ambulatory 24 h blood pressure (ABPM) analysis, postprandial insulin and triglycerides, fasting lipid panel and urine microalbumin. The Atherosclerotic Cardiovascular Disease (ASCVD) score was calculated to estimate 10-year risk of cardiovascular disease or stroke and the diabetes lifetime-perspective prediction (DIAL) score was calculated to estimate years free of cardiovascular disease. Results Six months after replacing exogenous insulin by DMR and GLP-1RA, visceral adipose tissue decreased significantly by 24%. Postprandial triglyceride and insulin concentrations decreased significantly (p < 0.001), as did total cholesterol (from median 3.64 (IQR 3.34–4.89) to 3.48 (3.18–3.97) mmol/l, p = 0.008), LDL (from median 1.92 (IQR 1.49–2.30) to 1.79 (1.49–2.08 mmol/l, p = 0.044), and urine microalbumin (from median 7 (IQR 3–27) to 4 (3–8) mg/l, p = 0.018). All daytime blood pressure values decreased significantly. The ASCVD 10-year risk score decreased (from median 13.6 (IQR 5.7–26.0) to 11.5 (4.2–22.5) %, p = 0.030)) and the DIAL score increased (from median 82 (IQR 81–83) to 83 (81–84) years, (p = 0.039)). Discussion The combination of DMR and GLP-1RA to replace insulin therapy in patients with T2DM is associated with a positive effect on multiple parameters of cardiovascular health. Taken together, they show a pattern of overall improvement in cardiovascular health, as evidenced by decreased risk scores for cardiovascular complications. However, it is not yet clear whether these improvements will translate into a true reduction in cardiovascular events. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01628-z.
Collapse
Affiliation(s)
- S Meiring
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - C B E Busch
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - A C G van Baar
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands.
| | - R Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - F Holleman
- Department of Internal Medicine, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - M Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - J J G H M Bergman
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, location AMC, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Schinkel M, Boerman AW, Bennis FC, Minderhoud TC, Lie M, Peters-Sengers H, Holleman F, Schade RP, de Jonge R, Wiersinga WJ, Nanayakkara PWB. Diagnostic stewardship for blood cultures in the emergency department: A multicenter validation and prospective evaluation of a machine learning prediction tool. EBioMedicine 2022; 82:104176. [PMID: 35853298 PMCID: PMC9294655 DOI: 10.1016/j.ebiom.2022.104176] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/16/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background Overuse of blood cultures (BCs) in emergency departments (EDs) leads to low yields and high numbers of contaminated cultures, accompanied by increased diagnostics, antibiotic usage, prolonged hospitalization, and mortality. We aimed to simplify and validate a recently developed machine learning model to help safely withhold BC testing in low-risk patients. Methods We extracted data from the electronic health records (EHR) for 44.123 unique ED visits with BC sampling in the Amsterdam UMC (locations VUMC and AMC; the Netherlands), Zaans Medical Center (ZMC; the Netherlands), and Beth Israel Deaconess Medical Center (BIDMC; United States) in periods between 2011 and 2021. We trained a machine learning model on the VUMC data to predict blood culture outcomes and validated it in the AMC, ZMC, and BIDMC with subsequent real-time prospective evaluation in the VUMC. Findings The model had an Area Under the Receiver Operating Characteristics curve (AUROC) of 0.81 (95%-CI = 0.78–0.83) in the VUMC test set. The most important predictors were temperature, creatinine, and C-reactive protein. The AUROCs in the validation cohorts were 0.80 (AMC; 0.78–0.82), 0.76 (ZMC; 0.74–0.78), and 0.75 (BIDMC; 0.74–0.76). During real-time prospective evaluation in the EHR of the VUMC, it reached an AUROC of 0.76 (0.71–0.81) among 590 patients with BC draws in the ED. The prospective evaluation showed that the model can be used to safely withhold blood culture analyses in at least 30% of patients in the ED. Interpretation We developed a machine learning model to predict blood culture outcomes in the ED, which retained its performance during external validation and real-time prospective evaluation. Our model can identify patients at low risk of having a positive blood culture. Using the model in practice can significantly reduce the number of blood culture analyses and thus avoid the hidden costs of false-positive culture results. Funding This research project was funded by the Amsterdam Public Health – Quality of Care program and the Dutch “Doen of Laten” project (project number: 839205002).
Collapse
Affiliation(s)
- Michiel Schinkel
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Anneroos W Boerman
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Frank C Bennis
- Department of Computer Science, Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, VU University, De Boelelaan 1105, 1081HV Amsterdam, the Netherlands
| | - Tanca C Minderhoud
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Mei Lie
- Department of EVA Service Center, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; Department of EVA Service Center, Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Hessel Peters-Sengers
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Frits Holleman
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Rogier P Schade
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Amsterdam UMC, Vrije Universiteit Amsterdam, AGEM Research Institute, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Section Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Prabath W B Nanayakkara
- Section General Internal Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, location VU University Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands.
| |
Collapse
|
10
|
Meiring S, van Baar ACG, Sørensen N, Holleman F, Soeters MR, Nieuwdorp M, Bergman JJGHM. A Changed Gut Microbiota Diversity Is Associated With Metabolic Improvements After Duodenal Mucosal Resurfacing With Glucagon-Like-Peptide-1 Receptor Agonist in Type 2 Diabetes in a Pilot Study. Front Clin Diabetes Healthc 2022; 3:856661. [PMID: 36992788 PMCID: PMC10012157 DOI: 10.3389/fcdhc.2022.856661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/11/2022] [Indexed: 12/14/2022]
Abstract
IntroductionThe gut microbiota influences and interacts with the host metabolism through effects on nutrient metabolism and digestion. Duodenal Mucosal Resurfacing (DMR) is a novel endoscopic procedure involving duodenal mucosal ablation by the use of hydrothermal energy. DMR, when combined with a glucagon-like peptide-1 receptor agonist (GLP-1RA), resulted in discontinuation of exogenous insulin treatment in 69% of patients with insulin dependent type 2 diabetes mellitus (T2DM) in the INSPIRE study. These patients also experienced improved glycaemic control and metabolic health. We thus investigated if these clinical effects were associated with a change in gut microbiota alpha and beta diversity.MethodsFaecal samples from the 16 patients were obtained for Illumina shotgun sequencing at baseline and 3 months after DMR. We assessed alpha and beta diversity of the gut microbiota in these samples and analysed its correlations with changes in HbA1c, body weight, and liver MRI proton density fat fraction (PDFF).ResultsHbA1c correlated negatively with alpha diversity (p=0.011, rho: -0.62) whereas changes in PDFF correlated significantly with beta diversity (p=0.036, rho: 0.55) 3 months after initiation of the combined intervention. These correlations with metabolic parameters were observed despite finding no change in gut microbiota diversity at 3 months post DMR.DiscussionThe correlation between gut microbiota richness (alpha diversity) and HbA1c as well as the change in PDFF and changed microbiota composition (beta diversity) suggests that changed gut microbiota diversity is associated with metabolic improvements after DMR in combination with glucagon-like-peptide-1 receptor agonist in type 2 diabetes. Larger controlled studies are however needed to find causal links between DMR with GLP-1RA, the gut microbiota, and improvements in metabolic health.
Collapse
Affiliation(s)
- Suzanne Meiring
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Annieke C. G. van Baar
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Nikolaj Sørensen
- Scientific Operations Clinical Microbiomics, Copenhagen, Denmark
| | - Frits Holleman
- Internal Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Maarten R. Soeters
- Endocrinology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Max Nieuwdorp
- Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | - Jacques J. G. H. M. Bergman
- Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, Netherlands
- *Correspondence: Jacques J. G. H. M. Bergman,
| |
Collapse
|
11
|
van den Berk IAH, Kanglie MMNP, van Engelen TSR, Altenburg J, Annema JT, Beenen LFM, Boerrigter B, Bomers MK, Bresser P, Eryigit E, Groenink M, Hochheimer SMR, Holleman F, Kooter JAJ, van Loon RB, Keijzers M, van der Lee I, Luijendijk P, Meijboom LJ, Middeldorp S, Schijf LJ, Soetekouw R, Sprengers RW, Montauban van Swijndregt AD, de Monyé W, Ridderikhof ML, Winter MM, Bipat S, Dijkgraaf MGW, Bossuyt PMM, Prins JM, Stoker J. Ultra-low-dose CT versus chest X-ray for patients suspected of pulmonary disease at the emergency department: a multicentre randomised clinical trial. Thorax 2022; 78:515-522. [PMID: 35688623 PMCID: PMC10176343 DOI: 10.1136/thoraxjnl-2021-218337] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Chest CT displays chest pathology better than chest X-ray (CXR). We evaluated the effects on health outcomes of replacing CXR by ultra-low-dose chest-CT (ULDCT) in the diagnostic work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. METHODS Pragmatic, multicentre, non-inferiority randomised clinical trial in patients suspected of non-traumatic pulmonary disease at the emergency department. Between 31 January 2017 and 31 May 2018, every month, participating centres were randomly allocated to using ULDCT or CXR. Primary outcome was functional health at 28 days, measured by the Short Form (SF)-12 physical component summary scale score (PCS score), non-inferiority margin was set at 1 point. Secondary outcomes included hospital admission, hospital length of stay (LOS) and patients in follow-up because of incidental findings. RESULTS 2418 consecutive patients (ULDCT: 1208 and CXR: 1210) were included. Mean SF-12 PCS score at 28 days was 37.0 for ULDCT and 35.9 for CXR (difference 1.1; 95% lower CI: 0.003). After ULDCT, 638/1208 (52.7%) patients were admitted (median LOS of 4.8 days; IQR 2.1-8.8) compared with 659/1210 (54.5%) patients after CXR (median LOS 4.6 days; IQR 2.1-8.8). More ULDCT patients were in follow-up because of incidental findings: 26 (2.2%) versus 4 (0.3%). CONCLUSIONS Short-term functional health was comparable between ULDCT and CXR, as were hospital admissions and LOS, but more incidental findings were found in the ULDCT group. Our trial does not support routine use of ULDCT in the work-up of patients suspected of non-traumatic pulmonary disease at the emergency department. TRIAL REGISTRATION NUMBER NTR6163.
Collapse
Affiliation(s)
- Inge A H van den Berk
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Maadrika M N P Kanglie
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Tjitske S R van Engelen
- Department of Internal Medicine, division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Josje Altenburg
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jouke T Annema
- Department of Pulmonary Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Ludo F M Beenen
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Boerrigter
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marije K Bomers
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Paul Bresser
- Department of Pulmonary Medicine, OLVG, Amsterdam, The Netherlands
| | - Elvin Eryigit
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maarten Groenink
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Frits Holleman
- Department of Internal Medicine, division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jos A J Kooter
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ramon B van Loon
- Department of Cardiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mitran Keijzers
- Department of Cardiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Ivo van der Lee
- Department of Pulmonary Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Paul Luijendijk
- Department of Cardiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine, division of Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Laura J Schijf
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Robin Soetekouw
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Ralf W Sprengers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Wouter de Monyé
- Department of Radiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Milan L Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel M Winter
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Shandra Bipat
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology & Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Epidemiology & Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jan M Prins
- Department of Internal Medicine, division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
12
|
Schinkel M, Bergsma L, Veldhuis LI, Ridderikhof ML, Holleman F. Comparing complaint-based triage scales and early warning scores for emergency department triage. Emerg Med J 2022; 39:691-696. [PMID: 35418407 PMCID: PMC9411919 DOI: 10.1136/emermed-2021-211544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 03/25/2022] [Indexed: 12/28/2022]
Abstract
Background Emergency triage systems are used globally to prioritise care based on patients’ needs. These systems are commonly based on patient complaints, while the need for timely interventions on regular hospital wards is usually assessed with early warning scores (EWS). We aim to directly compare the ability of currently used triage scales and EWS scores to recognise patients in need of urgent care in the ED. Methods We performed a retrospective, single-centre study on all patients who presented to the ED of a Dutch Level 1 trauma centre, between 1 September 2018 and 24 June 2020 and for whom a Netherlands Triage System (NTS) score as well as a Modified Early Warning Score (MEWS) was recorded. The performance of these scores was assessed using surrogate markers for true urgency and presented using bar charts, cross tables and a paired area under the curve (AUC). Results We identified 12 317 unique patient visits where NTS and MEWS scores were documented during triage. A paired comparison of the AUC of these scores showed that the MEWS score had a significantly better AUC than the NTS for predicting the need for hospital admission (0.65 vs 0.60; p<0.001) or 30-day all-cause mortality (0.70 vs 0.60; p<0.001). Furthermore, when non-urgent MEWS scores co-occur with urgent NTS scores, the MEWS score seems to more accurately capture the urgency level that is warranted. Conclusions The results of this study suggest that EWSs could potentially be used to replace the current emergency triage systems.
Collapse
Affiliation(s)
- Michiel Schinkel
- Center for Experimental and Molecular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Lyfke Bergsma
- Internal Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | | | | | - Frits Holleman
- Internal Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| |
Collapse
|
13
|
van Baar ACG, Devière J, Hopkins D, Crenier L, Holleman F, Galvão Neto MP, Becerra P, Vignolo P, Rodriguez Grunert L, Mingrone G, Costamagna G, Nieuwdorp M, Guidone C, Haidry RJ, Hayee B, Magee C, Carlos Lopez-Talavera J, White K, Bhambhani V, Cozzi E, Rajagopalan H, J G H M Bergman J. Durable metabolic improvements 2 years after duodenal mucosal resurfacing (DMR) in patients with type 2 diabetes (REVITA-1 Study). Diabetes Res Clin Pract 2022; 184:109194. [PMID: 35032562 DOI: 10.1016/j.diabres.2022.109194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/28/2021] [Revised: 09/10/2021] [Accepted: 01/04/2022] [Indexed: 12/18/2022]
Abstract
AIMS Duodenal mucosal resurfacing (DMR) is an endoscopic procedure developed to improve metabolic parameters and restore insulin sensitivity in patients with diabetes. Here we report long-term DMR safety and efficacy from the REVITA-1 study. MATERIALS AND METHODS REVITA-1 was a prospective, single-arm, open-label, multicenter study of DMR feasibility, safety, and efficacy in patients with type 2 diabetes (hemoglobin A1c [HbA1c] of 7.5-10.0% (58-86 mmol/mol)) on oral medication. Safety and glycemic (HbA1c), hepatic (alanine aminotransferase [ALT]), and cardiovascular (HDL, triglyceride [TG]/HDL ratio) efficacy parameters were assessed (P values presented for LS mean change). RESULTS Mean ± SD HbA1c levels reduced from 8.5 ± 0.7% (69.1 ± 7.1 mmol/mol) at baseline (N = 34) to 7.5 ± 0.8% (58.9 ± 8.8 mmol/mol) at 6 months (P < 0.001); and this reduction was sustained through 24 months post-DMR (7.5 ± 1.1% [59.0 ± 12.3 mmol/mol], P < 0.001) while in greater than 50% of patients, glucose-lowering therapy was reduced or unchanged. ALT decreased from 38.1 ± 21.1 U/L at baseline to 32.5 ± 22.1 U/L at 24 months (P = 0.048). HDL and TG/HDL improved during 24-months of follow-up. No device- or procedure-related serious adverse events, unanticipated device effects, or hypoglycemic events were noted between 12 and 24 months post-DMR. CONCLUSIONS DMR is associated with durable improvements in insulin sensitivity and multiple downstream metabolic parameters through 24 months post-treatment in type 2 diabetes. Clinical trial reg. no. NCT02413567, clinicaltrials.gov.
Collapse
Affiliation(s)
- Annieke C G van Baar
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Jacques Devière
- Gastroenterology, Erasme UnCiversity Hospital, Brussels, Belgium
| | - David Hopkins
- Institute of Diabetes, Endocrinology, and Obesity, King's Health Partners, London, UK
| | - Laurent Crenier
- Department of Endocrinology, Erasme University Hospital, Brussels, Belgium
| | - Frits Holleman
- Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Pablo Becerra
- CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
| | - Paulina Vignolo
- CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
| | | | - Geltrude Mingrone
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - Guido Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Max Nieuwdorp
- Internal and Vascular Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | - Caterina Guidone
- Internal Medicine, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
| | - Rehan J Haidry
- Department of Gastroenterology, University College Hospital, London, UK
| | - Bu Hayee
- Institute of Diabetes, Endocrinology, and Obesity, King's Health Partners, London, UK
| | - Cormac Magee
- Department of Gastroenterology, University College Hospital, London, UK; Center for Obesity Research, Department of Medicine, University College London, London, UK
| | | | - Kelly White
- Fractyl Laboratories Inc, Lexington, MA, USA
| | | | - Emily Cozzi
- Fractyl Laboratories Inc, Lexington, MA, USA
| | | | - Jacques J G H M Bergman
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands.
| |
Collapse
|
14
|
Meiring S, Meessen ECE, van Baar ACG, Holleman F, Nieuwdorp M, Olde Damink SW, Schaap FG, Vaz FM, Groen AK, Soeters MR, Bergman JJGHM. Duodenal mucosal resurfacing with a GLP-1 receptor agonist increases postprandial unconjugated bile acids in patients with insulin-dependent type 2 diabetes. Am J Physiol Endocrinol Metab 2022; 322:E132-E140. [PMID: 34957857 PMCID: PMC8858668 DOI: 10.1152/ajpendo.00337.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Duodenal mucosal resurfacing (DMR) is a new endoscopic ablation technique aimed at improving glycemia and metabolic control in patients with type 2 diabetes mellitus (T2DM). DMR appears to improve insulin resistance, which is the root cause of T2DM, but its mechanism of action is largely unknown. Bile acids function as intestinal signaling molecules in glucose and energy metabolism via the activation of farnesoid X receptor and secondary signaling [e.g., via fibroblast growth factor 19 (FGF19)], and are linked to metabolic health. We investigated the effect of DMR and glucagon-like peptide-1 (GLP-1) on postprandial bile acid responses in 16 patients with insulin-dependent T2DM, using mixed meal tests performed at the baseline and 6 mo after the DMR procedure. The combination treatment allowed discontinuation of insulin treatment in 11/16 (69%) of patients while improving glycemic and metabolic health. We found increased postprandial unconjugated bile acid responses (all P < 0.05), an overall increased secondary bile acid response (P = 0.036) and a higher 12α-hydroxylated:non-12α-hydroxylated ratio (P < 0.001). Total bile acid concentrations were unaffected by the intervention. Postprandial FGF19 and 7-α-hydroxy-4-cholesten-3-one (C4) concentrations decreased postintervention (both P < 0.01). Our study demonstrates that DMR with GLP-1 modulates the postprandial bile acid response. The alterations in postprandial bile acid responses may be the result of changes in the microbiome, ileal bile acid uptake and improved insulin sensitivity. Controlled studies are needed to elucidate the mechanism linking the combination treatment to metabolic health and bile acids.NEW & NOTEWORTHY Glycemic and metabolic improvements are seen in patients with type 2 diabetes after replacing their insulin therapy with DMR and GLP-1. These changes are accompanied by changes in postprandial bile acid concentrations: increased unconjugated and secondary bile acids.
Collapse
Affiliation(s)
- Suzanne Meiring
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Emma C E Meessen
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Annieke C G van Baar
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frits Holleman
- Department of Internal Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Cardiovascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Steven W Olde Damink
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Frank G Schaap
- Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Fred M Vaz
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry and Pediatrics, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Core Facility Metabolomics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Albert K Groen
- Department of Cardiovascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Maarten R Soeters
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
15
|
van Baar ACG, Meiring S, Holleman F, Hopkins D, Mingrone G, Devière J, Nieuwdorp M, Bergman JJGHM. Alternative treatments for type 2 diabetes and associated metabolic diseases: medical therapy or endoscopic duodenal mucosal remodelling? Gut 2021; 70:2196-2204. [PMID: 34497147 PMCID: PMC8515106 DOI: 10.1136/gutjnl-2020-323931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Annieke C G van Baar
- Gastroenterology and Hepatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Suzanne Meiring
- Gastroenterology and Hepatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
| | - Geltrude Mingrone
- Internal Medicine, Universita Cattolica del Sacro Cuore, Rome, Italy,Diabetes, King's College London School of Medical Education, London, UK
| | - Jacques Devière
- Gastroenterology and Hepatopancreatology, Erasme University Hospital, Brussels, Belgium
| | - Max Nieuwdorp
- Vascular Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | | |
Collapse
|
16
|
van Baar ACG, Meiring S, Smeele P, Vriend T, Holleman F, Barlag M, Mostafavi N, Tijssen JGP, Soeters MR, Nieuwdorp M, Bergman JJGHM. Duodenal mucosal resurfacing combined with glucagon-like peptide-1 receptor agonism to discontinue insulin in type 2 diabetes: a feasibility study. Gastrointest Endosc 2021; 94:111-120.e3. [PMID: 33359437 DOI: 10.1016/j.gie.2020.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Received: 09/25/2020] [Accepted: 12/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Duodenal mucosal resurfacing (DMR) is an endoscopic intervention in which the duodenal mucosa is ablated by hydrothermal energy. DMR improves glycemic control in patients with type 2 diabetes (T2D), most likely by altered duodenal signaling leading to insulin sensitization. We studied whether we could discontinue insulin use in T2D patients by combining DMR with glucagon-like peptide-1 receptor agonist (GLP-1RA) and lifestyle counseling. METHODS In this single-arm, single-center feasibility study in 16 insulin-treated patients with T2D (hemoglobin A1c [HbA1c] ≤8.0%, basal insulin <1 U/kg/day, C-peptide ≥.5 nmol/L), patients underwent a single DMR followed by a 2-week postprocedural diet, after which GLP-1RA (liraglutide) was introduced. Lifestyle counseling was provided per American Diabetes Association guidelines. The primary endpoint was percentage of patients without insulin with an HbA1c ≤7.5% (responders) at 6 months. Secondary endpoints were changes in multiple glycemic and metabolic parameters and percentage of responders at 12 and 18 months, respectively. RESULTS All 16 patients underwent successful DMR without procedure-related serious adverse events. At 6 months, 69% of patients were off insulin therapy with an HbA1c ≤7.5%. At 12 and 18 months 56% and 53% remained off insulin, respectively. All patients significantly improved in the glycemic and metabolic parameters of homeostatic model assessment for insulin resistance, body mass index, weight, and liver fat fraction. CONCLUSIONS In this feasibility study, the combination of a single DMR and GLP-1RA, supported by lifestyle counseling, eliminated the need for insulin therapy in most patients with T2D through 18 months postprocedure, with adequate beta-cell capacity, while improving glucose regulation and metabolic health in all patients. A randomized-sham controlled trial is currently initiated based on these results. (Clinical trial registration number: EudraCT 2017-00349-30.).
Collapse
Affiliation(s)
- Annieke C G van Baar
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Suzanne Meiring
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Paul Smeele
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Tessa Vriend
- Department of Dietetics, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Frits Holleman
- Department of Internal Medicine, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Marjon Barlag
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Nahid Mostafavi
- Department of Statistics, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Jan G P Tijssen
- Department of Statistics, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Maarten R Soeters
- Department of Endocrinology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Academic Medical Centre, Amsterdam, the Netherlands
| | - Jacques J G H M Bergman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| |
Collapse
|
17
|
Laan BJ, Huiszoon WB, Holleman F, Boermeester MA, Kaasjager KAH, Geerlings SE. Patient education materials to implement choosing wisely recommendations for internal medicine at the emergency department. BMJ Open Qual 2021; 10:bmjoq-2020-000971. [PMID: 33547155 PMCID: PMC7871247 DOI: 10.1136/bmjoq-2020-000971] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 12/23/2020] [Accepted: 01/21/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Choosing Wisely aims to reduce low-value care to improve quality and lower costs. In the Netherlands, this campaign offers three recommendations for internal medicine applicable in emergency departments (EDs): (1) do not place an indwelling urinary catheter in non-critically ill patients who can void; (2) do not order plain abdominal radiographs in patients with acute abdominal pain; and (3) discuss whether treatment limitations are needed. This quality improvement project aims to increase the implementation of the recommendations by patient information leaflets. METHODS In a prospective before-after study, we collected data every other week during baseline and intervention periods (both 7 months) in two university medical centres. The primary outcomes were the adherence rates to the recommendations. RESULTS 805 patients visited the EDs for internal medicine, of whom 391 (48.6%) were hospitalised. Only 153 (19%) patients received the information leaflet. We found no change in implementation rates of the recommendations after the introduction of the patient information leaflet. In the baseline period, 28 patients received a urinary catheter, of whom 5 (17.9%) had no appropriate indication, compared with 4 (25.0%) of 16 patients in the intervention period (p=0.572). Unnecessary abdominal X-ray occurred once in the baseline period and not in the intervention period. Treatment limitations were not reported in 13 (6.5%) of 200 hospitalised patients in the baseline period, and in 17 (8.9%) of 191 patients in the intervention period (p=0.373). CONCLUSIONS Patient information leaflets did not increase the implementation of Choosing Wisely recommendations, which can be due to a high baseline rate and a poor dissemination of leaflets. Our ED seems not to be a practicable setting for dissemination of leaflets, since staff engagement was not possible due to high workload and shortage of qualified nursing staff in the Netherlands.
Collapse
Affiliation(s)
- Bart J Laan
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willemijn B Huiszoon
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frits Holleman
- Department of Internal Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Division of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Karin A H Kaasjager
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
18
|
de Groot P, Nikolic T, Pellegrini S, Sordi V, Imangaliyev S, Rampanelli E, Hanssen N, Attaye I, Bakker G, Duinkerken G, Joosten A, Prodan A, Levin E, Levels H, Potter van Loon B, van Bon A, Brouwer C, van Dam S, Simsek S, van Raalte D, Stam F, Gerdes V, Hoogma R, Diekman M, Gerding M, Rustemeijer C, de Bakker B, Hoekstra J, Zwinderman A, Bergman J, Holleman F, Piemonti L, De Vos W, Roep B, Nieuwdorp M. Faecal microbiota transplantation halts progression of human new-onset type 1 diabetes in a randomised controlled trial. Gut 2021; 70:92-105. [PMID: 33106354 PMCID: PMC7788262 DOI: 10.1136/gutjnl-2020-322630] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Type 1 diabetes (T1D) is characterised by islet autoimmunity and beta cell destruction. A gut microbiota-immunological interplay is involved in the pathophysiology of T1D. We studied microbiota-mediated effects on disease progression in patients with type 1 diabetes using faecal microbiota transplantation (FMT). DESIGN Patients with recent-onset (<6 weeks) T1D (18-30 years of age) were randomised into two groups to receive three autologous or allogenic (healthy donor) FMTs over a period of 4 months. Our primary endpoint was preservation of stimulated C peptide release assessed by mixed-meal tests during 12 months. Secondary outcome parameters were changes in glycaemic control, fasting plasma metabolites, T cell autoimmunity, small intestinal gene expression profile and intestinal microbiota composition. RESULTS Stimulated C peptide levels were significantly preserved in the autologous FMT group (n=10 subjects) compared with healthy donor FMT group (n=10 subjects) at 12 months. Small intestinal Prevotella was inversely related to residual beta cell function (r=-0.55, p=0.02), whereas plasma metabolites 1-arachidonoyl-GPC and 1-myristoyl-2-arachidonoyl-GPC levels linearly correlated with residual beta cell preservation (rho=0.56, p=0.01 and rho=0.46, p=0.042, respectively). Finally, baseline CD4 +CXCR3+T cell counts, levels of small intestinal Desulfovibrio piger and CCL22 and CCL5 gene expression in duodenal biopsies predicted preserved beta cell function following FMT irrespective of donor characteristics. CONCLUSION FMT halts decline in endogenous insulin production in recently diagnosed patients with T1D in 12 months after disease onset. Several microbiota-derived plasma metabolites and bacterial strains were linked to preserved residual beta cell function. This study provides insight into the role of the intestinal gut microbiome in T1D. TRIAL REGISTRATION NUMBER NTR3697.
Collapse
Affiliation(s)
- Pieter de Groot
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Tanja Nikolic
- Department of Internal Medicine, LUMC, Leiden, Zuid-Holland, The Netherlands
| | - Silvia Pellegrini
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Sordi
- Diabetes Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Sultan Imangaliyev
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Elena Rampanelli
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Nordin Hanssen
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Ilias Attaye
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Guido Bakker
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Gaby Duinkerken
- Department of Internal Medicine, LUMC, Leiden, Zuid-Holland, The Netherlands
| | - Antoinette Joosten
- Department of Internal Medicine, LUMC, Leiden, Zuid-Holland, The Netherlands
| | - Andrei Prodan
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Evgeni Levin
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Han Levels
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | | | - Arianne van Bon
- Internal Medicine, Rijnstate, Arnhem, Gelderland, The Netherlands
| | - Catherina Brouwer
- Internal Medicine, OLVG, Location Oost, Amsterdam, Noord-Holland, The Netherlands
| | - Sytze van Dam
- Internal Medicine, OLVG, Location Oost, Amsterdam, Noord-Holland, The Netherlands
| | - Suat Simsek
- Internal Medicine, North West Hospital Group, Alkmaar, Noord-Holland, The Netherlands
| | - Daniel van Raalte
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Frank Stam
- Internal Medicine, North West Hospital Group, Alkmaar, Noord-Holland, The Netherlands
| | - Victor Gerdes
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Roel Hoogma
- Internal Medicine, Groene Hart Hospital, Gouda, Zuid-Holland, The Netherlands
| | - Martin Diekman
- Internal Medicine, Deventer Hospital, Deventer, Overijssel, The Netherlands
| | - Martin Gerding
- Internal Medicine, Deventer Hospital, Deventer, Overijssel, The Netherlands
| | - Cees Rustemeijer
- Internal Medicine, Hospital Amstelland, Amstelveen, North Holland, The Netherlands
| | - Bernadette de Bakker
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Joost Hoekstra
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Aeilko Zwinderman
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Jacques Bergman
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Frits Holleman
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Lorenzo Piemonti
- Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Bart Roep
- Department of Internal Medicine, LUMC, Leiden, Zuid-Holland, The Netherlands,Department of Diabetes Immunology, Diabetes & Metabolism Research Institute at the Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Max Nieuwdorp
- Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| |
Collapse
|
19
|
van Daalen FV, Smeulers M, Bartels EJH, Holleman F, Visser CE, Geerlings SE. A healthcare failure mode and effect analysis to optimise the process of blood culture performance. Neth J Med 2020; 78:341-348. [PMID: 33380531] [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: 06/12/2023]
Abstract
BACKGROUND Blood cultures are essential diagnostic tools to identify pathogens in systemic infections. However, logistics of blood culture performance is often suboptimal. This study analyses the pre-analytic phase of blood culture processing through different types of risk assessments. METHODS We performed direct observations to gain in-depth knowledge of the root causes of suboptimal blood culture performance. These findings were summarised in a Bow-Tie chart. We then utilised a healthcare failure mode and effect analysis to prioritise failures per step in the process and to organise improvement activities. Finally, improvement actions were planned. RESULTS Not obtaining a second set of blood cultures in the logistics of blood culture performance had the highest priority for action. Several failure modes, including human and system factors, were identified. Improvement actions included training and clinical lessons for nurses in the emergency department, updating hospital search engines to ease identification of relevant protocols, and an evaluation of the workload at the emergency department. Failure modes caused by human factors appear easy to address, however changing human behaviour is challenging. CONCLUSIONS The analysis provided useful insight into the different steps in the logistics of blood culture performance and facilitated the organisation of actions focused on addressing the most urgent root causes.
Collapse
Affiliation(s)
- F V van Daalen
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | | |
Collapse
|
20
|
Rensink MJ, van Laarhoven HWM, Holleman F. Cocoon vaccination for influenza in patients with a solid tumor: a retrospective study. Support Care Cancer 2020; 29:3657-3666. [PMID: 33179137 PMCID: PMC7657941 DOI: 10.1007/s00520-020-05883-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
Purpose Oncological patients are susceptible to various severe viral infections, including influenza. Vaccinating oncological patients and their household contacts (“cocoon vaccination”) may protect these patients from contracting influenza. To understand the potential of cocoon vaccination in oncological patients, this study assesses the influenza vaccination status of oncological patients and their household contacts and their considerations regarding the vaccination. Methods In this retrospective study, oncological patients with a solid tumor were asked to fill in a questionnaire about their own and their household contacts’ influenza vaccination status in the influenza season of 2018–2019. Results Ninety-eight patients were included (response rate 88%). The influenza vaccination rates of oncological patients and their first household contacts were 43.9% and 44.9%, respectively. The majority of vaccinated patients and vaccinated first household contacts had been advised by their general practitioner to get the vaccination. A minority of the first household contacts reported getting vaccinated specifically because of the patient’s vulnerability. Unvaccinated patients and unvaccinated household contacts mainly believed the vaccination was unnecessary or were afraid of side effects. None of the included patients had been hospitalized with influenza. Conclusion The oncological patients’ and first household contacts’ vaccination rates in this study were lower than the vaccination rates of the general Dutch population of over 60 years old, possibly due to a lack of knowledge and misconceptions about the vaccination. Further research is required to establish whether cocoon vaccination can contribute to protecting oncological patients from contracting an influenza infection. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-020-05883-2.
Collapse
Affiliation(s)
- M J Rensink
- Department of Internal Medicine, Amsterdam University Medical Centers (UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - H W M van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers (UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - F Holleman
- Department of Internal Medicine, Amsterdam University Medical Centers (UMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
21
|
de Groot PF, Nikolic T, Imangaliyev S, Bekkering S, Duinkerken G, Keij FM, Herrema H, Winkelmeijer M, Kroon J, Levin E, Hutten B, Kemper EM, Simsek S, Levels JHM, van Hoorn FA, Bindraban R, Berkvens A, Dallinga-Thie GM, Davids M, Holleman F, Hoekstra JBL, Stroes ESG, Netea M, van Raalte DH, Roep BO, Nieuwdorp M. Oral butyrate does not affect innate immunity and islet autoimmunity in individuals with longstanding type 1 diabetes: a randomised controlled trial. Diabetologia 2020; 63:597-610. [PMID: 31915895 DOI: 10.1007/s00125-019-05073-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS The pathophysiology of type 1 diabetes has been linked to altered gut microbiota and more specifically to a shortage of intestinal production of the short-chain fatty acid (SCFA) butyrate, which may play key roles in maintaining intestinal epithelial integrity and in human and gut microbial metabolism. Butyrate supplementation can protect against autoimmune diabetes in mouse models. We thus set out to study the effect of oral butyrate vs placebo on glucose regulation and immune variables in human participants with longstanding type 1 diabetes. METHODS We administered a daily oral dose of 4 g sodium butyrate or placebo for 1 month to 30 individuals with longstanding type 1 diabetes, without comorbidity or medication use, in a randomised (1:1), controlled, double-blind crossover trial, with a washout period of 1 month in between. Participants were randomly allocated to the 'oral sodium butyrate capsules first' or 'oral placebo capsules first' study arm in blocks of five. The clinical investigator received blinded medication from the clinical trial pharmacy. All participants, people doing measurements or examinations, or people assessing the outcomes were blinded to group assignment. The primary outcome was a change in the innate immune phenotype (monocyte subsets and in vitro cytokine production). Secondary outcomes were changes in blood markers of islet autoimmunity (cell counts, lymphocyte stimulation indices and CD8 quantum dot assays), glucose and lipid metabolism, beta cell function (by mixed-meal test), gut microbiota and faecal SCFA. The data was collected at the Amsterdam University Medical Centers. RESULTS All 30 participants were analysed. Faecal butyrate and propionate levels were significantly affected by oral butyrate supplementation and butyrate treatment was safe. However, this modulation of intestinal SCFAs did not result in any significant changes in adaptive or innate immunity, or in any of the other outcome variables. In our discussion, we elaborate on this important discrepancy with previous animal work. CONCLUSIONS/INTERPRETATION Oral butyrate supplementation does not significantly affect innate or adaptive immunity in humans with longstanding type 1 diabetes. TRIAL REGISTRATION Netherlands Trial Register: NL4832 (www.trialregister.nl). DATA AVAILABILITY Raw sequencing data are available in the European Nucleotide Archive repository (https://www.ebi.ac.uk/ena/browse) under study PRJEB30292. FUNDING The study was funded by a Le Ducq consortium grant, a CVON grant, a personal ZONMW-VIDI grant and a Dutch Heart Foundation grant.
Collapse
Affiliation(s)
- Pieter F de Groot
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands.
| | - Tatjana Nikolic
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Sultan Imangaliyev
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Siroon Bekkering
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gaby Duinkerken
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Fleur M Keij
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Hilde Herrema
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Maaike Winkelmeijer
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Jeffrey Kroon
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Evgeni Levin
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Barbara Hutten
- Department of Epidemiology, Amsterdam University Medical Centers, Academic Medical Centre, Amsterdam, the Netherlands
| | - Elles M Kemper
- Clinical Pharmacy, Amsterdam University Medical Centers, Academic Medical Centre, Amsterdam, the Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Alkmaar Medical Center (MCA), Alkmaar, the Netherlands
| | - Johannes H M Levels
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Flora A van Hoorn
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Renuka Bindraban
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Alicia Berkvens
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Geesje M Dallinga-Thie
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Mark Davids
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Frits Holleman
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Joost B L Hoekstra
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Erik S G Stroes
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
| | - Mihai Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Department for Genomics & Immunoregulation, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
| | - Daniël H van Raalte
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, VU University Medical Centre, Amsterdam, the Netherlands
| | - Bart O Roep
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
- Department of Diabetes Immunology, Diabetes & Metabolism Research Institute at the Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Academic Medical Center, Meibergdreef 9, Room D3-316, 1105 AZ, Amsterdam, the Netherlands
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Centers, VU University Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
22
|
de Groot P, Scheithauer T, Bakker GJ, Prodan A, Levin E, Khan MT, Herrema H, Ackermans M, Serlie MJM, de Brauw M, Levels JHM, Sales A, Gerdes VE, Ståhlman M, Schimmel AWM, Dallinga-Thie G, Bergman JJGHM, Holleman F, Hoekstra JBL, Groen A, Bäckhed F, Nieuwdorp M. Donor metabolic characteristics drive effects of faecal microbiota transplantation on recipient insulin sensitivity, energy expenditure and intestinal transit time. Gut 2020; 69:502-512. [PMID: 31147381 PMCID: PMC7034343 DOI: 10.1136/gutjnl-2019-318320] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Bariatric surgery improves glucose metabolism. Recent data suggest that faecal microbiota transplantation (FMT) using faeces from postbariatric surgery diet-induced obese mice in germ-free mice improves glucose metabolism and intestinal homeostasis. We here investigated whether allogenic FMT using faeces from post-Roux-en-Y gastric bypass donors (RYGB-D) compared with using faeces from metabolic syndrome donors (METS-D) has short-term effects on glucose metabolism, intestinal transit time and adipose tissue inflammation in treatment-naïve, obese, insulin-resistant male subjects. DESIGN Subjects with metabolic syndrome (n=22) received allogenic FMT either from RYGB-D or METS-D. Hepatic and peripheral insulin sensitivity as well as lipolysis were measured at baseline and 2 weeks after FMT by hyperinsulinaemic euglycaemic stable isotope (2H2-glucose and 2H5-glycerol) clamp. Secondary outcome parameters were changes in resting energy expenditure, intestinal transit time, faecal short-chain fatty acids (SCFA) and bile acids, and inflammatory markers in subcutaneous adipose tissue related to intestinal microbiota composition. Faecal SCFA, bile acids, glycaemic control and inflammatory parameters were also evaluated at 8 weeks. RESULTS We observed a significant decrease in insulin sensitivity 2 weeks after allogenic METS-D FMT (median rate of glucose disappearance: from 40.6 to 34.0 µmol/kg/min; p<0.01). Moreover, a trend (p=0.052) towards faster intestinal transit time following RYGB-D FMT was seen. Finally, we observed changes in faecal bile acids (increased lithocholic, deoxycholic and (iso)lithocholic acid after METS-D FMT), inflammatory markers (decreased adipose tissue chemokine ligand 2 (CCL2) gene expression and plasma CCL2 after RYGB-D FMT) and changes in several intestinal microbiota taxa. CONCLUSION Allogenic FMT using METS-D decreases insulin sensitivity in metabolic syndrome recipients when compared with using post-RYGB-D. Further research is needed to delineate the role of donor characteristics in FMT efficacy in human insulin-resistant subjects. TRIAL REGISTRATION NUMBER NTR4327.
Collapse
Affiliation(s)
- Pieter de Groot
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Torsten Scheithauer
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Guido J Bakker
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Andrei Prodan
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Evgeni Levin
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Muhammad Tanweer Khan
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborgs Universitet, Gothenburg, Sweden
| | - Hilde Herrema
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Mariette Ackermans
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Mireille J M Serlie
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Maurits de Brauw
- Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Johannes H M Levels
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Amber Sales
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Victor E Gerdes
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Marcus Ståhlman
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborgs Universitet, Gothenburg, Sweden
| | - Alinda W M Schimmel
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Geesje Dallinga-Thie
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Jacques JGHM Bergman
- Department of Gastroenterology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Frits Holleman
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Joost B L Hoekstra
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Albert Groen
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Fredrik Bäckhed
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Goteborgs Universitet, Gothenburg, Sweden
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| |
Collapse
|
23
|
van Baar ACG, Holleman F, Crenier L, Haidry R, Magee C, Hopkins D, Rodriguez Grunert L, Galvao Neto M, Vignolo P, Hayee B, Mertens A, Bisschops R, Tijssen J, Nieuwdorp M, Guidone C, Costamagna G, Devière J, Bergman JJGHM. Endoscopic duodenal mucosal resurfacing for the treatment of type 2 diabetes mellitus: one year results from the first international, open-label, prospective, multicentre study. Gut 2020; 69:295-303. [PMID: 31331994 PMCID: PMC6984054 DOI: 10.1136/gutjnl-2019-318349] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/19/2019] [Accepted: 06/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The duodenum has become a metabolic treatment target through bariatric surgery learnings and the specific observation that bypassing, excluding or altering duodenal nutrient exposure elicits favourable metabolic changes. Duodenal mucosal resurfacing (DMR) is a novel endoscopic procedure that has been shown to improve glycaemic control in people with type 2 diabetes mellitus (T2D) irrespective of body mass index (BMI) changes. DMR involves catheter-based circumferential mucosal lifting followed by hydrothermal ablation of duodenal mucosa. This multicentre study evaluates safety and feasibility of DMR and its effect on glycaemia at 24 weeks and 12 months. METHODS International multicentre, open-label study. Patients (BMI 24-40) with T2D (HbA1c 59-86 mmol/mol (7.5%-10.0%)) on stable oral glucose-lowering medication underwent DMR. Glucose-lowering medication was kept stable for at least 24 weeks post DMR. During follow-up, HbA1c, fasting plasma glucose (FPG), weight, hepatic transaminases, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), adverse events (AEs) and treatment satisfaction were determined and analysed using repeated measures analysis of variance with Bonferroni correction. RESULTS Forty-six patients were included of whom 37 (80%) underwent complete DMR and 36 were finally analysed; in remaining patients, mainly technical issues were observed. Twenty-four patients had at least one AE (52%) related to DMR. Of these, 81% were mild. One SAE and no unanticipated AEs were reported. Twenty-four weeks post DMR (n=36), HbA1c (-10±2 mmol/mol (-0.9%±0.2%), p<0.001), FPG (-1.7±0.5 mmol/L, p<0.001) and HOMA-IR improved (-2.9±1.1, p<0.001), weight was modestly reduced (-2.5±0.6 kg, p<0.001) and hepatic transaminase levels decreased. Effects were sustained at 12 months. Change in HbA1c did not correlate with modest weight loss. Diabetes treatment satisfaction scores improved significantly. CONCLUSIONS In this multicentre study, DMR was found to be a feasible and safe endoscopic procedure that elicited durable glycaemic improvement in suboptimally controlled T2D patients using oral glucose-lowering medication irrespective of weight loss. Effects on the liver are examined further. TRIAL REGISTRATION NUMBER NCT02413567.
Collapse
Affiliation(s)
- Annieke C G van Baar
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Laurent Crenier
- Endocrinology, Erasme University Hospital, Brussels, Belgium
| | - Rehan Haidry
- Gastroenterology, University College Hospital, London, UK
| | - Cormac Magee
- Centre for Obesity Research, Department of Medicine, University College Hospital, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King’s Health Partners, London, UK
| | | | - Manoel Galvao Neto
- Bariatric Endoscopy Service, Gastro Obeso Center, Sao Paulo, Brazil,College of Medicine, Florida International University, Miami, Florida, USA
| | - Paulina Vignolo
- CCO Clinical Center for Diabetes, Obesity and Reflux, Santiago, Chile
| | | | - Ann Mertens
- Clinical and Experimental Endocrinology, Catholic University of Leuven, Leuven, Belgium
| | - Raf Bisschops
- Gastroenterology and Hepatology, Catholic University of Leuven, Leuven, Belgium
| | - Jan Tijssen
- Cardiology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Internal and Vascular Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Caterina Guidone
- Internal Medicine, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Catholic University, Gemelli University Hospital, Roma, Italy
| | - Jacques Devière
- Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Jacques J G H M Bergman
- Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
24
|
Kremers MNT, Zaalberg T, van den Ende ES, van Beneden M, Holleman F, Nanayakkara PWB, Haak HR. Patient's perspective on improving the quality of acute medical care: determining patient reported outcomes. BMJ Open Qual 2019; 8:e000736. [PMID: 31637327 PMCID: PMC6768353 DOI: 10.1136/bmjoq-2019-000736] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022] Open
Abstract
Rationale There is an increasing societal demand for quality assurance and transparency of medical care. The American National Academy of Medicine has determined patient centredness as a quality domain for improvement of healthcare. While many of the current quality indicators are disease specific, most emergency department (ED) patients present with undifferentiated complaints. Therefore, there is a need for generic outcome measures. Our objective was to determine relevant patient reported outcomes (PROs) for quality measurement of acute care. Methods We conducted semistructured interviews in patients ≥18 years presenting at the ED for internal medicine. Patients with a cognitive impairment or language barrier were excluded. Interviews were analysed using qualitative content analysis. Results Thirty patients were interviewed. Patients reported outcomes as relevant in five domains: relief of symptoms, understanding the diagnosis, presence and understanding of the diagnostic and/or therapeutic plan, reassurance and patient experiences. Experiences were often mentioned as relevant to the perceived quality of care and appeared to influence the domain reassurance. Conclusion We determined five domains of relevant PROs in acute care. These domains will be used for developing generic patient reported measures for acute care. The patients’ perspective will be incorporated in these measures with the ultimate aim of organising truly patient-centred care at the ED.
Collapse
Affiliation(s)
- Marjolein N T Kremers
- Faculty of Health Medicine and Life Sciences, and CAPHRI School for Public Health and Primary Care, Aging and Long Term care, Maastricht University, Maastricht, The Netherlands.,Internal Medicine, Máxima MC, Veldhoven/Eindhoven, The Netherlands
| | - Tessel Zaalberg
- Internal Medicine, Máxima MC, Veldhoven/Eindhoven, The Netherlands
| | - Eva S van den Ende
- Internal Medicine, Section Acute Medicine, Amsterdam UMC, Location VUMC, Amsterdam, The Netherlands
| | - Marlou van Beneden
- Internal Medicine, Section Acute Medicine, Amsterdam UMC, Location VUMC, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Prabath W B Nanayakkara
- Internal Medicine, Section Acute Medicine, Amsterdam UMC, Location VUMC, Amsterdam, The Netherlands
| | - Harm R Haak
- Faculty of Health Medicine and Life Sciences, and CAPHRI School for Public Health and Primary Care, Aging and Long Term care, Maastricht University, Maastricht, The Netherlands.,Internal Medicine, Máxima MC, Veldhoven/Eindhoven, The Netherlands
| |
Collapse
|
25
|
Özcan B, Rutters F, Snoek FJ, Roosendaal M, Sijbrands EJ, Elders PJM, Holleman F, Pijl H, Tack CJ, Abbink EJ, de Valk HW, Wolffenbuttel BHR, Stehouwer CDA, Schaper NC, Dekker JM, Schram MT. High Diabetes Distress Among Ethnic Minorities Is Not Explained by Metabolic, Cardiovascular, or Lifestyle Factors: Findings From the Dutch Diabetes Pearl Cohort. Diabetes Care 2018; 41:1854-1861. [PMID: 29945936 DOI: 10.2337/dc17-2181] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/17/2017] [Accepted: 05/20/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes distress among patients from ethnic minorities is still poorly understood. We investigated the association between ethnicity and diabetes distress among ethnic minority groups of people with type 2 diabetes in the Netherlands, focusing on the possible effects of glycemic control, lifestyle factors, cardiovascular risk factors, and diabetes complications. RESEARCH DESIGN AND METHODS Cross-sectional data from the Dutch Diabetes Pearl cohort included people with type 2 diabetes from primary, secondary, and tertiary diabetes care programs. We used the 20-item Problem Areas in Diabetes Survey (PAID) scale to assess diabetes distress; a score ≥40 is considered to represent high distress. Ethnicity was estimated on the basis of country of birth. Sociodemographic and lifestyle data were self-reported; cardiovascular and metabolic data were retrieved from medical charts. Logistic regression analysis determined the association between ethnicity and diabetes distress, with Caucasians as the reference group. RESULTS Diabetes distress scores and ethnicity were available for 4,191 people with type 2 diabetes: 3,684 were Caucasian, 83 were Asian, 51 were Moroccan, 92 were African, 134 were Latin American, 46 were Turkish, and 101 were Hindustani-Surinamese. Overall, participants in minority groups had worse health outcomes than those of Caucasian descent, and diabetes distress was more prevalent (ranging from 9.6 to 31.7%, compared with 5.8% among Caucasians), even after adjusting for age, sex, education level, alcohol use, smoking, BMI, lipid profile, HbA1c, medication use, and the presence of diabetes complications. CONCLUSIONS Among people with type 2 diabetes in the Netherlands, ethnicity is independently associated with high diabetes distress. Further research is warranted to explain the higher prevalence of diabetes distress in minority groups and to develop effective interventions.
Collapse
Affiliation(s)
- Behiye Özcan
- Erasmus Medical Center, Rotterdam, the Netherlands
| | - Femke Rutters
- VU University Medical Center, Amsterdam, the Netherlands
| | - Frank J Snoek
- VU University Medical Center, Amsterdam, the Netherlands.,Academic Medical Center, Amsterdam, the Netherlands
| | - Mandy Roosendaal
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | | | | | | | - Hanno Pijl
- Leiden University Medical Center, Leiden, the Netherlands
| | - Cees J Tack
- Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | | | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Nicholas C Schaper
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | | | - Miranda T Schram
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | | |
Collapse
|
26
|
van der Woude SW, van Doormaal FF, Hutten BA, J Nellen F, Holleman F. Classifying sepsis patients in the emergency department using SIRS, qSOFA or MEWS. Neth J Med 2018; 76:158-166. [PMID: 29845938] [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: 06/08/2023]
Abstract
OBJECTIVE To determine the effect of qSOFA and SOFA compared with the MEWS and SIRS criteria on the classification of emergency department (ED) patients with an infection as having sepsis. METHODS A retrospective single-centre study was performed in a random sample of 600 medical patients who visited the ED of the Academic Medical Centre Amsterdam between 1 November 2015 and 1 November 2016. Data for the different sepsis scores, as well as general data and demographics were retrieved. Descriptive analytics and sensitivity/specificity analysis were used to evaluate the performance of the different sepsis tools. RESULTS Of 577 evaluable medical patients, 198 patients (34.3%) had a probable infection. The SIRS sepsis criteria, severe sepsis criteria, MEWS ≥ 5 and qSOFA criteria classified 141/198 (71.2%), 55/198 (27.8%), 58/198 (29.3%) and 17/198 patients (8.6%) respectively, as septic. The in-hospital mortality of patients classified as septic by the SIRS and qSOFA score was 6.4% and 29.4%. The qSOFA and SIRS score of ≥ 2 had a specificity of 93.7% (95% CI: 91.3-95.6) and 56.9% (52.7-61.1) in predicting in-hospital mortality. CONCLUSION No major differences in gender, age, comorbidity and site of infection between patients with sepsis or severe sepsis classified by the SIRS, qSOFA criteria or MEWS of ≥ 5 were found. The qSOFA criteria classifies a smaller group of patients as septic compared with the SIRS or MEWS. Due to this strict selection, the qSOFA score seems unsuitable as a bedside tool in the work-up and treatment of sepsis at the ED.
Collapse
Affiliation(s)
- S W van der Woude
- Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | |
Collapse
|
27
|
Affiliation(s)
| | - Max Nieuwdorp
- Academic Medical Center and VUMC Free University, Amsterdam, the Netherlands and University of Gothenburg, Gothenburg, Sweden
| | | | | | - Albert K Groen
- Academic Medical Center Amsterdam and University Medical Center Groningen, Amsterdam, the Netherlands
| | | |
Collapse
|
28
|
Alam N, Oskam E, Stassen PM, Exter PV, van de Ven PM, Haak HR, Holleman F, Zanten AV, Leeuwen-Nguyen HV, Bon V, Duineveld BAM, Nannan Panday RS, Kramer MHH, Nanayakkara PWB, Alam N, Nanayakkara P, Oskam E, Stassen P, Haak H, Holleman F, Nannan Panday R, Duineveld B, van Exter P, van de Ven P, Bon V, Goselink J, De Kreek A, van Grunsven P, Biekart M, Deddens G, Weijschede F, Rijntjes N, Franschman G, Janssen J, Frenken J, Versluis J, Boomars R, de Vries G, den Boer E, van Gent A, Willeboer M, Buunk G, Timmers G, Snijders F, Posthuma N, Stoffelen S, Claassens S, Ammerlaan H, Sankatsing S, Frenken J, Alsma J, van Zanten A, Slobbe L, de Melo M, Dees A, Carels G, Wabbijn M, van Leeuwen-Nguyen T, Assink J, van der Honing A, Luik P, Poortvliet W, Schouten W, Veenstra J, Holkenborg J, Cheung T, van Bokhorst J, Kors B, Louis- Wattel G, Roeleveld T, Toorians A, Jellema W, Govers A, Kaasjager H, Dekker D, Verhoeven M, Kramer M, Flietstra T, Roest L, Peters E, Hekker T, Ang W, van der Wekken W, Ghaem Maghami P, Kanen B, Wesselius H, Heesterman L, Zwietering A, Stoffers J. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet Respiratory Medicine 2018; 6:40-50. [DOI: 10.1016/s2213-2600(17)30469-1] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/22/2017] [Accepted: 10/25/2017] [Indexed: 11/29/2022]
|
29
|
de Groot PF, Belzer C, Aydin Ö, Levin E, Levels JH, Aalvink S, Boot F, Holleman F, van Raalte DH, Scheithauer TP, Simsek S, Schaap FG, Olde Damink SWM, Roep BO, Hoekstra JB, de Vos WM, Nieuwdorp M. Distinct fecal and oral microbiota composition in human type 1 diabetes, an observational study. PLoS One 2017; 12:e0188475. [PMID: 29211757 PMCID: PMC5718513 DOI: 10.1371/journal.pone.0188475] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [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] [Received: 07/31/2017] [Accepted: 11/07/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Environmental factors driving the development of type 1 diabetes (T1D) are still largely unknown. Both animal and human studies have shown an association between altered fecal microbiota composition, impaired production of short-chain fatty acids (SCFA) and T1D onset. However, observational evidence on SCFA and fecal and oral microbiota in adults with longstanding T1D vs healthy controls (HC) is lacking. RESEARCH DESIGN AND METHODS We included 53 T1D patients without complications or medication and 50 HC matched for age, sex and BMI. Oral and fecal microbiota, fecal and plasma SCFA levels, markers of intestinal inflammation (fecal IgA and calprotectin) and markers of low-grade systemic inflammation were measured. RESULTS Oral microbiota were markedly different in T1D (eg abundance of Streptococci) compared to HC. Fecal analysis showed decreased butyrate producing species in T1D and less butyryl-CoA transferase genes. Also, plasma levels of acetate and propionate were lower in T1D, with similar fecal SCFA. Finally, fecal strains Christensenella and Subdoligranulum correlated with glycemic control, inflammatory parameters and SCFA. CONCLUSIONS We conclude that T1D patients harbor a different amount of intestinal SCFA (butyrate) producers and different plasma acetate and propionate levels. Future research should disentangle cause and effect and whether supplementation of SCFA-producing bacteria or SCFA alone can have disease-modifying effects in T1D.
Collapse
Affiliation(s)
- Pieter F. de Groot
- Department of Internal and Vascular Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| | - Clara Belzer
- Laboratory of Microbiology, Wageningen University, Wageningen, the Netherlands
| | - Ömrüm Aydin
- Department of Internal and Vascular Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| | - Evgeni Levin
- Department of Internal and Vascular Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| | - Johannes H. Levels
- Department of Internal and Vascular Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| | - Steven Aalvink
- Laboratory of Microbiology, Wageningen University, Wageningen, the Netherlands
| | - Fransje Boot
- Department of Internal and Vascular Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| | - Frits Holleman
- Department of Internal and Vascular Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| | - Daniël H. van Raalte
- Department of Internal medicine, VU University Medical Center, Amsterdam, The Netherlands
- ICAR, VU University Medical Center, Amsterdam, The Netherlands
| | - Torsten P. Scheithauer
- Department of Internal and Vascular Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
- Department of Internal medicine, VU University Medical Center, Amsterdam, The Netherlands
- ICAR, VU University Medical Center, Amsterdam, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, Medisch Centrum Alkmaar, Alkmaar, the Netherlands
| | - Frank G. Schaap
- Department of Surgery, Maastricht University, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | | | - Bart O. Roep
- Department of Immunohaematology & Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
- Beckman Research Institute, DMRI, City of Hope, Duarte, CA, United States of America
| | - Joost B. Hoekstra
- Department of Internal and Vascular Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
| | - Willem M. de Vos
- Laboratory of Microbiology, Wageningen University, Wageningen, the Netherlands
- RPU Immunobiology, University of Helsinki, Helsinki, Finland
| | - Max Nieuwdorp
- Department of Internal and Vascular Medicine, Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
- Department of Internal medicine, VU University Medical Center, Amsterdam, The Netherlands
- ICAR, VU University Medical Center, Amsterdam, The Netherlands
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
30
|
Udayappan SD, Kovatcheva-Datchary P, Bakker GJ, Havik SR, Herrema H, Cani PD, Bouter KE, Belzer C, Witjes JJ, Vrieze A, de Sonnaville N, Chaplin A, van Raalte DH, Aalvink S, Dallinga-Thie GM, Heilig HGHJ, Bergström G, van der Meij S, van Wagensveld BA, Hoekstra JBL, Holleman F, Stroes ESG, Groen AK, Bäckhed F, de Vos WM, Nieuwdorp M. Intestinal Ralstonia pickettii augments glucose intolerance in obesity. PLoS One 2017; 12:e0181693. [PMID: 29166392 PMCID: PMC5699813 DOI: 10.1371/journal.pone.0181693] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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] [Received: 01/13/2017] [Accepted: 07/04/2017] [Indexed: 01/07/2023] Open
Abstract
An altered intestinal microbiota composition has been implicated in the pathogenesis of metabolic disease including obesity and type 2 diabetes mellitus (T2DM). Low grade inflammation, potentially initiated by the intestinal microbiota, has been suggested to be a driving force in the development of insulin resistance in obesity. Here, we report that bacterial DNA is present in mesenteric adipose tissue of obese but otherwise healthy human subjects. Pyrosequencing of bacterial 16S rRNA genes revealed that DNA from the Gram-negative species Ralstonia was most prevalent. Interestingly, fecal abundance of Ralstonia pickettii was increased in obese subjects with pre-diabetes and T2DM. To assess if R. pickettii was causally involved in development of obesity and T2DM, we performed a proof-of-concept study in diet-induced obese (DIO) mice. Compared to vehicle-treated control mice, R. pickettii-treated DIO mice had reduced glucose tolerance. In addition, circulating levels of endotoxin were increased in R. pickettii-treated mice. In conclusion, this study suggests that intestinal Ralstonia is increased in obese human subjects with T2DM and reciprocally worsens glucose tolerance in DIO mice.
Collapse
Affiliation(s)
| | - Petia Kovatcheva-Datchary
- Wallenberg Laboratory, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Guido J. Bakker
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Stefan R. Havik
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Hilde Herrema
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail: (MN); (HH)
| | - Patrice D. Cani
- Université catholique de Louvain, WELBIO (Walloon Excellence in Life sciences and BIOtechnology), Louvain Drug Research Institute, Brussels, Belgium
| | - Kristien E. Bouter
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Clara Belzer
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
| | - Julia J. Witjes
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Anne Vrieze
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Noor de Sonnaville
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Alice Chaplin
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Daniel H. van Raalte
- Diabetes Center, Department of Internal medicine, VU University Medical Center, Amsterdam, The Netherlands
- ICAR, VU University Medical Center, Amsterdam, The Netherlands
| | - Steven Aalvink
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
| | | | | | - Göran Bergström
- Wallenberg Laboratory, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Joost B. L. Hoekstra
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Frits Holleman
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Erik S. G. Stroes
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Albert K. Groen
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Fredrik Bäckhed
- Wallenberg Laboratory, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Receptology and Enteroendocrinology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Willem M. de Vos
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
- RPU Immunobiology, University of Helsinki, Helsinki, Finland
| | - Max Nieuwdorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Wallenberg Laboratory, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Diabetes Center, Department of Internal medicine, VU University Medical Center, Amsterdam, The Netherlands
- ICAR, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail: (MN); (HH)
| |
Collapse
|
31
|
Rutte A, Rauh SP, Schram MT, Nijpels G, DeVries JH, Holleman F, Pijl H, Dekkers OM, Özcan B, Sijbrands EJG, Tack CJ, Abbink EJ, de Valk HW, Silvius B, Wolffenbuttel BHR, Stehouwer CDA, Schaper NC, Dekker JM, Beulens JW, Elders PJM, Rutters F. Individual and partner's level of occupation and the association with HbA 1c levels in people with Type 2 diabetes mellitus: the Dutch Diabetes Pearl cohort. Diabet Med 2017; 34:1623-1628. [PMID: 28703888 DOI: 10.1111/dme.13422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Abstract
AIMS Individual indicators of socio-economic status have been associated with glycaemic control in people with Type 2 diabetes, but little is known about the association between partner's socio-economic status and HbA1c levels. We therefore examined the cross-sectional association between individual and partner's level of occupation on HbA1c levels in people with Type 2 diabetes in the Netherlands. METHODS We included people with Type 2 diabetes with a partner who were treated in primary, secondary and tertiary care in the Diabetes Pearl cohort. Occupational level was classified according to International Standard Classification of Occupations (ISCO)-08 skill levels. Linear regression analyses were performed stratified for sex, and corrected for age, recruitment centre and diabetes medication. RESULTS In total, 3257 participants (59.8% men, mean 62.2±9.4 years) were included. For men, having a partner with an intermediate level of occupation was associated with lower HbA1c levels [e.g. ISCO level 3: -2 mmol/mol (95% CI -4;-1) or -0.2% (95% CI -0.4;-0.1)], compared with having a partner of the highest occupational level (ISCO level 4). In women, having an unemployed partner was associated with higher HbA1c levels [14 mmol/mol (95% CI 6; 22) or 1.3% (95% CI 0.6; 2.0)], compared with having a partner of the highest occupational level. CONCLUSIONS Partner's occupational status provided additional information on the association between socio-economic status and HbA1c levels in people with Type 2 diabetes. Women seemed to benefit from a partner with a higher occupational status, while men seemed to benefit from a partner with a lower status. Because of the cross-sectional nature of the present study, more research is necessary to explore this association.
Collapse
Affiliation(s)
- A Rutte
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - S P Rauh
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - M T Schram
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - G Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - J H DeVries
- Department of Internal Medicine, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - F Holleman
- Department of Internal Medicine, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - H Pijl
- Department of Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands
| | - O M Dekkers
- Department of Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, The Netherlands
| | - B Özcan
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - E J G Sijbrands
- Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C J Tack
- Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E J Abbink
- Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - H W de Valk
- Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - B Silvius
- Department of Internal Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - B H R Wolffenbuttel
- Department of Endocrinology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - C D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - N C Schaper
- Department of Endocrinology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J M Dekker
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - J W Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - F Rutters
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
32
|
Bahler L, Holleman F, Verberne HJ. Reply to: Activation and quantification of human brown adipose tissue: Methodological considerations for between studies comparisons. Eur J Intern Med 2017; 41:e41-e42. [PMID: 28279565 DOI: 10.1016/j.ejim.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Lonneke Bahler
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
| | - Frits Holleman
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Hein J Verberne
- Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
33
|
Bahler L, Holleman F, Chan MW, Booij J, Hoekstra JB, Verberne HJ. 18F-FDG uptake in the colon is modulated by metformin but not associated with core body temperature and energy expenditure. PLoS One 2017; 12:e0176242. [PMID: 28464031 PMCID: PMC5413044 DOI: 10.1371/journal.pone.0176242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/06/2017] [Indexed: 12/30/2022] Open
Abstract
Purpose Physiological colonic 18F-fluorodeoxyglucose (18F-FDG) uptake is a frequent finding on 18F-FDG positron emission tomography computed tomography (PET-CT). Interestingly, metformin, a glucose lowering drug associated with moderate weight loss, is also associated with an increased colonic 18F-FDG uptake. Consequently, increased colonic glucose use might partly explain the weight losing effect of metformin when this results in an increased energy expenditure and/or core body temperature. Therefore, we aimed to determine whether metformin modifies the metabolic activity of the colon by increasing glucose uptake. Methods In this open label, non-randomized, prospective mechanistic study, we included eight lean and eight overweight males. We measured colonic 18F-FDG uptake on PET-CT, energy expenditure and core body temperature before and after the use of metformin. The maximal colonic 18F-FDG uptake was measured in 5 separate segments (caecum, colon ascendens,—transversum,—descendens and sigmoid). Results The maximal colonic 18F-FDG uptake increased significantly in all separate segments after the use of metformin. There was no significant difference in energy expenditure or core body temperature after the use of metformin. There was no correlation between maximal colonic 18F-FDG uptake and energy expenditure or core body temperature. Conclusion Metformin significantly increases colonic 18F-FDG uptake, but this increased uptake is not associated with an increase in energy expenditure or core body temperature. Although the colon might be an important site of the glucose plasma lowering actions of metformin, this mechanism of action does not explain directly any associated weight loss.
Collapse
Affiliation(s)
- Lonneke Bahler
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Frits Holleman
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Man-Wai Chan
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Booij
- Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Joost B. Hoekstra
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Hein J. Verberne
- Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Alsma J, van Saase JL, Nanayakkara PW, Schouten WEMI, Baten A, Bauer MP, Holleman F, Ligtenberg JJ, Stassen PM, Kaasjager KH, Haak HR, Bosch FH, Schuit SC, Arends JJ, Buunk G, Veldman BJ, Ammerlaan HS, Sankatsing SU, Jacobs EM, van Bemmel T, Ruiter R, Bots EM, Reuters RA, Carels G, Diepeveen SH, Heitz AFN, Hien van Leeuwen-Nguyen T, Keurlings PA, Barnhard R, Schreurs RH, ter Avest E, Brink HS, van Kinschot CM, van der Hoeven N, van der Zijden MA, Hageman IM, Roeleveld TC, Klomp CM, Dekker D, Blom A, Wesselius HM, van Bemmel MM, de Jong B, Hillen J, Langbroek GB, de Bie S. The Power of Flash Mob Research. Chest 2017; 151:1106-1113. [DOI: 10.1016/j.chest.2016.11.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/12/2016] [Accepted: 11/23/2016] [Indexed: 11/17/2022] Open
|
35
|
Bahler L, Holleman F, Booij J, Hoekstra JB, Verberne HJ. Hot heads & cool bodies: The conundrums of human brown adipose tissue (BAT) activity research. Eur J Intern Med 2017; 40:26-29. [PMID: 28065662 DOI: 10.1016/j.ejim.2016.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 09/09/2016] [Revised: 11/07/2016] [Accepted: 12/30/2016] [Indexed: 10/20/2022]
Abstract
Brown adipose tissue is able to increase energy expenditure by converting glucose and fatty acids into heat. Therefore, BAT is able to increase energy expenditure and could thereby facilitate weight loss or at least weight maintenance. Since cold is a strong activator of BAT, most prospective research is performed during cold to activate BAT. In current research, there are roughly two methods of cooling. Cooling by lowering ambient air temperature, which uses a fixed temperature for all subjects and personalized cooling, which uses cooling blankets or vests with temperatures that can be adjusted to the individual set point of shivering. These methods might trigger mechanistically different cold responses and hence result in a different BAT activation. This hypothesis is underlined by two studies with the same research question (difference in BAT activity between Caucasians and South Asians) one study found no differences in BAT activity whereas the other did found differences in BAT activity. Since most characteristics (e.g. age, BMI) were similar in the two studies, the best explanation for the differences in outcomes is the use of different cooling protocols. One of the reasons for differences in outcomes might be the sensory input from the facial skin, which might be important for the activation of BAT. In this review we will elaborate on the differences between the two cooling protocols used to activate BAT.
Collapse
Affiliation(s)
- Lonneke Bahler
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
| | - Frits Holleman
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Booij
- Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Joost B Hoekstra
- Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Hein J Verberne
- Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
36
|
Bahler L, Verberne H, Soeters M, Booij J, Hoekstra J, Holleman F. Dopaminergic Effects on Brown Adipose Tissue (DEBAT): A prospective physiological study. Diabetes & Metabolism 2017; 43:172-175. [DOI: 10.1016/j.diabet.2016.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
|
37
|
Boerlage TCC, Acherman YIZ, Houweling ST, Holleman F, Gerdes VEA. [Bariatric surgery: who, when and where?; an overview for the referring physician]. Ned Tijdschr Geneeskd 2017; 161:D1249. [PMID: 28745245] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
- Bariatric surgery is performed in patients with a body mass index (BMI) > 40kg/m2, or BMI > 35 kg/m2 with obesity-related comorbidities. The Roux-en-Y gastric bypass and sleeve gastrectomy are the most frequently used procedures.- On average, patients have lost 25-27% of their original weight 10 years after surgery.- Obesity-related comorbidities improve dramatically in many patients following surgery. The effect is most noticeable in patients with diabetes mellitus type 2 and obstructive sleep apnoea syndrome. - The prevalence of 30-day complications is < 5%. Mortality is < 0.2% in centres with a lot of experience. - Commonly occurring long-term complications of bariatric surgery include deficiencies, particularly of iron and vitamin B12, along with gallstone disease and sagging skin. - Specific complications can arise following Roux-en-Y gastric bypass, such as internal herniation and hypoglycaemia, and these are often not recognised.
Collapse
|
38
|
Bahler L, Holleman F, Verberne HJ. An old male with multiple hotspots on 18F-FDG PET-CT. Neth J Med 2017; 75:43. [PMID: 28124674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
39
|
Bahler L, Verberne HJ, Brakema E, Tepaske R, Booij J, Hoekstra JB, Holleman F. Bromocriptine and insulin sensitivity in lean and obese subjects. Endocr Connect 2016; 5:44-52. [PMID: 27758845 PMCID: PMC5097144 DOI: 10.1530/ec-16-0051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/10/2016] [Indexed: 01/18/2023]
Abstract
Bromocriptine is a glucose-lowering drug, which was shown to be effective in obese subjects with insulin resistance. It is usually administered in the morning. The exact working mechanism of bromocriptine still has to be elucidated. Therefore, in this open-label randomized prospective cross-over mechanistic study, we assessed whether the timing of bromocriptine administration (morning vs evening) results in different effects and whether these effects differ between lean and obese subjects. We studied the effect of bromocriptine on insulin sensitivity in 8 lean and 8 overweight subjects using an oral glucose tolerance test. The subjects used bromocriptine in randomized cross-over order for 2 weeks in the morning and 2 weeks in the evening. We found that in lean subjects, bromocriptine administration in the evening resulted in a significantly higher post-prandial insulin sensitivity as compared with the pre-exposure visit (glucose area under the curve (AUC) 742 mmol/L * 120 min (695-818) vs 641 (504-750), P = 0.036, AUC for insulin did not change, P = 0.575). In obese subjects, both morning and evening administration of bromocriptine resulted in a significantly higher insulin sensitivity: morning administration in obese: insulin AUC (55,900 mmol/L * 120 min (43,236-96,831) vs 36,448 (25,213-57,711), P = 0.012) and glucose AUC P = 0.069; evening administration in obese: glucose AUC (735 mmol/L * 120 min (614-988) vs 644 (568-829), P = 0.017) and insulin AUC, P = 0.208. In conclusion, bromocriptine increases insulin sensitivity in both lean and obese subjects. In lean subjects, this effect only occurred when bromocriptine was administrated in the evening, whereas in the obese, insulin sensitivity increased independent of the timing of bromocriptine administration.
Collapse
Affiliation(s)
- L Bahler
- Internal MedicineAcademic Medical Center, Amsterdam, The Netherlands
| | - H J Verberne
- Nuclear MedicineAcademic Medical Center, Amsterdam, The Netherlands
| | - E Brakema
- Internal MedicineAcademic Medical Center, Amsterdam, The Netherlands
| | - R Tepaske
- Intensive Care MedicineAcademic Medical Center, Amsterdam, The Netherlands
| | - J Booij
- Nuclear MedicineAcademic Medical Center, Amsterdam, The Netherlands
| | - J B Hoekstra
- Internal MedicineAcademic Medical Center, Amsterdam, The Netherlands
| | - F Holleman
- Internal MedicineAcademic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
40
|
Bahler L, Deelen JW, Hoekstra JB, Holleman F, Verberne HJ. Seasonal influence on stimulated BAT activity in prospective trials: a retrospective analysis of BAT visualized on 18F-FDG PET-CTs and 123I-mIBG SPECT-CTs. J Appl Physiol (1985) 2016; 120:1418-23. [DOI: 10.1152/japplphysiol.00008.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/11/2016] [Indexed: 12/31/2022] Open
Abstract
Retrospective studies have shown that outdoor temperature influences the prevalence of detectable brown adipose tissue (BAT). Prospective studies use acute cold exposure to activate BAT. In prospective studies, BAT might be preconditioned in winter months leading to an increased BAT response to various stimuli. Therefore the aim of this study was to assess whether outdoor temperatures and other weather characteristics modulate the response of BAT to acute cold. To assess metabolic BAT activity and sympathetic outflow to BAT, 64 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) and 56 additional 123I- meta-iodobenzylguanidine (123I- mIBG) single-photon emission computed tomography-CT (SPECT-CT) scans, respectively, of subjects participating in previously executed trials were retrospectively included. BAT activity was measured in subjects after an overnight fast, following 2 h of cold exposure (∼17°C). The average daytime outdoor temperatures and other weather characteristics were obtained from the Dutch Royal Weather Institute. Forty-nine subjects were BAT positive. One week prior to the scan, outdoor temperature was significantly lower in the BAT-positive group compared with the BAT-negative group. Higher outdoor temperatures on preceding days resulted in lower stimulated metabolic BAT activity and volume (all P < 0.01). Outdoor temperatures did not correlate with sympathetic outflow to BAT. In conclusion, outdoor temperatures influence metabolic BAT activity and volume, but not sympathetic outflow to BAT, in subjects exposed to acute cold. To improve the consistency of the findings of future BAT studies in humans and to exclude bias introduced by outdoor temperatures, these studies should be planned in periods of similar outdoor temperatures.
Collapse
Affiliation(s)
- Lonneke Bahler
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands; and
| | - Jan W. Deelen
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands; and
| | - Joost B. Hoekstra
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands; and
| | - Frits Holleman
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands; and
| | - Hein J. Verberne
- Department of Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
41
|
Polderman JAW, de Groot FA, Zamanbin A, Hollmann MW, Holleman F, Preckel B, Hermanides J. An automated reminder for perioperative glucose regulation improves protocol compliance. Diabetes Res Clin Pract 2016; 116:80-2. [PMID: 27321319 DOI: 10.1016/j.diabres.2016.04.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/03/2016] [Accepted: 04/15/2016] [Indexed: 11/17/2022]
Abstract
A growing proportion of patients presenting for surgery have diabetes. Unfortunately, perioperative diabetes protocol compliance is low. Using digitalization of the perioperative environment, an automated reminder in the preoperative assessment platform proved to increase compliance and we advocate its use throughout the perioperative process.
Collapse
Affiliation(s)
| | - Fleur A de Groot
- Department of Anesthesiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Alaleh Zamanbin
- Department of Anesthesiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology and Laboratory of Experimental Intensive Care and Anesthesiology L.E.I.C.A., Academic Medical Centre, Amsterdam, The Netherlands
| | - Frits Holleman
- Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Benedikt Preckel
- Department of Anesthesiology and Laboratory of Experimental Intensive Care and Anesthesiology L.E.I.C.A., Academic Medical Centre, Amsterdam, The Netherlands
| | - Jeroen Hermanides
- Department of Anesthesiology, Academic Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
42
|
Bahler L, Stroek K, Hoekstra JB, Verberne HJ, Holleman F. Metformin-related colonic glucose uptake; potential role for increasing glucose disposal?--A retrospective analysis of (18)F-FDG uptake in the colon on PET-CT. Diabetes Res Clin Pract 2016; 114:55-63. [PMID: 27103370 DOI: 10.1016/j.diabres.2016.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/02/2015] [Revised: 02/11/2016] [Accepted: 02/18/2016] [Indexed: 12/13/2022]
Abstract
AIM The use of metformin has been associated with diffusely increased colonic (18)F-fluorodeoxyglucose ((18)F-FDG) uptake. Interestingly, metformin use is associated with moderate weight loss. It could be hypothesized that increased colonic glucose disposal is related to this weight loss. It is unknown whether other factors influence (18)F-FDG uptake in the colon. The aim of this study was to retrospectively assess independent determinants of colonic (18)F-FDG uptake. METHODS We retrospectively analysed 270 (18)F-FDG PET-CTs which were made for diagnostic purposes. Colonic (18)F-FDG uptake was assessed using a 4-point scale using the liver as a reference (1; lower, 2; similar, 3; moderately higher than hepatic activity, 4; intense diffuse increased uptake). Determinants of (18)F-FDG uptake in the colon were assessed using forward logistic regression (i.e., grade 1&2 vs 3&4). RESULTS The patients had a mean age of 60.2±14.8 years, a BMI of 25.8±5.2kg/m(2) and 52% were female. Most patients had a grade 2 (44%) or grade 3 (39%) (18)F-FDG uptake in the colon. Diabetes mellitus type 2 was observed in 14% of the patients. In total, 5% of the patients used insulin, 12% used metformin and 5% used sulfonylurea derivatives (SU). While there seemed to be an effect of SU on (18)F-FDG uptake in the ileum [OR 3.6 (95% CI: 1.3-33.1), p=0.03], metformin was the only drug associated with (18)F-FDG uptake for both the whole colon [OR 10.0 (95% CI: 2.9-34.7), p<0.001] and all individual segments. CONCLUSION Metformin use is an independent determinant of increased colonic (18)F-FDG uptake, suggesting a potential role for increasing colonic glucose disposal.
Collapse
Affiliation(s)
- Lonneke Bahler
- Internal Medicine, Academic Medical Center, F4-257, P.O. Box 22660, Amsterdam 1100DD, The Netherlands.
| | - Kevin Stroek
- Internal Medicine, Academic Medical Center, F4-257, P.O. Box 22660, Amsterdam 1100DD, The Netherlands
| | - Joost B Hoekstra
- Internal Medicine, Academic Medical Center, F4-257, P.O. Box 22660, Amsterdam 1100DD, The Netherlands
| | - Hein J Verberne
- Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Academic Medical Center, F4-257, P.O. Box 22660, Amsterdam 1100DD, The Netherlands
| |
Collapse
|
43
|
Alam N, Doerga KB, Hussain T, Hussain S, Holleman F, Kramer MH, Nanayakkara PW. Epidemiology, recognition and documentation of sepsis in the pre-hospital setting and associated clinical outcomes: a prospective multicenter study. Acute Med 2016; 15:168-175. [PMID: 28112285] [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: 06/06/2023]
Abstract
INTRODUCTION General practitioners (GPs) and the emergency medical services (EMS) personnel have a pivotal role as points of entry into the acute care chain. This study was conducted to investigate the recognition of sepsis by GPs and EMS personnel and to evaluate the associations between recognition of sepsis in the pre-hospital setting and patient outcomes. Methods Design: prospective, observational study during a 12 week period in the emergency department (ED) of two academic hospitals. STUDY POPULATION Patients >18 years presenting with sepsis at the ED. The information available in the ED discharge letter and the ED charts was used to make a definite diagnosis of sepsis, severe sepsis and septic shock Outcome measures: primary: recognition/documentation of sepsis. Secondary: ED arrival time to antibiotic administration, in-hospital mortality, hospital length of stay (LOS) and intensive care unit (ICU) admission. RESULTS A total of 301 patients were included in the study. GPs and EMS personnel correctly identified and documented 31.6% (n=114) and 41.4% of all sepsis patients (n=140) respectively. Recognition and documentation of sepsis improved with increasing severity. The mean time to administration of antibiotics (TTA) was nearly halved for the group of patients where sepsis was documented (GP: 66,4 minutes, EMS: 65,6 minutes) compared to the group in which sepsis was not documented (GP: 123,9 minutes, EMS: 101,5 minutes; p: 0.365 and p: 0.024 respectively). Conclusions There is room for improvement in the recognition of sepsis, severe sepsis and septic shock by practitioners working in the pre-hospital setting. Documentation of sepsis prior to arrival in hospital led to a reduced time delay in administration of antibiotics.
Collapse
Affiliation(s)
- Nadia Alam
- Departments of Internal Medicine and Section Acute Medicineb, VU University Medical Center, Amsterdam, The Netherlands
| | - Kirtiedevi Bns Doerga
- Departments of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Tahira Hussain
- Departments of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Sadia Hussain
- Departments of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Frits Holleman
- Departments of Internal Medicine and Section Acute Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark Hh Kramer
- Departments of Internal Medicine and Section Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Prabath Wb Nanayakkara
- Departments of Internal Medicine and Section Acute Medicine, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
44
|
Bahler L, Verberne HJ, Admiraal WM, Stok WJ, Soeters MR, Hoekstra JB, Holleman F. Differences in Sympathetic Nervous Stimulation of Brown Adipose Tissue Between the Young and Old, and the Lean and Obese. J Nucl Med 2015; 57:372-7. [DOI: 10.2967/jnumed.115.165829] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/28/2015] [Indexed: 11/16/2022] Open
|
45
|
Abstract
OBJECTIVE To determine whether trial publications of glucose lowering drugs are dominated by a small group of highly prolific authors ("supertrialists") and to identify some of their characteristics. DESIGN Bibliographic analysis of trial publications. DATA SOURCES AND REVIEW METHODS We searched PubMed for all randomised controlled trials (RCTs) relating to glucose lowering drugs published between 1 January 1993 and 31 December 2013. From these publications we identified the 110 most prolific authors using PubReMiner. The 991 RCTs they published were examined for various characteristics such as author number, commercial sponsorship, company authorship, conflicts of interest, etc. The track record of the top 11 authors was studied in more detail. MAIN OUTCOME MEASURE Proportion of articles published by the top 110 and the top 11 authors. RESULTS 3782 articles from 13,592 authors were identified. The top 110 authors were named in 1227 (32.4%) of all articles, and the top 11 authors in 397 (10.5%) of all articles. The top 110 authors published 991 RCTs for a median of 20 (range 4-77) RCTs per author; the top 11 published 354 RCTs for a median of 42 (36-77) RCTs per author. Of the 110 top authors, 48 were employed by a pharmaceutical company. Of the 991 RCTs, 906 were commercially sponsored. Of 704 articles that could be assessed for conflicts of interest, only 42 (6%) were considered fully independent. Medical writing assistance was acknowledged in 439 (44.3%) of 991 RCTs. CONCLUSION The past two decades have seen an explosive increase in the number of published clinical trials regarding glucose lowering treatment. Some authors have made a disproportionate contribution to the therapeutic evidence base; one third of the RCT evidence base on glucose lowering drug treatment for diabetes was generated by <: 1% of authors. Of these, 44% were company employees and 56% were academics who work closely with the pharmaceutical companies.
Collapse
Affiliation(s)
- Frits Holleman
- Department of Internal Medicine F4-112, Academic Medical Center, 1105AZ Amsterdam, Netherlands
| | - Mick Uijldert
- Department of Internal Medicine F4-112, Academic Medical Center, 1105AZ Amsterdam, Netherlands
| | - Lennart F Donswijk
- Department of Internal Medicine, Gelre Ziekenhuizen, Apeldoorn, Netherlands
| | - Edwin A M Gale
- Department of Diabetes and Metabolism, University of Bristol, Bristol, UK
| |
Collapse
|
46
|
Schopman JE, Hoekstra JBL, Frier BM, Ackermans MT, de Sonnaville JJJ, Stades AM, Zwertbroek R, Hartmann B, Holst JJ, Knop FK, Holleman F. Effects of sitagliptin on counter-regulatory and incretin hormones during acute hypoglycaemia in patients with type 1 diabetes: a randomized double-blind placebo-controlled crossover study. Diabetes Obes Metab 2015; 17:546-553. [PMID: 25694217 DOI: 10.1111/dom.12453] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 11/17/2014] [Revised: 02/01/2015] [Accepted: 02/16/2015] [Indexed: 11/26/2022]
Abstract
AIMS To assess whether the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin affects glucagon and other counter-regulatory hormone responses to hypoglycaemia in patients with type 1 diabetes. METHODS We conducted a single-centre, randomized, double-blind, placebo-controlled, three-period crossover study. We studied 16 male patients with type 1 diabetes aged 18-52 years, with a diabetes duration of 5-20 years and intact hypoglycaemia awareness. Participants received sitagliptin (100 mg/day) or placebo for 6 weeks and attended the hospital for three acute hypoglycaemia studies (at baseline, after sitagliptin treatment and after placebo). The primary outcome was differences between the three hypoglycaemia study days with respect to plasma glucagon responses from the initialization phase of the hypoglycaemia intervention to 40 min after onset of the autonomic reaction. RESULTS Sitagliptin treatment significantly increased active levels of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1. No significant differences were observed for glucagon or adrenergic counter-regulatory responses during the three hypoglycaemia studies. Growth hormone concentration at 40 min after occurrence of autonomic reaction was significantly lower after sitagliptin treatment [median (IQR) 23 (0.2-211.0) mEq/l] compared with placebo [median (IQR) 90 (8.8-180) mEq/l; p = 0.008]. CONCLUSIONS Sitagliptin does not affect glucagon or adrenergic counter-regulatory responses in patients with type 1 diabetes, but attenuates the growth hormone response during late hypoglycaemia.
Collapse
Affiliation(s)
- J E Schopman
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - J B L Hoekstra
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - B M Frier
- Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M T Ackermans
- Department of Clinical Chemistry, Laboratory of Endocrinology and Radiochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | | | - A M Stades
- Department of Internal Medicine, University Medical Center, Utrecht, The Netherlands
| | - R Zwertbroek
- Department of Internal Medicine, Westfriesgasthuis, Hoorn, The Netherlands
| | - B Hartmann
- Department of Biomedical Sciences, NNF Centre for Basic Metabolic Research, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - J J Holst
- Department of Biomedical Sciences, NNF Centre for Basic Metabolic Research, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - F K Knop
- Department of Biomedical Sciences, NNF Centre for Basic Metabolic Research, Panum Institute, University of Copenhagen, Copenhagen, Denmark
- Department of Internal Medicine, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - F Holleman
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
47
|
van der Wekken LCW, Alam N, Holleman F, van Exter P, Kramer MHH, Nanayakkara PWB. Epidemiology of Sepsis and Its Recognition by Emergency Medical Services Personnel in the Netherlands. PREHOSP EMERG CARE 2015; 20:90-6. [PMID: 26024065 DOI: 10.3109/10903127.2015.1037476] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little is known about the epidemiology of sepsis in the Netherlands. In addition, information regarding the ability of emergency medical services (EMS) personnel to recognize sepsis is lacking. The aim of this study is to determine epidemiological characteristics of sepsis and the recognition of sepsis by EMS personnel in an urban area in the Netherlands. We conducted a retrospective cohort study using transport information from EMS Amsterdam and admission diagnoses at the emergency department gathered through discharge data from two academic hospitals in Amsterdam for the year 2012. A total of 253 patients with sepsis were evaluated, of which 131 were transported by ambulance. The in-hospital mortality rate of the total population was 21% and a mean length of hospital stay was of 13.5 days. Sixty-seven patients (26.5%) were admitted to the intensive care unit. Almost half of the patients were assigned to the internal medicine ward (117; 46.2%). The most common site of infection was the urinary tract (30%). E. coli was the most frequent cause of infections. EMS staff recognized 18/131 (13.7%) transported patients with (severe) sepsis or septic shock. In 52 cases (39.7%) sepsis went unrecognized, probably due to an incomplete primary survey. In 60 cases (45.8%) sepsis went unrecognized, although enough systemic inflammatory response syndrome criteria were present at initial presentation. Recognition of sepsis by EMS staff in the Netherlands is low, probably due to a lack of awareness of the syndrome and infrequent measurement of temperature and respiratory rate. As early initiation of treatment is crucial, the EMS staff, general practitioners, and other specialties could benefit from more education on this critical illness.
Collapse
|
48
|
Balink H, Tan SS, Veeger NJGM, Holleman F, van Eck-Smit BLF, Bennink RJ, Verberne HJ. ¹⁸F-FDG PET/CT in inflammation of unknown origin: a cost-effectiveness pilot-study. Eur J Nucl Med Mol Imaging 2015; 42:1408-13. [PMID: 25655485 DOI: 10.1007/s00259-015-3010-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Patients with increased inflammatory parameters, nonspecific signs and symptoms without fever and without a diagnosis after a variety of diagnostic procedures are a diagnostic dilemma and are referred to as having inflammation of unknown origin (IUO). The objective of this pilot study was to compare the cost-effectiveness of a diagnostic work-up/strategy with and without (18)F-FDG PET/CT in patients with IUO using a published dataset as a reference. METHODS IUO patients without (18)F-FDG PET/CT (group A, 46 patients) and IUO patients referred for (18)F-FDG PET/CT (group B, 46 patients) were selected. IUO was defined as the combination of nonspecific signs and symptoms and a prolonged erythrocyte sedimentation rate (ESR), defined as ≥age/2 in men and ≥(age + 10)/2 in women (ESR in millimetres per hour and age in years), and/or C-reactive protein (CRP) ≥15 mg/l. The costs of all tests and procedures and the number of hospitalization days in each patient to reach a diagnosis were calculated using current Dutch tariffs. RESULTS In group A a diagnosis was reached in 14 of the 46 patients. The mean cost per patient of all the diagnostic procedures was <euro>2,051, and including the cost of hospitalization was <euro>12,614. In group B a diagnosis was reached in 32 of the 46 patients. The mean cost per patient of all the diagnostic procedures was <euro>1,821, significantly lower than in group A (p < 0.0002), and including the cost of hospitalization was <euro>5,298. CONCLUSION In IUO (18)F-FDG PET/CT has the potential to become a cost-effective routine imaging technique indicating the direction for further diagnostic decisions thereby allowing unnecessary, invasive and expensive diagnostic investigations to be avoided and possibly the duration of hospitalization to be reduced. However, a prospective multicentre "bottom-up microcosting" cost-effectiveness study is warranted before these preliminary data can be extrapolated to clinical practice.
Collapse
Affiliation(s)
- H Balink
- Department of Nuclear Medicine, Medical Center Leeuwarden, P.O. Box 850, 8901 BR, Leeuwarden, The Netherlands,
| | | | | | | | | | | | | |
Collapse
|
49
|
van Santen HM, Schouten-Meeteren AY, Serlie M, Meijneke RWH, van Trotsenburg AS, Verberne H, Holleman F, Fliers E. Effects of T3 treatment on brown adipose tissue and energy expenditure in a patient with craniopharyngioma and hypothalamic obesity. J Pediatr Endocrinol Metab 2015; 28:53-7. [PMID: 25514327 DOI: 10.1515/jpem-2014-0337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/04/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients treated for childhood craniopharyngioma often develop hypothalamic obesity (HO), which has a huge impact on the physical condition and quality of life of these patients. Treatment for HO thus far has been disappointing, and although several different strategies have been attempted, all interventions had only transient effects. Since thyroid hormones increase energy expenditure metabolism (thyroid hormone induced thermogenesis), it was speculated that treatment with tri-iodothyronine (T3) may be beneficial. In 2002, a case report was published on reduction of body weight after T3 treatment for HO. No studies have been reported since. Recent experimental studies in rodents showed that T3 increases brown adipose tissue (BAT) activity via (pre)sympathetic pathways between the hypothalamus and BAT. Our aim was to investigate whether T3 treatment increases BAT activity in a patient with HO resulting from (treatment of) childhood craniopharyngioma. METHODS Thyroxine treatment for central hypothyroidism was switched to T3 monotherapy. Serum T3 and free thyroxine (FT4) concentrations were measured twice weekly for 2 months. ¹²³I-MIBG and ¹⁸F-FDG-PET after induction of non-shivering thermogenesis for the assessment of sympathetic and metabolic activity of BAT as well as indirect calorimetry for assessment of resting energy expenditure were performed before and during T3 treatment. RESULTS No change in sympathetic and metabolic BAT activity, energy expenditure, or BMI was seen during T3 treatment despite the expected changes in thyroid hormone plasma concentrations. CONCLUSION We conclude that T3 monotherapy does not seem to be effective in decreasing HO in childhood craniopharyngioma.
Collapse
|
50
|
Simon ACR, Schopman JE, Hoekstra JBL, Abu-Hanna A, Gerdes VEA, Peek N, Holleman F. Factors that drive insulin-dosing decisions of diabetes care providers: a vignette-based study in the Netherlands. Diabet Med 2015; 32:69-77. [PMID: 25204362 DOI: 10.1111/dme.12586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/05/2014] [Revised: 07/09/2014] [Accepted: 09/04/2014] [Indexed: 01/09/2023]
Abstract
AIM To test how certain patient factors would influence the decision of Dutch care providers regarding insulin dose adjustments. We hypothesize that some of these decisions would diverge from recent evidence and consensus statements. METHODS We developed narrative vignettes describing clinical scenarios of patients receiving basal insulin therapy. For each vignette, the respondents were asked to indicate whether they would advise a change in insulin dose. A total of 520 paper questionnaires were distributed among physicians and nurses in primary and secondary care in the Netherlands. Multivariate linear and logistic regression analyses were performed to identify factors associated with dosing decisions. RESULTS A total of 190 (37%) questionnaires were returned. In cases of a severe rather than mild hypoglycaemic event, care providers were nearly five times more likely to decrease the dose (odds ratio 4.77, 95% CI 1.65-13.75). Care providers were six times more likely to increase the dose when the patient's current dose was low (30 units) rather than high (90 units) (odds ratio 6.38, 95% CI 3.04-13.37). The plasma glucose concentration during a hypoglycaemic event and a known history of cardiovascular disease did not influence the care providers' dosing decisions. CONCLUSION Evidence regarding the optimum insulin titration is not always translated into clinical practice. When formulating guidelines, misconceptions should be identified and addressed.
Collapse
Affiliation(s)
- A C R Simon
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands; Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | |
Collapse
|