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Larsen TJ, Pettersen MB, Nygaard Jensen H, Lynge Pedersen M, Lund-Andersen H, Jørgensen ME, Byberg S. The use of artificial intelligence to assess diabetic eye disease among the Greenlandic population. Int J Circumpolar Health 2024; 83:2314802. [PMID: 38359160 PMCID: PMC10877649 DOI: 10.1080/22423982.2024.2314802] [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: 08/02/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
Background: Retina fundus images conducted in Greenland are telemedically assessed for diabetic retinopathy by ophthalmological nurses in Denmark. Applying an AI grading solution, in a Greenlandic setting, could potentially improve the efficiency and cost-effectiveness of DR screening.Method: We developed an AI model using retina fundus photos, performed on persons registered with diabetes in Greenland and Denmark, using Optos® ultra wide-field scanning laser ophthalmoscope, graded according to ICDR.Using the ResNet50 network we compared the model's ability to distinguish between different images of ICDR severity levels in a confusion matrix.Results: Comparing images with ICDR level 0 to images of ICDR level 4 resulted in an accuracy of 0.9655, AUC of 0.9905, sensitivity and specificity of 96.6%.Comparing ICDR levels 0,1,2 with ICDR levels 3,4, we achieved a performance with an accuracy of 0.8077, an AUC of 0.8728, a sensitivity of 84.6% and a specificity of 78.8%. For the other comparisons, we achieved a modest performance.Conclusion: We developed an AI model using Greenlandic data, to automatically detect DR on Optos retina fundus images. The sensitivity and specificity were too low for our model to be applied directly in a clinical setting, thus optimising the model should be prioritised.
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Affiliation(s)
- Trine Jul Larsen
- Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
| | | | | | - Michael Lynge Pedersen
- Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
- Rigshospitalet-Glostrup University Hospital, Glostrup, Denmark
| | - Henrik Lund-Andersen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- Rigshospitalet-Glostrup University Hospital, Glostrup, Denmark
| | | | - Stine Byberg
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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Brath MSG, Sahakyan M, Mark EB, Rasmussen HH, Østergaard LR, Frøkjær JB, Weinreich UM, Jørgensen ME. Ethnic differences in CT derived abdominal body composition measures: a comparative retrospect pilot study between European and Inuit study population. Int J Circumpolar Health 2024; 83:2312663. [PMID: 38314517 PMCID: PMC10846476 DOI: 10.1080/22423982.2024.2312663] [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: 11/09/2023] [Accepted: 01/28/2024] [Indexed: 02/06/2024] Open
Abstract
Understanding ethnic variations in body composition is crucial for assessing health risks. Universal models may not suit all ethnicities, and there is limited data on the Inuit population. This study aimed to compare body composition between Inuit and European adults using computed tomography (CT) scans and to investigate the influence of demographics on these measurements. A retrospective analysis was conducted on 50 adults (29 Inuit and 21 European) who underwent standard trauma CT scans. Measurements focused on skeletal muscle index (SMI), various fat indices, and densities at the third lumbar vertebra level, analyzed using the Wilcoxon-Mann-Whitney test and multiple linear regression. Inuit women showed larger fat tissue indices and lower muscle and fat densities than European women. Differences in men were less pronouncehd, with only Intramuscular fat density being lower among Inuit men. Regression indicated that SMI was higher among men, and skeletal muscle density decreased with Inuit ethnicity and age, while visceral fat index was positively associated with age. This study suggests ethnic differences in body composition measures particularly among women, and indicates the need for Inuit-specific body composition models. It higlights the importance of further research into Inuit-specific body composition measurements for better health risk assessment.
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Affiliation(s)
- Mia Solholt Godthaab Brath
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
- Respiratory Research Aalborg, Reaal, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marina Sahakyan
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department. of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Højgaard Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Danish Nutrition Science Center, Department. of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Center for Nutrition and Intestinal Failure, Department. of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lasse Riis Østergaard
- Medical Informatics group, Department. of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
- Respiratory Research Aalborg, Reaal, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
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Quist JS, Pedersen HE, Jensen MM, Clemmensen KKB, Bjerre N, Ekblond TS, Uldal S, Størling J, Wewer Albrechtsen NJ, Holst JJ, Torekov SS, Nyeland ME, Vistisen D, Jørgensen ME, Panda S, Brock C, Finlayson G, Blond MB, Færch K. Effects of 3 months of 10-h per-day time-restricted eating and 3 months of follow-up on bodyweight and cardiometabolic health in Danish individuals at high risk of type 2 diabetes: the RESET single-centre, parallel, superiority, open-label, randomised controlled trial. Lancet Healthy Longev 2024:S2666-7568(24)00028-X. [PMID: 38588687 DOI: 10.1016/s2666-7568(24)00028-x] [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] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Time-restricted eating (TRE) has been suggested to be a simple, feasible, and effective dietary strategy for individuals with overweight or obesity. We aimed to investigate the effects of 3 months of 10-h per-day TRE and 3 months of follow-up on bodyweight and cardiometabolic risk factors in individuals at high risk of type 2 diabetes. METHODS This was a single-centre, parallel, superiority, open-label randomised controlled clinical trial conducted at Steno Diabetes Center Copenhagen (Denmark). The inclusion criteria were age 30-70 years with either overweight (ie, BMI ≥25 kg/m2) and concomitant prediabetes (ie, glycated haemoglobin [HbA1c] 39-47 mmol/mol) or obesity (ie, BMI ≥30 kg/m2) with or without prediabetes and a habitual self-reported eating window (eating and drinking [except for water]) of 12 h per day or more every day and of 14 h per day or more at least 1 day per week. Individuals were randomly assigned 1:1 to 3 months of habitual living (hereafter referred to as the control group) or TRE, which was a self-selected 10-h per-day eating window placed between 0600 h and 2000 h. Randomisation was done in blocks varying in size and was open for participants and research staff, but outcome assessors were masked during statistical analyses. The randomisation list was generated by an external statistician. The primary outcome was change in bodyweight, assessed after 3 months (12 weeks) of the intervention and after 3 months (13 weeks) of follow-up. Adverse events were reported and registered at study visits or if participants contacted study staff to report events between visits. This trial is registered on ClinicalTrials.gov (NCT03854656). FINDINGS Between March 12, 2019, and March 2, 2022, 100 participants (66 [66%] were female and 34 [34%] were male; median age 59 years [IQR 52-65]) were enrolled and randomly assigned (50 to each group). Of those 100, 46 (92%) in the TRE group and 46 (92%) in the control group completed the intervention period. After 3 months of the intervention, there was no difference in bodyweight between the TRE group and the control group (-0·8 kg, 95% CI -1·7 to 0·2; p=0·099). Being in the TRE group was not associated with a lower bodyweight compared with the control group after subsequent 3-month follow-up (-0·2 kg, -1·6 to 1·2). In the per-protocol analysis, participants who completed the intervention in the TRE group lost 1·0 kg (-1·9 to -0·0; p=0·040) bodyweight compared with the control group after 3 months of intervention, which was not maintained after the 3-month follow-up period (-0·4 kg, -1·8 to 1·0). During the trial and follow-up period, one participant in the TRE group reported a severe adverse event: development of a subcutaneous nodule and pain when the arm was in use. This side-effect was evaluated to be related to the trial procedures. INTERPRETATION 3 months of 10-h per-day TRE did not lead to clinically relevant effects on bodyweight in middle-aged to older individuals at high risk of type 2 diabetes. FUNDING Novo Nordisk Foundation, Aalborg University, Helsefonden, and Innovation Fund Denmark.
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Affiliation(s)
- Jonas Salling Quist
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; School of Psychology, University of Leeds, Leeds, UK.
| | - Hanne Enghoff Pedersen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; iMotions, Copenhagen, Denmark; Novo Nordisk, Søborg, Denmark
| | - Marie Møller Jensen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Natasja Bjerre
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Uldal
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Joachim Størling
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Martin Erik Nyeland
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Steno Diabetes Center Greenland, Nuuk, Greenland
| | | | - Christina Brock
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; Steno Diabetes Center Northern Jutland, Aalborg, Denmark
| | - Graham Finlayson
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; School of Psychology, University of Leeds, Leeds, UK
| | - Martin Bæk Blond
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark
| | - Kristine Færch
- Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Novo Nordisk, Søborg, Denmark
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Backe MB, Kallestrup P, Rasmussen K, Jørgensen ME, Pedersen ML. Burden of selected chronic non-communicable diseases in a primary healthcare setting in Nuuk, Greenland, compared to a Danish suburb. Scand J Prim Health Care 2024:1-7. [PMID: 38578458 DOI: 10.1080/02813432.2024.2334746] [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: 12/16/2023] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION Noncommunicable diseases (NCDs) constitute a massive global burden and are the leading cause of death and disability worldwide. In Greenland, the prevalence of NCDs has historically been low. However, during the past approximately 70 years, life circumstances have changed dramatically resulting in increased life expectancy. Today, the proportion of inhabitants in Greenland ≥65 years has nearly tripled since the 1980s, and the prevalence of obesity and diabetes has increased rapidly within the past decades. The aim of this study was to describe the burden of selected NCDs in a primary care setting in Nuuk and compare it to a modern westernized suburban general practice in Denmark. METHODS The study was performed as a cross sectional register-based study using data extracted from the electronic medical records (EMR) based on diagnosis codes from inhabitants living in Nuuk, Greenland, and a suburb in Denmark. Estimates of prevalence were age-standardized to the WHO world standard population. RESULTS In both Nuuk and the Danish suburb, the highest prevalence was observed for hypertension (13.2% for both populations), followed by asthma (4.4 and 9.5%, respectively) and diabetes (4.3 and 2.9%, respectively). The age-standardized prevalences of diabetes, COPD, atrial fibrillation, and heart failure, were significantly higher in Nuuk, while seven NCDs including asthma, ischemic heart disease, arthritis urica, psoriasis, hyperthyreosis, hypothyreosis and osteoporosis were significantly higher in the Danish suburb. CONCLUSION In contrast to the disease pattern observed in Greenland in the last century, the prevalence of diagnosed NCDs in Nuuk is no longer rare. Thus, the overall prevalence of NCDs in the population of Nuuk is now comparable to or even higher than in the suburb in Denmark. This calls for increased focus on all NCDs in the primary healthcare system in Greenland and adaption of the primary healthcare services to a changed disease spectrum.
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Affiliation(s)
- Marie Balslev Backe
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Per Kallestrup
- Skødstrup Lægepraksis, General Practice Clinic, Skødstrup, Denmark
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Center for Global Health, Aarhus University, Aarhus, Denmark
| | - Kurt Rasmussen
- Skødstrup Lægepraksis, General Practice Clinic, Skødstrup, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Center for Public Health in Greenland, University of Southern Denmark, Copenhagen, Denmark
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Andersen K, Hansen T, Jørgensen ME, Senftleber N. Healthcare Burden in Greenland of Gastrointestinal Symptoms in Adults with Inherited Loss of Sucrase-Isomaltase Function. Appl Clin Genet 2024; 17:15-21. [PMID: 38328770 PMCID: PMC10849137 DOI: 10.2147/tacg.s437484] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
Background Congenital sucrase isomaltase deficiency (CSID) is in general a very rare disease. However, 2-3% of the Greenlandic population are homozygous (HO) carriers of an Arctic-specific loss-of-function (LoF) variant in the sucrase-isomaltase (SI) encoding gene, causing CSID. The condition is characterized by gastrointestinal symptoms such as stomachache, diarrhea, and weight loss when consuming sucrose, the most common dietary sugar. However, the awareness of the condition in the population and the healthcare system seems to be limited, potentially leading to a higher healthcare burden. Hence, we aimed to investigate whether HO-carriers visit the healthcare system more with gastrointestinal symptoms compared to the control groups by using registry data. Methods We performed a case-control study identifying cases and controls using genotype information from the 1999-2001 and 2005-2010 Greenlandic health population cohorts. The cases were defined as HO LoF SI-carriers and controls were defined as non-carriers and were matched (1:1) on sex, age, place of residence, and European genetic admixture. We used electronic medical records to assess the number of electronic medical record contacts (EMRc) related to gastrointestinal symptoms and the number of gastrointestinal-related diagnostic procedures. Results A total of 80 HO-carriers and 80 non-carriers were included. The HO-carriers had 19% more EMRc related to gastrointestinal symptoms (IRR, 1.19, 95% CI [1.02;1.40], p=0.02) and had a 41% higher incidence of gastrointestinal related diagnostic procedures compared to controls (IRR, 1.41, 95% CI [1.05-1.92], p=0.02). Only one HO-carrier was aware of the condition according to the electronic medical records. Conclusion HO-carriers of the LoF SI-variant had both significantly more gastrointestinal-related EMRc and significantly more diagnostic procedures conducted due to gastrointestinal symptoms. Only one HO-carrier was aware of the condition. Given the high prevalence of HO-carriers in the Greenlandic population, we anticipate that diagnosing more patients with CSID and providing dietary advice could potentially reduce symptom burden and healthcare visits among HO-carriers.
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Affiliation(s)
- Kristine Andersen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Clinical Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ninna Senftleber
- Steno Diabetes Center Greenland, Nuuk, Greenland
- Clinical Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark
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6
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Senftleber NK, Andersen MK, Jørsboe E, Stæger FF, Nøhr AK, Garcia-Erill G, Meisner J, Santander CG, Balboa RF, Gilly A, Bjerregaard P, Larsen CVL, Grarup N, Jørgensen ME, Zeggini E, Moltke I, Hansen T, Albrechtsen A. GWAS of lipids in Greenlanders finds association signals shared with Europeans and reveals an independent PCSK9 association signal. Eur J Hum Genet 2024; 32:215-223. [PMID: 37903942 PMCID: PMC10853193 DOI: 10.1038/s41431-023-01485-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 09/14/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023] Open
Abstract
Perturbation of lipid homoeostasis is a major risk factor for cardiovascular disease (CVD), the leading cause of death worldwide. We aimed to identify genetic variants affecting lipid levels, and thereby risk of CVD, in Greenlanders. Genome-wide association studies (GWAS) of six blood lipids, triglycerides, LDL-cholesterol, HDL-cholesterol, total cholesterol, as well as apolipoproteins A1 and B, were performed in up to 4473 Greenlanders. For genome-wide significant variants, we also tested for associations with additional traits, including CVD events. We identified 11 genome-wide significant loci associated with lipid traits. Most of these loci were already known in Europeans, however, we found a potential causal variant near PCSK9 (rs12117661), which was independent of the known PCSK9 loss-of-function variant (rs11491147). rs12117661 was associated with lower LDL-cholesterol (βSD(SE) = -0.22 (0.03), p = 6.5 × 10-12) and total cholesterol (-0.17 (0.03), p = 1.1 × 10-8) in the Greenlandic study population. Similar associations were observed in Europeans from the UK Biobank, where the variant was also associated with a lower risk of CVD outcomes. Moreover, rs12117661 was a top eQTL for PCSK9 across tissues in European data from the GTEx portal, and was located in a predicted regulatory element, supporting a possible causal impact on PCSK9 expression. Combined, the 11 GWAS signals explained up to 16.3% of the variance of the lipid traits. This suggests that the genetic architecture of lipid levels in Greenlanders is different from Europeans, with fewer variants explaining the variance.
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Affiliation(s)
- Ninna Karsbæk Senftleber
- Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
- Section for Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Mette K Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emil Jørsboe
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Frederik Filip Stæger
- Section for Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Anne Krogh Nøhr
- Center for Clinical Data Science, Department of Clinical Medicine, Aalborg University and Research, Education, and Innovation, Aalborg University Hospital, Aalborg, Denmark
| | - Genis Garcia-Erill
- Section for Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Meisner
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cindy G Santander
- Section for Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Renzo F Balboa
- Section for Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Arthur Gilly
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Peter Bjerregaard
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christina Viskum Lytken Larsen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Greenland Center for Health Research, Institute for Health and Nature, University of Greenland, Nuuk, Greenland
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Clinical Research, Copenhagen University Hospital-Steno Diabetes Center Copenhagen, Herlev, Denmark
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Technical University of Munich (TUM) and Klinikum Rechts der Isar, TUM School of Medicine, Munich, Germany
| | - Ida Moltke
- Section for Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark.
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Anders Albrechtsen
- Section for Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark.
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Senftleber NK, Skøtt Pedersen K, Schnoor Jørgensen C, Pedersen H, Bjerg Christensen MM, Kabel Madsen E, Andersen K, Jørsboe E, Gillum MP, Frøst MB, Hansen T, Jørgensen ME. The effect of sucrase-isomaltase deficiency on metabolism, food intake and preferences: protocol for a dietary intervention study. Int J Circumpolar Health 2023; 82:2178067. [PMID: 38113483 PMCID: PMC9970217 DOI: 10.1080/22423982.2023.2178067] [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: 11/22/2022] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
In Greenland, traditional marine foods are increasingly being replaced by sucrose- and starch-rich foods. A knock-out c.273_274delAG variant in the sucrase-isomaltase (SI) gene is relatively common in Greenland, with homozygous carriers being unable to digest sucrose and some starch. The variant is associated with a healthier metabolic phenotype in Greenlanders, which is confirmed by SI-knockout mice. We aim to assess if the healthy phenotype is explained by metabolic and microbial differences and if food and taste preferences differ between SI-genotypes. This paper describes the protocol for a randomised cross-over trial conducted in Greenland in 2022 with two dietary interventions of three days; a traditional meat- and fish-rich diet and a starch-rich Western diet with 11 energy% sucrose. The power calculation showed that 22 homozygous SI-carriers and 22 non-carriers were sufficient to detect a 0.5 mmol/L difference in glycaemic variability (80% power, α=0.05). We enrolled 18 carriers and 20 non-carriers. We examined food preferences at baseline and collected samples before and after each intervention for metabolic, metabolome, and microbiome profiling. Analyses of samples have not been completed yet. The Ethics Committee of Greenland approved the study. Results will be disseminated in international peer-reviewed journals and to the general Greenlandic population. NCT05375656.
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Affiliation(s)
- Ninna Karsbæk Senftleber
- Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Steno Diabetes Center Greenland, Queen Ingrid's Hospital, Nuuk, Greenland
| | | | | | - Hanne Pedersen
- Clinical Research, Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | | | - Kristine Andersen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emil Jørsboe
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Matthew Paul Gillum
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Michael Bom Frøst
- Department of Food Science, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
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Bjerregaard P, Ottendahl CB, Jensen T, Nørtoft K, Jørgensen ME, Larsen CVL. Muscular strength, mobility in daily life and mental wellbeing among older adult Inuit in Greenland. The Greenland population health survey 2018. Int J Circumpolar Health 2023; 82:2184751. [PMID: 36880125 PMCID: PMC10013347 DOI: 10.1080/22423982.2023.2184751] [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] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
The purpose was to analyse the association of muscular strength, muscle pain and reduced mobility in daily life with mental wellbeing among older Inuit men and women in Greenland. Data (N = 846) was collected as part of a countrywide cross-sectional health survey in 2018. Hand grip strength and 30-seconds chair stand test were measured according to established protocols. Mobility in daily life was assessed by five questions about the ability to perform specific activities of daily living. Mental wellbeing was assessed by questions about self-rated health, life satisfaction and Goldberg's General Health Questionnaire. In binary multivariate logistic regression models adjusted for age and social position, muscular strength (OR 0.87-0.94) and muscle pain (OR 1.53-1.79) were associated with reduced mobility. In fully adjusted models, muscle pain (OR 0.68-0.83) and reduced mobility (OR 0.51-0.55) but were associated with mental wellbeing. Chair stand score was associated with life satisfaction (OR 1.05). With an increasingly sedentary lifestyle, increasing prevalence of obesity and increasing life expectancy the health consequences of musculoskeletal dysfunction are expected to grow. Prevention and clinical handling of poor mental health among older adults need to consider reduced muscle strength, muscle pain and reduced mobility as important determinants.
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Affiliation(s)
- Peter Bjerregaard
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Tenna Jensen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Denmark.,Institute of Nursing and Health Science, University of Greenland, Greenland
| | - Kamilla Nørtoft
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Denmark
| | - Marit Eika Jørgensen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Denmark.,Institute of Nursing and Health Science, University of Greenland, Greenland.,Steno Diabetes Center Greenland, Nuuk, Greenland.,Steno Diabetes Center Copenhagen, Denmark
| | - Christina Viskum Lytken Larsen
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Denmark.,Institute of Nursing and Health Science, University of Greenland, Greenland
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9
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Overvad M, Díaz LJ, Bjerregaard P, Pedersen ML, Larsen CVL, Grarup N, Hansen T, Rossing P, Jørgensen ME. The effect of diabetes and the diabetogenic TBC1D4 p.Arg684ter variant on kidney function in Inuit in Greenland. Int J Circumpolar Health 2023; 82:2191406. [PMID: 36944026 PMCID: PMC10035948 DOI: 10.1080/22423982.2023.2191406] [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] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
The aim of this study was to examine the effect of diabetes and the diabetogenic TBC1D4 variant on kidney function in Greenland in a population-based setting. Health survey data and TBC1D4 genotypes from 5,336 Greenlanders were used to estimate odds ratios (ORs) of albuminuria (>30 mg/g creatinine) and chronic kidney disease (CKD, eGFR <60 ml/min/1.73m2), comparing individuals with and without diabetes, including the effect of TBC1D4 variant. Of the 3,909 participants with complete data, 9.3% had diabetes. Albuminuria was found in 27.6% and 9.5% and CKD was found in 10.8% and 6.3% among those with and without diabetes, respectively. Diabetes was cross-sectionally associated with an increased risk of albuminuria (OR (95% CI) = 2.37 (1.69,3.33); p < 0.001) and the TBC1D4 variant protected against albuminuria (OR (95% CI) = 0.44 (0.22,0.90); p = 0.02) in a multivariable model. Neither diabetes nor the TBC1D4 variant significantly associated with CKD. The presence/absence of diabetes did not predict changes in eGFR and UACR in longitudinal analyses. Diabetes conferred an increased risk of albuminuria, and the TBC1D4 variant was associated with a decreased risk of albuminuria, but neither was associated with CKD. The potential renoprotective association of the TBC1D4 variant on albuminuria calls for further studies.
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Affiliation(s)
- Maria Overvad
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lars Jorge Díaz
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Michael Lynge Pedersen
- Greenland Center for Health Research, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Greenland Center for Health Research, University of Greenland, Nuuk, Greenland
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Rossing
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Greenland Center for Health Research, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Greenland, Nuuk, Greenland
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10
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Backe MB, Jørgensen ME, Pedersen ML. High quality of diabetes care in Greenland since the launch of Steno Diabetes Center Greenland 2020 - geographical disparities need attention. Int J Circumpolar Health 2023; 82:2290305. [PMID: 38055761 PMCID: PMC10997303 DOI: 10.1080/22423982.2023.2290305] [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: 10/17/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
The aim of this study was to estimate the prevalence of diagnosed diabetes in Greenland and evaluate quality of care according to sex, region and healthcare unit within regions. Data on all inhabitants registered with diabetes were extracted from the electronic medical record. We found a crude prevalence of diagnosed diabetes in the population aged ≥ 20 years to be 4.7%, and the prevalence of diabetes standardised to the WHO world population was 4.0%. Compared to males, a significantly higher proportion of females had mean glycated haemoglobin (HbA1c) level below 7% (68.9% vs. 57.5%) and blood pressure below 140/90 mmHg (83.4% vs. 73.5%). Regarding healthcare unit within regions, quality of care was higher in regional cities compared to smaller cities, concerning proportion of persons having blood pressure measured regularly (86.0% vs. 71.7%), urine tested for albuminuria (70.6% vs. 51.2%), receiving eye examination (86.9% vs. 79.5%) and foot examination (87.9% vs. 79.4%). In conclusion, the prevalence of diagnosed diabetes in Greenland is the highest reported yet. The overall quality of diabetes care was high and significantly improved compared to 2018. We observed geographical inequality in diabetes care and improvements in the quality of care in specific remote locations are necessary to minimise health care disparities.
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Affiliation(s)
- Marie Balslev Backe
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland Center of Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland Center of Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Herlev, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Michael Lynge Pedersen
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
- Greenland Center of Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland
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Larsen HE, Geisler UW, Gustafsson F, Jørgensen ME, Pedersen ML. Prevalence and clinical features of heart failure in Greenland. Int J Circumpolar Health 2023; 82:2178068. [PMID: 36803445 PMCID: PMC9946303 DOI: 10.1080/22423982.2023.2178068] [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] [Indexed: 02/23/2023] Open
Abstract
Heart Failure (HF) constitutes a significant burden for healthcare around the world. In Greenland, risk factors like smoking, diabetes, and obesity are prevalent. Yet, the prevalence of HF remains unexplored. This register-based cross-sectional study uses data from the national medical record in Greenland to estimate the age- and gender-specific prevalence of HF and to describe the characteristics of patients with HF in Greenland. A total of 507 patients (26% women) with a mean age of 65 years were included based on a diagnosis of HF. The overall prevalence was 1.1% and higher among men compared to women (1.6% vs. 0.6%, p < 0.05). The highest prevalence was among men above 84 years (11.1%). More than half (53%) had a body mass index above 30 kg/m2 and 43% were current daily smokers. The proportion diagnosed with ischaemic heart disease (IHD) was 33%. The overall prevalence of HF in Greenland is consistent with that in other high-income countries, yet high among men in some age groups, compared to Danish men. Almost half the patients were obese and/or smokers. A low prevalence of IHD was observed indicating that other factors may play a role in developing HF among Greenlanders.
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Affiliation(s)
- Hjalte Erichsen Larsen
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland,Medical Department, Queen Ingrid’s Hospital, Nuuk, Greenland,CONTACT Hjalte Erichsen Larsen Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Dronning Ingridsvej 14, 503, 3900Nuuk, Greenland
| | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland,Clinical Research, Steno Diabetes Center Greenland, Nuuk, Greenland,Centre for Public Health in Greenland National Institute of Public Health, University of Southern Denmark, Denmark
| | - Michael Lynge Pedersen
- Greenland Center for Health Research, Institute of Health and Nature, University of Greenland, Nuuk, Greenland,Clinical Research, Steno Diabetes Center Greenland, Nuuk, Greenland
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Karstoft K, Ried-Larsen M, Bruhn L, Pilmark NS, Hansen KB, Persson F, Jørgensen ME, Blond MB, Færch K. The effect of metformin treatment on volumes of free-living physical activity and sedentary behaviour: A post-hoc analysis of the PRE-D trial. J Sports Sci 2023; 41:1687-1691. [PMID: 38053246 DOI: 10.1080/02640414.2023.2291737] [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: 06/13/2022] [Accepted: 11/28/2023] [Indexed: 12/07/2023]
Abstract
Perceived physical exertion is increased when exercise is performed on metformin treatment, but the clinical relevance of this is unknown. In this post hoc analysis of a randomized, controlled trial, we investigated whether metformin treatment was associated with lower levels of free-living physical activity. Ninety individuals with overweight/obesity (BMI>25 m2/kg) and HbA1c-defined prediabetes (39-47 mmol/mol) were randomized to treatment with dapagliflozin (SGLT2-inhibitor; 10 mg once daily, n=30), metformin (850 mg twice daily, n=30) or no treatment (control, n=30) for 13 weeks in a parallel-group, open-label trial. Before (baseline), during (6 weeks) and immediately after (13 weeks) cessation of treatment, a 6-day assessment of physical activity and sedentary behaviour was performed using accelerometer-based physical activity monitors. Intention-to-treat analyses revealed no within-group changes or differences in change between the groups for any measures of physical activity or sedentary behaviour at neither 6 nor 13 weeks. Short-term metformin treatment does not reduce free-living physical activity level in individuals with overweight/obesity and HbA1c-defined prediabetes.
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Affiliation(s)
- Kristian Karstoft
- Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Pharmacology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lea Bruhn
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Nanna Skytt Pilmark
- Centre for Physical Activity Research (CFAS), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katrine Bagge Hansen
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Frederik Persson
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
- Steno Diabetes Center Greenland (SDCG), Nuuk, Greenland
| | - Martin Bæk Blond
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
| | - Kristine Færch
- Department of Clinical Research, Steno Diabetes Center Copenhagen (SDCC), Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Senftleber NK, Ramne S, Moltke I, Jørgensen ME, Albrechtsen A, Hansen T, Andersen MK. Genetic Loss of Sucrase-Isomaltase Function: Mechanisms, Implications, and Future Perspectives. Appl Clin Genet 2023; 16:31-39. [PMID: 36994449 PMCID: PMC10041990 DOI: 10.2147/tacg.s401712] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
Genetic variants causing loss of sucrase-isomaltase (SI) function result in malabsorption of sucrose and starch components and the condition congenital sucrase-isomaltase deficiency (CSID). The identified genetic variants causing CSID are very rare in all surveyed populations around the globe, except the Arctic-specific c.273_274delAG loss-of-function (LoF) variant, which is common in the Greenlandic Inuit and other Arctic populations. In these populations, it is, therefore, possible to study people with loss of SI function in an unbiased way to elucidate the physiological function of SI, and investigate both short-term and long-term health effects of reduced small intestinal digestion of sucrose and starch. Importantly, a recent study of the LoF variant in Greenlanders reported that adult homozygous carriers have a markedly healthier metabolic profile. These findings indicate that SI inhibition could potentially improve metabolic health also in individuals not carrying the LoF variant, which is of great interest considering the massive number of individuals with obesity and type 2 diabetes worldwide. Therefore, the objectives of this review, are 1) to describe the biological role of SI, 2) to describe the metabolic impact of the Arctic SI LoF variant, 3) to reflect on potential mechanisms linking reduced SI function to metabolic health, and 4) to discuss what knowledge is necessary to properly evaluate whether SI inhibition is a potential therapeutic target for improving cardiometabolic health.
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Affiliation(s)
- Ninna Karsbæk Senftleber
- Clinical Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Stina Ramne
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida Moltke
- Section for Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Clinical Research, Copenhagen University Hospital – Steno Diabetes Center Copenhagen, Herlev, Denmark
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Anders Albrechtsen
- Section for Computational and RNA Biology, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette K Andersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Correspondence: Mette K Andersen, University of Copenhagen, Blegdamsvej 3B, Mærsk Tårnet, 8. sal, 2200 København N., Copenhagen, Denmark, Tel +45 35325282, Email
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Bjerregaard P, Larsen CVL, Olesen I, Ottendahl CB, Backer V, Senftleber N, Christensen MMB, Larsen TJ, Byberg S, Hansen T, Jørgensen ME. The Greenland population health survey 2018 - methods of a prospective study of risk factors for lifestyle related diseases and social determinants of health amongst Inuit. Int J Circumpolar Health 2022; 81:2090067. [PMID: 35711125 PMCID: PMC9225753 DOI: 10.1080/22423982.2022.2090067] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Since 1993, regular population health surveys in Greenland have supported and monitored the public health strategy of Greenland and have monitored cardiometabolic and lung diseases. The most recent of these surveys included 2539 persons aged 15+ from 20 communities spread over the whole country. The survey instruments included personal interviews, self-administered questionnaires, blood sampling, anthropometric measurements, blood pressure, ECG, oral glucose test, pulmonary function, hand grip strength and chair stand test. Blood samples were analysed for glucose, glycated haemoglobin (HbA1c), insulin, incretin hormones, cholesterol, kidney function, fatty acids in erythrocyte membranes and mercury, urine for albumin-creatinine ratio, and aliquots were stored at -80°C for future use. Data were furthermore collected for studies of the gut microbiome and diabetes complications. Survey participants were followed up with register data. The potential of the study is to contribute to the continued monitoring of risk factors and health conditions as part of Greenland's public health strategy and to study the epidemiology of cardiometabolic diseases and other chronic diseases and behavioural risk factors. The next population health survey is planned for 2024. The emphasis of the article is on the methods of the study and results will be presented in other publications.
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Affiliation(s)
- Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Ingelise Olesen
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | | | - Vibeke Backer
- Department of otorhinolaryngology Head & Neck surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Ninna Senftleber
- Steno Diabetes Center Greenland, Nuuk, Greenland.,Steno Diabetes Center Copenhagen, Denmark
| | | | - Trine Jul Larsen
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | | | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Institute of Health and Nature, University of Greenland, Nuuk, Greenland.,Steno Diabetes Center Greenland, Nuuk, Greenland.,Steno Diabetes Center Copenhagen, Denmark
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Amadid H, Clemmensen KKB, Vistisen D, Persson F, Jørgensen ME. Time trends of cardiovascular risk management in type 1 diabetes - nationwide analyses of real-life data. Cardiovasc Diabetol 2022; 21:255. [PMID: 36419118 PMCID: PMC9685843 DOI: 10.1186/s12933-022-01692-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Individuals diagnosed with and treated for type 1 diabetes (T1D) have increased risk of micro- and macrovascular disease and excess mortality. Improving cardiovascular (CV) risk factors in individuals with T1D is known to reduce diabetes- related CV complications. AIM To examine time trends in CV risk factor levels and CV-protective treatment patterns. Additionally, examine incidence rates of diabetes-related CV complications in relation to exposure CV-protective treatment. METHODS We analysed records from 41,630 individuals with T1D, registered anytime between 1996 and 2017 in a nationwide diabetes register. We obtained CV risk factor measurements (2010-2017), CV-protective drug profiles (1996-2017) and CV complication history (1977-2017) from additional nationwide health registers. RESULTS From 2010 to 2017 there were decreasing levels of HbA1c, LDL-C, and blood pressure. Decreasing proportion of smokers, individuals with glycaemic dysregulation (HbA1c ≥ 58 mmol/mol), dyslipidaemia (LDL-C > 2.6 mmol/l), and hypertension (≥ 140/85 mmHg). Yet, one fifth of the T1D population by January 1st, 2017 was severely dysregulated (HbA1c > 75 mmol/mol). A slight increase in levels of BMI and urinary albumin creatinine ratio and a slight decrease in estimated glomerular filtration rate (eGFR) levels was observed. By January 1st, 2017, one fourth of the T1D population had an eGFR < 60 ml/min/1.73 m2. The proportion of the T1D population redeeming lipid-lowering drugs (LLDs) increased from 5% in 2000 to 30% in 2010 followed by a plateau and then a decline. The proportion of the T1D population redeeming antihypertensive drugs (AHDs) increased from 28% in 1996 to 42% in 2010 followed by a tendency to decline. Use of LLDs was associated with lower incidence of micro- and macrovascular complications, while use of AHDs had higher incidence of CVD and CKD, when compared to non-use and discontinued use, respectively. CONCLUSION Improvements were seen in CV risk factor control among individuals with T1D in Denmark between 2010 and 2017. However, there is clearly a gap between current clinical guidelines and clinical practice for CV risk management in T1D. Action is needed to push further improvements in CV risk control to reduce CVD and the related excess mortality.
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Affiliation(s)
- Hanan Amadid
- grid.419658.70000 0004 0646 7285Steno Diabetes Center Copenhagen, Borgmester Ib Juuls vej 83, 2730 Herlev, Danmark
| | | | - Dorte Vistisen
- grid.419658.70000 0004 0646 7285Steno Diabetes Center Copenhagen, Borgmester Ib Juuls vej 83, 2730 Herlev, Danmark
| | - Frederik Persson
- grid.419658.70000 0004 0646 7285Steno Diabetes Center Copenhagen, Borgmester Ib Juuls vej 83, 2730 Herlev, Danmark
| | - Marit Eika Jørgensen
- grid.419658.70000 0004 0646 7285Steno Diabetes Center Copenhagen, Borgmester Ib Juuls vej 83, 2730 Herlev, Danmark ,Steno Diabetes Center Greenland, Nuuk, Greenland
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Laursen JC, Jepsen R, Bruun-Rasmussen NE, Frimodt-Møller M, Jørgensen ME, Rossing P, Hansen CS. Blood oxygen saturation is lower in persons with pre-diabetes and screen-detected diabetes compared with non-diabetic individuals: A population-based study of the Lolland-Falster Health Study cohort. Front Epidemiol 2022; 2:1022342. [PMID: 38455289 PMCID: PMC10910962 DOI: 10.3389/fepid.2022.1022342] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/20/2022] [Indexed: 03/09/2024]
Abstract
Aims Low blood oxygen saturation is associated with increased mortality and persons with diabetes have sub-clinical hypoxemia. We aimed to confirm the presence of sub-clinical hypoxemia in pre-diabetes, screen-detected diabetes and known diabetes. Methods Pre-diabetes was defined as hemoglobin A1C (HbA1C) ≥ 42 mmol/mol and <48 mmol/mol; known diabetes as history or treatment of diabetes; screen-detected diabetes as no history or treatment of diabetes and HbA1C ≥ 48 mmol/mol. Blood oxygen saturation was measured with pulse oximetry. Urine albumin-to creatinine ratio (UACR) was measured on a single spot urine. Results The study included 829 adults (≥18 years) with diabetes (713 (86%) with known diabetes; 116 (14%) with screen-detected diabetes) and 12,747 without diabetes (11,981 (94%) healthy controls; 766 (6%) with pre-diabetes). Mean (95% CI) blood oxygen saturation was 96.3% (96.3% to 96.4%) in diabetes which was lower than in non-diabetes [97.3% (97.2-97.3%)] after adjustment for age, gender, and smoking (p < 0.001), but significance was lost after adjustment for BMI (p = 0.25). Sub-groups with pre-diabetes and screen-detected diabetes had lower blood oxygen saturations than healthy controls (p-values < 0.01). Lower blood oxygen saturation was associated with higher UACR. Conclusions Persons with pre-diabetes and screen-detected diabetes have sub-clinical hypoxemia, which is associated with albuminuria.
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Affiliation(s)
| | - Randi Jepsen
- Center for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | | | | | | | - Peter Rossing
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Jensen OC, Flores A, Corman V, Canals ML, Lucas D, Denisenko I, Lucero-Prisno DEIII, Secher AL, Andersen GS, Jørgensen ME, Pujol HE, Cohen G, Gyntelberg F. Screening for type 2 diabetes and hypertension in seafarers’ medical examinations. Int Marit Health 2022; 73:64-72. [DOI: 10.5603/imh.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
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18
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Pedersen H, Diaz LJ, Clemmensen KKB, Jensen MM, Jørgensen ME, Finlayson G, Quist JS, Vistisen D, Færch K. Predicting Food Intake from Food Reward and Biometric Responses to Food Cues in Adults with Normal Weight Using Machine Learning. J Nutr 2022; 152:1574-1581. [PMID: 35325189 DOI: 10.1093/jn/nxac053] [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] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/21/2021] [Accepted: 03/03/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Eating behaviors are determined by a complex interplay between behavioral and physiologic signaling occurring before, during, and after eating. OBJECTIVES The aim was to explore how selected behavioral and physiologic variables separately and grouped together predicted intake of 8 different foods. METHODS One hundred adults with normal weight performed a food preference task combined with biometric measurements (the Steno Biometric Food Preference Task) in the fasting state. The task measured food reward as well as biometric (eye tracking, electrodermal activity, and facial expressions) responses to images of foods varying in fat content and taste. Energy intake from an ad libitum buffet of the same 8 foods as assessed in the preference task was subsequently assessed. A mixed-effects random forest approach was applied to explore how individual and combined measures of food reward and biometric responses predicted energy intake of the 8 single foods. The performance of the different prediction models was compared with the predictions from a linear model including only an intercept (naïve model) using bootstrap cross-validation. RESULTS Participants had a median [IQR] intake of 369 kJ [126-472 kJ] per food. Combined or separate measures of food reward or biometric responses did not predict energy intake better than the naïve model. CONCLUSIONS We did not find that the reward or biometric responses to food cues assessed in a clinical setting were useful in predicting energy intake of single foods. However, this study provides a framework in the field of behavioral nutrition for applying machine learning with a focus on individual predictions. This is necessary on the road toward personalized nutrition and provides great potential for handling complex data with multiple variables.This trial was registered at clinicaltrials.gov as NCT03986619.
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Affiliation(s)
- Hanne Pedersen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Jorge Diaz
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Marie Mølle Jensen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Marit Eika Jørgensen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Graham Finlayson
- Appetite Control and Energy Balance Research Group, School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Jonas Salling Quist
- Appetite Control and Energy Balance Research Group, School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Dorte Vistisen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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19
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Jensen OC, Flores A, Corman V, Luisa Canals M, Lucas D, Denisenko I, Lucero-Prisno DEI, Lilja Secher A, Stig Andersen G, Eika Jørgensen M, Estopà Pujol H, Cohen G, Gyntelberg F. Rethinking the use of urine dipstick for early diagnosis of Type 2 diabetes mellitus. Diabetes Res Clin Pract 2022; 184:109222. [PMID: 35114298 DOI: 10.1016/j.diabres.2022.109222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 11/20/2022]
Abstract
Transport workers, seafarers and fishers have biannual mandatory fit-for duty medical examinations. Urinedipstick is used for early diagnosis of Type 2 diabetes mellitus. Due to low sensitivity with more than 80% false negatives the method should be replaced by highly sensitive blood tests, Hb1Ac or similar for diagnosis of Type 2 diabetes mellitus to pursue the UN Global Sustainable Goals, especially Goal 3: Good health and well-being for all workers and Goal 8: Decent Work and Economic Growth.
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Affiliation(s)
- Olaf C Jensen
- Centre for Maritime Health and Society, Department of Public Health, University of Southern Denmark, Degnevej 14, 6705 Esbjerg, Denmark; University of Cadiz FUECA, Spain.
| | - Agnes Flores
- Universidad Metropolitana de Educación Ciencia y Tecnología, Facultad de las Ciencias y Tecnología, Panamá & Caja Seguro Social, Vacamonte Rep. of Panamá, Panama
| | - Victoria Corman
- Department of Public Health, University of Southern Denmark, Esbjerg, Denmark.
| | - Maria Luisa Canals
- University of Cadiz FUECA, Spain; Sociedad Española de Medicina Marítima (SEMM) /Sanidad Marítima, Tarragona, Spain; Sanidad Maritima (ISM), Barcelona, Spain
| | - David Lucas
- ORPHY Laboratory, University Brest, F-29200 Brest, France; Occupational and Environmental Diseases Center, Teaching Hospital, F-29200 Brest, France; French Society of Maritime Medicine Brest, F-29200, France.
| | | | - Don Eliseo-Iii Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; Faculty of Management and Development Studies, University of the Philippines Open University, Los Baños, Laguna, Philippines.
| | | | | | | | - Helena Estopà Pujol
- Sociedad Española de Medicina Marítima (SEMM) /Sanidad Marítima, Tarragona, Spain; Sanidad Maritima (ISM), Barcelona, Spain.
| | - Guido Cohen
- Faculty of Medicine, Panama University, Rep. of Panamá
| | - Finn Gyntelberg
- National Research Center for Work Environment & Occup. Med. Clinic, Bispebjerg Hospital, Denmark
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20
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Jensen OC, Flores A, Corman V, Canals ML, Lucas D, Denisenko I, Lucero-Prisno DEI, Secher AEL, Andersen GS, Jørgensen ME, Gyntelberg F. Early diagnosis of T2DM using high sensitive tests in the mandatory medical examinations for fishers, seafarers and other transport workers. Prim Care Diabetes 2022; 16:211-213. [PMID: 34996691 DOI: 10.1016/j.pcd.2021.12.018] [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: 12/09/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 01/02/2023]
Abstract
Transport workers like seafarers, truck-, bus-, train- and taxi drivers and fishers have a known great inequity in health at work including high risk of developing type 2 diabetes. Their routine mandatory medical examinations use urine glucose for diabetes check with more than 50% false negatives, which should be replaced by high sensitive tests for diabetes-2, like A1C, Fasting Glucose (FPG) or Oral Glucose Tolerance Test (OGTT).
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Affiliation(s)
- Olaf C Jensen
- Centre for Maritime Health and Society, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark; University of Cadiz FUECA, Spain.
| | - Agnes Flores
- Caja Seguro Social, Vacamonte, Rep. of Panamá; Universidad Metropolitana de Educación Ciencia y Tecnología. Facultad de las Ciencias y Tecnología, City of Panamá, Rep. of Panamá.
| | - Victoria Corman
- Department of Public Health, University of Southern Denmark, Esbjerg, Denmark.
| | - Maria Luisa Canals
- University of Cadiz FUECA, Spain; Sociedad Española de Medicina Marítima (SEMM)/Sanidad Marítima, Tarragona, Spain.
| | - David Lucas
- ORPHY Laboratory, University Brest, F-29200 Brest, France; Occupational and Environmental Diseases Center, Teaching Hospital, F-29200 Brest France; French Society of Maritime Medicine Brest, F-29200, France.
| | | | - Don Eliseo-Iii Lucero-Prisno
- London School of Hygiene and Tropical Medicine, London, United Kingdom; University of the Philippines Open University, Philippines.
| | | | | | | | - Finn Gyntelberg
- National Research Center for Work Environment, Copenhagen & Occup. Med. Clinic, Bispebjerg Hospital, Denmark.
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21
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Pedersen H, Beaulieu K, Finlayson G, Færch K, Jørgensen ME, Lewis JI, Lind MV, Lauritzen L, Quist JS. Food Reward after a Traditional Inuit or a Westernised Diet in an Inuit Population in Greenland. Nutrients 2022; 14:nu14030561. [PMID: 35276918 PMCID: PMC8839061 DOI: 10.3390/nu14030561] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/14/2022] [Accepted: 01/22/2022] [Indexed: 12/17/2022] Open
Abstract
The food availability and dietary behaviours in Greenland have changed with increasing Westernisation. Food reward is an important driver of food choice and intake, which has not previously been explored in the Arctic population. The aim of this study was to explore differences in food reward after a four-week intervention period with a traditional Inuit diet (TID) or Westernised diet (WD) in Inuit populations in Northern and Western Greenland. This cross-sectional analysis included 44 adults (n = 20 after TID and n = 24 after WD). We assessed the food reward components, explicit liking and implicit wanting, using the Leeds Food Preference Questionnaire under standardised conditions 60 min after drinking a glucose drink as part of an oral glucose tolerance test after four weeks following a TID or WD. The food intake was assessed using food frequency questionnaires. The intervention groups differed only in implicit wanting for high-fat sweet foods, with higher implicit wanting among the participants following TID compared to WD. Both groups had lower explicit liking and implicit wanting for sweet relative to savoury foods and for high-fat relative to low-fat foods. This exploratory study can guide future studies in Inuit populations to include measures of food reward to better understand food intake in the Arctic.
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Affiliation(s)
- Hanne Pedersen
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark;
- Correspondence:
| | - Kristine Beaulieu
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- Appetite Control and Energy Balance Research, School of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - Graham Finlayson
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- Appetite Control and Energy Balance Research, School of Psychology, University of Leeds, Leeds LS2 9JT, UK
| | - Kristine Færch
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- Department of Biomedical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Marit Eika Jørgensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, DK-1455 Copenhagen, Denmark;
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark
- Steno Diabetes Center Greenland, Dronning Ingrids Vej, Nuuk 3900, Greenland
| | - Jack Ivor Lewis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-2200 Copenhagen N, Denmark; (J.I.L.); (M.V.L.); (L.L.)
| | - Mads Vendelbo Lind
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-2200 Copenhagen N, Denmark; (J.I.L.); (M.V.L.); (L.L.)
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, DK-2200 Copenhagen N, Denmark; (J.I.L.); (M.V.L.); (L.L.)
| | - Jonas Salling Quist
- Clinical Research, Copenhagen University Hospital—Steno Diabetes Center Copenahgen, Borgmester Ib Juuls Vej 83, DK-2730 Herlev, Denmark; (K.B.); (G.F.); (K.F.); (J.S.Q.)
- Appetite Control and Energy Balance Research, School of Psychology, University of Leeds, Leeds LS2 9JT, UK
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22
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Knudsen L, Hansen DL, Joensen LE, Wibaek R, Benros ME, Jørgensen ME, Andersen GS. Need for improved diabetes support among people with psychiatric disorders and diabetes treated in psychiatric outpatient clinics: results from a Danish cross-sectional study. BMJ Open Diabetes Res Care 2022; 10:10/1/e002366. [PMID: 35078855 PMCID: PMC8796247 DOI: 10.1136/bmjdrc-2021-002366] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 01/04/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION People with psychiatric disorders have increased risk of premature death partly due to diabetes. This study aims to explore the quality of diabetes care, diabetes management, diabetes support and well-being of people with psychiatric disorders and diabetes. RESEARCH DESIGN AND METHODS A total of 107 participants aged ≥18 years with diabetes and psychiatric disorders treated at psychiatric outpatient clinics in Denmark were recruited from August 2018 to June 2019. This descriptive cross-sectional study includes data from medical records on quality of diabetes care (eg, level and annual examination of hemoglobin A1c (HbA1c)) and questionnaires on diabetes management (measured on items from the Summary of Diabetes Self-Care Activities Scale and diabetes distress based on Problem Areas in Diabetes Scale (PAID-5)), diabetes support (no, some or high support from eight potential support persons and experience of care actions measured on items from Patient Assessment of Chronic Illness Care) and well-being (WHO 5-Item Scale and self-rated general health). RESULTS The mean age was 52 years, 56% were men, the mean body mass index was 31.9 kg/m2, the median HbA1c was 53 mmol/mol (7.0%) and the mean blood pressure was 131/83 mm Hg. The proportion with annual measurements of HbA1c was 93%, blood pressure 80%, cholesterol 93%, foot examination 77% and eye examination 75%. Fifty-one per cent had high diabetes distress (PAID-5 score ≥8). Diabetologists and general practitioners (39% and 37%) were the health professionals most frequently reported to provide high diabetes support. CONCLUSIONS This study highlights a need for improved diabetes support in people with psychiatric disorders and diabetes. Although a high proportion received appropriate diabetes care, we found high levels of diabetes distress, moderate levels of optimal self-management behaviors, low well-being and low diabetes support from psychiatric health professionals, while one-third of the population found it relevant to receive diabetes support from psychiatric health professionals.
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Affiliation(s)
- Lenette Knudsen
- Education, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Lene Eide Joensen
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Rasmus Wibaek
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Michael Eriksen Benros
- Biological and Precision Psychiatry, Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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23
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Reinholdt K, Munk C, Thomsen LT, Dehlendorff C, Carstensen B, Jørgensen ME, Kjaer SK. Increased incidence of genital warts among women and men with type 1 diabetes compared with the general population-results from a nationwide registry-based, cohort study. Acta Diabetol 2022; 59:105-112. [PMID: 34499240 DOI: 10.1007/s00592-021-01786-8] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/11/2021] [Indexed: 01/23/2023]
Abstract
AIMS To estimate the incidence rates of genital warts (GWs) in women and men with type 1 diabetes compared to persons without diabetes. METHODS In this nationwide registry-based cohort study, we included the entire population aged 15 to 49 years living in Denmark between 1996 and 2016. From national registries, we retrieved individual level information on diabetes status, diagnoses and treatment of GWs, and potential confounding variables. We used Poisson regression to model sex- and age-specific incidence rates of GWs in persons with type 1 diabetes and persons without diabetes. Based on the models, we computed sex-specific incidence rate ratios (IRRs) of GWs in persons with type 1 diabetes compared to persons without diabetes, overall and according to age. RESULTS The analysis included 3,514,824 persons without type 2 diabetes and no GW diagnoses before baseline. The incidence rate of GWs in persons with type 1 diabetes was higher than in those without diabetes, both among women (IRR = 1.59; 95% CI, 1.42-1.78) and men (IRR = 1.36; 95% CI, 1.25-1.48). The pattern of increased incidence rates of GWs in persons with type 1 diabetes was seen at all ages. CONCLUSIONS Persons with type 1 diabetes have higher incidence rates of GWs than persons without diabetes. This supports the importance of HPV vaccination of young girls and boys with type 1 diabetes.
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Affiliation(s)
- K Reinholdt
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - C Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L T Thomsen
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - C Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - B Carstensen
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - M E Jørgensen
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- University of Southern Denmark, Odense, Denmark
| | - S K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
- Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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24
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Pedersen H, Quist JS, Jensen MM, Clemmensen KKB, Vistisen D, Jørgensen ME, Færch K, Finlayson G. Investigation of eye tracking, electrodermal activity and facial expressions as biometric signatures of food reward and intake in normal weight adults. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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25
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Christensen MMB, Hansen CS, Fleischer J, Vistisen D, Byberg S, Larsen T, Laursen JC, Jørgensen ME. Normative data on cardiovascular autonomic function in Greenlandic Inuit. BMJ Open Diabetes Res Care 2021; 9:e002121. [PMID: 34598933 PMCID: PMC8487188 DOI: 10.1136/bmjdrc-2021-002121] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Diabetes is increasing among Greenlandic Inuit; however, the prevalence of cardiovascular autonomic neuropathy (CAN) is yet unknown. The assessment of CAN requires an ability to differentiate between normal and abnormal. The aim was to establish normative reference data of cardiovascular autonomic function in Greenlandic Inuit. RESEARCH DESIGN AND METHODS In this cross-sectional study, cardiovascular autonomic function was evaluated in participants without diabetes during the Greenlandic Population Study 2018 and in the town Qasigiannguit in 2020. Assessment included cardiovascular autonomic reflex tests (CARTs) and power spectral analysis of heart rate variability (HRV). Normative reference limits were estimated by applying piecewise linear quantile regression models at the fifth percentile. Models were adjusted for age and sex. RESULTS Based on examinations of 472 participants (61.7% females), normative reference data was established for all outcomes. Mean age was 54 years (SD 13.1). Higher age was inversely associated with all outcomes of CARTs and HRV. A linear fall in cardiovascular autonomic function tended to level off beyond age of 60 or 70 years for supine-to-upright position ratio and low frequency power. However, the number of observations in subjects older than 60 or 70 years was limited, which may have caused a flattening of the curve around that age. No other associations were found. CONCLUSIONS The general level of the CARTs and HRV for all age groups is notably lower than in previous studies from other nationalities. We speculate that sociodemographic and cultural aspects of the Greenlandic Inuit population including body mass index, smoking, physical activity and alcohol consumption may have affected the cardiovascular autonomic function.
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Affiliation(s)
- Marie Mathilde Bjerg Christensen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, Aarhus Universitet, Aarhus, Midtjylland, Denmark
| | | | - Jesper Fleischer
- Steno Diabetes Center Aarhus, Aarhus, Denmark
- Steno Diabetes Center Zealand, Holbæk, Denmark
| | - Dorte Vistisen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Stine Byberg
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Trine Larsen
- Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Ilulissat, Greenland
| | - Jens Christian Laursen
- Department of Complication Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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26
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Reinholdt K, Thomsen LT, Munk C, Dehlendorff C, Carstensen B, Jørgensen ME, Kjaer SK. Incidence of HPV-related Anogenital Intraepithelial Neoplasia and Cancer in Men With Diabetes Compared With the General Population. Epidemiology 2021; 32:705-711. [PMID: 34039899 DOI: 10.1097/ede.0000000000001375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetes may increase risk of human papillomavirus (HPV)-related precancer and cancer. We estimated incidence of penile and anal high-grade intraepithelial neoplasia (hgPeIN, hgAIN) and squamous cell carcinoma (SCC) in men with diabetes compared with the entire Danish male population without diabetes. METHODS In this registry-based cohort study, we included all men born 1916-2001 and residing in Denmark (n = 2,528,756). From nationwide registries, we retrieved individual-level information on diabetes, educational level, and diagnoses of hgPeIN, hgAIN, penile SCC, and anal SCC. We used Poisson regression models to estimate incidence of hgPeIN, hgAIN, penile SCC, and anal SCC as a function of diabetes status, attained age, calendar period, and education. We estimated incidence rate ratios (IRRs) of each outcome in men with diabetes compared with nondiabetic men, both for diabetes overall and separately for type 1 (T1D) and type 2 diabetes (T2D). RESULTS Men with diabetes had increased incidence rate of penile SCC compared with nondiabetic men (IRR = 1.5, 95% CI = 1.2, 1.9). We saw similar trends for anal SCC, hgPeIN, and hgAIN. The combined incidence rate of penile and anal SCC was increased in men with T2D (IRR = 1.5, 95% CI = 1.3, 1.8), but not with T1D (IRR = 0.53, 95% CI = 0.20, 1.4) compared with men without diabetes. CONCLUSION The incidence of penile and anal high-grade intraepithelial neoplasia and SCC in men with diabetes was increased compared with men without diabetes. For penile and anal SCCs, this was primarily due to an increased risk in men with T2D.
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Affiliation(s)
- Kristian Reinholdt
- From the Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise Thirstrup Thomsen
- From the Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Munk
- From the Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Susanne Krüger Kjaer
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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27
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Kosjerina V, Carstensen B, Jørgensen ME, Brock B, Christensen HR, Rungby J, Andersen GS. Discontinuation of diabetes medication in the 10 years before death in Denmark: a register-based study. The Lancet Healthy Longevity 2021; 2:e561-e570. [DOI: 10.1016/s2666-7568(21)00170-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023]
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28
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Bjerregaard P, Ottendahl CB, Jørgensen ME. Hand grip strength and chair stand test amongst Greenlandic Inuit: reference values and international comparisons. Int J Circumpolar Health 2021; 80:1966186. [PMID: 34423740 PMCID: PMC8386702 DOI: 10.1080/22423982.2021.1966186] [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] [Indexed: 11/17/2022] Open
Abstract
Muscle strength is an important predictor for function and mortality among older adults. We measured hand grip strength among 1442 participants aged 15+ years and carried out a 30 second chair stand test among 786 participants aged 55+ years. Neither test has been carried out among the Inuit before. We present reference values for men and women as means with standard deviations and medians with 10th, 25th, 75th and 90th percentiles. Hand grip strength was higher among men than among women (means 45.2 kg and 25.8 kg; p < 0.0001), in linear regression analyses it increased with height (βmen = 0.69; βwomen = 0.46), weight (βmen = 0.24; βwomen = 0.08) and body mass index (βmen = 0.56; βwomen = 0.24), and decreased with age (βmen = −0.49; βwomen = −0.29) and Inuit genetic ancestry (βmen = −0.96; βwomen = −0.59). Chair stand score showed similar associations with sex (mean score for men and women 13.8 and 11.5; p < 0.0001), age (βmen = −0.22; βwomen = −0.20) and Inuit genetic ancestry (βmen = −0.38; βwomen = −0.41). The hand grip strength of the Inuit was at the same level as in European and North American populations whereas chair stand score was lower than that of a mostly white US population.
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Affiliation(s)
- Peter Bjerregaard
- National Institute Of Public Health, University Of Southern Denmark, Denmark
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Abstract
To assess the prevalence of diabetic retinopathy (DR) among persons with diabetes and prediabetes participating in the 2018 Population Health Survey in Greenland (B2018), a follow-up survey of three previous health surveys. Participants were invited to a diabetes complication screening. We assessed the prevalence of DR using Optos Daytona Ultra-wide field fundus camera and assessed differences in prevalence according to demographic and clinical characteristics using chi square test and a t-test and assessed DR based on ethnicity. The overall prevalence of DR was 2% (10/483). Among participants with HbA1c ≥48 mmol/mol (6.5%) DR prevalence was 9% (9/91), compared with <1% (1/382) among participants with HbA1c <48 mmol/mol (6.5%). All participants with DR lived in towns. The mean Inuit genetic admixture was lower among participants with DR. The prevalence of DR is low in Greenland and almost non-existent among persons with HbA1c below the diabetes threshold.
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Affiliation(s)
- Trine Louise Jul Larsen
- Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
| | - Marit Eika Jørgensen
- Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland.,Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Michael Lynge Pedersen
- Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland.,Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Henrik Lund-Andersen
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Marianne Valerius
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Ellen Juul
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Stine Byberg
- Clinical Epidemiology Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Senftleber NK, Overvad M, Dahl-Petersen IK, Bjerregaard P, Jørgensen ME. Diet and physical activity in Greenland: genetic interactions and associations with obesity and diabetes. Appl Physiol Nutr Metab 2021; 46:849-855. [PMID: 34107227 DOI: 10.1139/apnm-2021-0020] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The Inuit in Greenland have gone through dramatic lifestyle changes during the last half century. More time is spent being sedentary and imported foods replaces traditional foods like seal and whale. The population has also experienced a rapid growth in obesity and metabolic disturbances and diabetes is today common despite being almost unknown few decades ago. In this paper, we describe and discuss the role of lifestyle changes and genetics for Inuit metabolic health. Novelty: Cardiometabolic disease risk has increased in Greenland. Lifestyle changes and possibly gene-lifestyle interactions play a role.
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Affiliation(s)
| | | | | | - Peter Bjerregaard
- National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark.,University of Greenland, Nuuk, Greenland
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31
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Byberg S, Vistisen D, Jørgensen ME, Diaz LJ, Valerius M, Hajari JN, Lund‐Andersen H. Quality assessment of a screening algorithm for diabetic retinopathy: prolongation of screening intervals with minimal effect of HbA 1c and arterial hypertension on the length of intervals. Acta Ophthalmol 2021; 99:e360-e367. [PMID: 32930495 DOI: 10.1111/aos.14590] [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] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE At Steno Diabetes Center Copenhagen (SDCC), diabetic retinopathy (DR) screening intervals are based on quantification of retinal lesions. Screening intervals are, for the milder forms of DR, prolonged to 2-3 years. The purpose of the present study was to evaluate the effect of the prolongation on developing unexpected events and to evaluate the effect of HbA1c and arterial hypertension. METHODS We assessed 18 972 screening intervals from 6000 patients from 1/1-2003 to 1/5-2017 for occurrence of unexpected events, defined as: (1) DR progression requiring treatment, at the following screening date, and (2) DR-related hospital contact within the planned interval. We modelled the effect of several risk factors for developing unexpected events in a Cox regression. Furthermore, we assessed the risk of unexpected events in a logistic regression analysis using cubic splines to model the effect of HbA1c , stratified by arterial hypertension status. RESULTS 16 283 (86%) intervals followed the planned interval and among those, only 86 (0.5%) experienced unexpected events. Intervals of dysregulated patients (86% of all intervals) did not experience more unexpected events, compared with well-regulated patient intervals (Hazard Ratio: 1.12, 95% CI: 0.55-2.27). We found a nonlinear effect of HbA1c on the risk of unexpected events which peaked around HbA1c levels of 80 mmol/mol. Having arterial hypertension slightly increased the risk of unexpected events. CONCLUSIONS The present study supports the validity of the current algorithm. We found no increased risk of unexpected events among dysregulated intervals but a nonlinear effect of HbA1c . Age, diabetes duration and diabetes type were significantly associated with unexpected events.
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Affiliation(s)
- Stine Byberg
- Steno Diabetes Center Copenhagen Gentofte Denmark
| | | | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen Gentofte Denmark
- National Institute of Public Health University of Southern Denmark Copenhagen Denmark
| | | | - Marianne Valerius
- Steno Diabetes Center Copenhagen Gentofte Denmark
- University Hospital Glostrup Glostrup Denmark
| | - Javad Nouri Hajari
- Steno Diabetes Center Copenhagen Gentofte Denmark
- University Hospital Glostrup Glostrup Denmark
| | - Henrik Lund‐Andersen
- Steno Diabetes Center Copenhagen Gentofte Denmark
- University Hospital Glostrup Glostrup Denmark
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32
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Knudsen ST, Bodegård J, Birkeland KI, Furuseth K, Thuresson M, Lindh A, Nilsson PM, Alvarsson M, Jørgensen ME, Søndergaard J, Persson F. Risk factor management of type 2 diabetic patients in primary care in the Scandinavian countries between 2003 and 2015. Prim Care Diabetes 2021; 15:262-268. [PMID: 33032936 DOI: 10.1016/j.pcd.2020.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/19/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 01/19/2023]
Abstract
AIMS To observe and report population demography, comorbidities, risk factor levels and risk factor treatment in a sample of individuals treated for type 2 diabetes in primary care in Norway, Sweden and Denmark. METHODS Retrospective observational cohort using extraction of data from electronic medical records linked with national health care registries. RESULTS Sixty primary care clinics participated with annual cross-sectional data (2003 to 2015). In 2015 the sample consisted of 31,632 individuals. Mean age (64.5-66.8 years) and proportion of women (43-45%) were similar. The prevalence of cardiovascular disease in 2015 was 40.7%, 41.6% and 38.0% for Norway, Sweden and Denmark, respectively and 84% to 89% of patients were receiving a pharmacological anti-diabetic treatment. More Danish patients reached targets for HbA1c and LDL cholesterol, while more patients in Sweden and Denmark met the blood pressure target of <130/80 mmHg as compared to Norway. CONCLUSIONS In three comparable public primary health care systems we found a high prevalence of cardiovascular disease and differences in risk factor treatment and attainment of risk factor goals. With recent guideline changes there is potential for further prevention of diabetes complications in primary care in the future.
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Affiliation(s)
- Søren Tang Knudsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | | | | | | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark; University of Southern Denmark, Odense, Denmark
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33
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Møller G, Lind MV, Hauptmann AL, Senftleber N, Hansen CB, Hansen T, Jørgensen ME, Lauritzen L. The role of a traditional and western diet on glucose homeostasis in Greenlandic Inuit carriers and non-carriers of type 2 diabetes variant in the TBC1D4 gene: A protocol for a randomized clinical trial. Contemp Clin Trials Commun 2021; 21:100734. [PMID: 33604488 PMCID: PMC7873626 DOI: 10.1016/j.conctc.2021.100734] [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: 08/05/2020] [Revised: 11/14/2020] [Accepted: 01/19/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The lifestyle of Inuit in Greenland and worldwide is undergoing a transition from a fisher-hunter to a westernized society and meanwhile the prevalence of type-2 diabetes (T2D) has increased dramatically. Studies have shown that a common nonsense p.Arg684Ter variant in TBC1D4, which is frequent in Greenland, confers genetic susceptibility towards high risk of T2D. The aim of the study is to investigate whether a traditional marine diet, with high fat and low carbohydrate, will improve glycemic control in Greenland Inuit compared to a western diet. Moreover, we want to examine if the response is more pronounced in carriers of the p.Arg684Ter variant. MATERIALS AND METHODS We will conduct a randomized, clinical cross-over trial with two dietary intervention periods of four weeks duration. The diet intervention comprise provision of >20E% and instruction for the remaining part of the diet. We expect to include 30 homozygous carriers and 30 homozygous non-carriers of the p.Arg684Ter variant, aged 18-80 years, across three Greenlandic towns. The primary outcome is plasma (p)-glucose 2 h post an oral glucose tolerance test and we aim to have 80% power, at α = 0.05, to detect a difference of 1.1 mmol/L. We will also include supporting measures of glucose homeostasis, assess other markers of the metabolic syndrome and perform metabolome and microbiome profiling. The statistical analysis will be performed as complete case analyses using linear mixed models. ETHICS AND DISSEMINATION The study received approval by the Ethics Committee of Greenland (KVUG 2018-26) and will be disseminated via international peer-reviewed journal articles and conferences. TRIAL REGISTRATION NUMBER Clinicaltrials.gov identifier no. NCT04011904.
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Affiliation(s)
- Grith Møller
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | - Mads Vendelbo Lind
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | | | - Ninna Senftleber
- Bioinformatics Centre, Department of Biology, University of Copenhagen, Copenhagen, and Steno Diabetes Center Copenhagen, Denmark
| | | | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Marit Eika Jørgensen
- National Institute of Public Health, University of Southern Denmark, Ilisimatusarfik, The University of Greenland, and Steno Diabetes Center Copenhagen, Denmark
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
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34
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Carstensen B, Rønn PF, Jørgensen ME. Lifetime risk and years lost to type 1 and type 2 diabetes in Denmark, 1996-2016. BMJ Open Diabetes Res Care 2021; 9:9/1/e001065. [PMID: 33653710 PMCID: PMC7929801 DOI: 10.1136/bmjdrc-2019-001065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 11/02/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Lifetime risk and lifetime lost to diabetes are measures of current diabetes burden in a population. We aimed at quantifying these measures in the Danish population. RESEARCH DESIGN AND METHODS We modeled incidence and mortality of type 1 diabetes (T1D) and type 2 diabetes (T2D) and non-diabetes mortality based on complete follow-up of the entire population of Denmark in 1996-2016. A multistate model with these transition rates was used to assess the lifetime risk of diabetes, as well as the difference in expected lifetime between persons with type 1 and T2D and persons without. RESULTS In 2016, the lifetime risk of T1D was 1.1% and that for T2D 24%, the latter a 50% increase from 1996. For 50-year-old persons, the lifetime lost was 6.6 years for T1D and 4.8 years for T2D. These figures have been declining over the study period.At 2016, the total foreseeable lives lost in Denmark among patients with T1D were 182 000 years, and those among patients with T2D were 766 000 years, corresponding to 6.6 and 3.0 years per person, respectively. CONCLUSION At the individual level, improvements in the disease burden for both T1D and T2D have occurred. At the population level, the increasing number of patients with T2D has contributed to a large increase in the total loss of lifetime.
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Affiliation(s)
| | | | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Clinical Epidemiology, University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
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35
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Færch K, Amadid H, Bruhn L, Clemmensen KKB, Hulman A, Ried-Larsen M, Blond MB, Jørgensen ME, Vistisen D. Discordance Between Glucose Levels Measured in Interstitial Fluid vs in Venous Plasma After Oral Glucose Administration: A Post-Hoc Analysis From the Randomised Controlled PRE-D Trial. Front Endocrinol (Lausanne) 2021; 12:753810. [PMID: 34675886 PMCID: PMC8525890 DOI: 10.3389/fendo.2021.753810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS The oral glucose tolerance test (OGTT) is together with haemoglobin A1c (HbA1c) gold standard for diagnosing prediabetes and diabetes. The objective of this study was to assess the concordance between glucose values obtained from venous plasma versus interstitial fluid after oral glucose administration in 120 individuals with prediabetes and overweight/obesity. METHODS 120 adults with prediabetes defined by HbA1c 39-47 mmol/mol and overweight or obesity who participated in the randomised controlled PRE-D trial were included in the study. Venous plasma glucose concentrations were measured at 0, 30, 60 and 120 minutes during a 75 g oral glucose tolerance test (OGTT) performed on three different occasions within a 26 weeks period. During the OGTT, the participants wore a CGM device (IPro2, Medtronic), which assessed glucose concentrations every five minutes. RESULTS A total of 306 OGTTs with simultaneous CGM measurements were obtained. Except in fasting, the CGM glucose values were below the OGTT values throughout the OGTT period with mean (SD) differences of 0.2 (0.7) mmol/L at time 0 min, -1.1 (1.3) at 30 min, -1.4 (1.8) at 60 min, and -0.5 (1.1) at 120 min). For measurements at 0 and 120 min, there was a proportional bias with an increasing mean difference between CGM and OGTT values with increasing mean of the two measurements. CONCLUSIONS Due to poor agreement between the OGTT and CGM with wide 95% limits of agreement and proportional bias at 0 and 120 min, the potential for assessing glucose tolerance in prediabetes using CGM is questionable.
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Affiliation(s)
- Kristine Færch
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- *Correspondence: Kristine Færch,
| | - Hanan Amadid
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Lea Bruhn
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus, Denmark
| | - Mathias Ried-Larsen
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen, Denmark
- Institute of Sports and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Martin Bæk Blond
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- University of Southern Denmark, Copenhagen, Denmark
| | - Dorte Vistisen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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36
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Reinholdt K, Thomsen LT, Munk C, Dehlendorff C, Aalborg GL, Carstensen B, Jørgensen ME, Kjaer SK. Incidence of human papillomavirus-related anogenital precancer and cancer in women with diabetes: A nationwide registry-based cohort study. Int J Cancer 2020; 148:2090-2101. [PMID: 33129233 DOI: 10.1002/ijc.33365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/17/2020] [Accepted: 10/20/2020] [Indexed: 12/29/2022]
Abstract
In this register-based cohort study, we estimated the incidence of human papillomavirus (HPV)-related anogenital precancer and cancer in women with diabetes compared with women without diabetes. We followed all women living in Denmark born 1916 to 2001 (n = 2 508 321) for individual-level information on diabetes (Type 1 or 2 [T1D or T2D]), diagnoses of cervical, vaginal, vulvar and anal intraepithelial neoplasia Grade 2 or 3 (IN2/3) and cancer and other covariates from nationwide registries. We used Poisson regression to model the incidence rates of anogenital IN2/3 and cancer as a function of diabetes status, age, HPV vaccination, education, calendar year, and cervical cancer screening status. Incidence rate ratios (IRRs) were estimated for diabetes overall, and separately for T1D and T2D, compared with women without diabetes. Women with diabetes had higher rates of vulvar IN2/3 (IRR = 1.63; 95% confidence interval [CI]: 1.41-1.88), vulvar cancer (IRR = 1.61; 95% CI: 1.36-1.91) and vaginal cancer (IRR = 1.79; 95% CI: 1.27-1.91) than women without diabetes. Similar patterns were observed for anal IN2/3, anal cancer and cervical cancer, although not statistically significant. In contrast, women with diabetes had lower rates of cervical IN2/3 (IRR = 0.74; 95% CI: 0.69-0.79) than women without diabetes. Patterns were generally similar in women with T1D and T2D, although cancer rates were higher in women with T2D. In conclusion, the incidence of most anogenital precancers and cancers were increased in women with diabetes. However, women with diabetes had lower incidence of cervical precancer. Our findings could be explained by biological mechanisms and/or behavioral factors, such as smoking and less frequent cervical screening participation.
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Affiliation(s)
- Kristian Reinholdt
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Christian Munk
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Dehlendorff
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Gitte Lerche Aalborg
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Rønn PF, Andersen GS, Lauritzen T, Christensen DL, Aadahl M, Carstensen B, Grarup N, Jørgensen ME. Abdominal visceral and subcutaneous adipose tissue and associations with cardiometabolic risk in Inuit, Africans and Europeans: a cross-sectional study. BMJ Open 2020; 10:e038071. [PMID: 32928857 PMCID: PMC7490939 DOI: 10.1136/bmjopen-2020-038071] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Abdominal fat has been identified as a risk marker of cardiometabolic disease independent of overall adiposity. However, it is not clear whether there are ethnic disparities in this risk. We investigated the associations of visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) with cardiometabolic risk factors in three ethnic diverse populations of Inuit, Africans and Europeans. DESIGN Cross-sectional pooled study. SETTING Greenland, Kenya and Denmark. METHODS A total of 5113 participants (2933 Inuit, 1397 Africans and 783 Europeans) from three studies in Greenland, Kenya and Denmark were included. Measurements included abdominal fat distribution assessed by ultrasound, oral glucose tolerance test, hepatic insulin resistance, blood pressure and lipids. The associations were analysed using multiple linear regressions. RESULTS Across ethnic group and gender, an increase in VAT of 1 SD was associated with higher levels of hepatic insulin resistance (ranging from 14% to 28%), triglycerides (8% to 16%) and lower high-density lipoprotein cholesterol (HDL-C, -1.0 to -0.05 mmol/L) independent of body mass index. VAT showed positive associations with most of the other cardiometabolic risk factors in Inuit and Europeans, but not in Africans. In contrast, SAT was mainly associated with the outcomes in Inuit and Africans. Of notice was that higher SAT was associated with higher HDL-C in African men (0.11 mmol/L, 95% CI: 0.03 to 0.18) and with lower HDL-C in Inuit (-0.07 mmol/L, 95% CI: -0.12 to -0.02), but not in European men (-0.02 mmol/L, 95% CI: -0.09 to 0.05). Generally weaker associations were observed for women. Furthermore, the absolute levels of several of the cardiometabolic outcomes differed between the ethnic groups. CONCLUSIONS VAT and SAT were associated with several of the cardiometabolic risk factors beyond overall adiposity. Some of these associations were specific to ethnicity, suggesting that ethnicity plays a role in the pathway from abdominal fat to selected cardiometabolic risk factors.
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Affiliation(s)
- Pernille Falberg Rønn
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Public Health, Centre for Arctic Health, Aarhus University, Aarhus, Denmark
| | | | - Torsten Lauritzen
- Department of Public Health, General Practice, Aarhus University, Aarhus, Denmark
| | - Dirk Lund Christensen
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Mette Aadahl
- Center for Clinical Research and Prevention, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Niels Grarup
- Novo Nordisk Foundation, Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Greenland University, Nuuk, Greenland
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Stougaard EB, Amadid H, Søndergaard E, Jørgensen ME, Persson F, Rossing P. [SGLT 2 inhibitors in Type 1 diabetes]. Ugeskr Laeger 2020; 182:V05200351. [PMID: 32829747] [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: 06/11/2023]
Abstract
The sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin has been approved for the treatment of Type 1 diabetes (T1D) with significant reductions in HbA1c, weight, total daily insulin dose and significant increase in time in range without an increased risk of hypoglycaemia. The use of SGLT2i in T1D has, however, shown a significant increase from 1,9% to 4,0% in the risk of diabetic ketoacidosis (DKA), which may present as euglycaemic DKA. In this review we therefore find it important to know, that DKA may present with normal/near-normal blood glucose levels, if the patient is treated with an SGLT2i.
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39
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Carstensen B, Rønn PF, Jørgensen ME. Components of diabetes prevalence in Denmark 1996-2016 and future trends until 2030. BMJ Open Diabetes Res Care 2020; 8:8/1/e001064. [PMID: 32784246 PMCID: PMC7418686 DOI: 10.1136/bmjdrc-2019-001064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Incidence rates of diabetes have been increasing and mortality rates have been decreasing. Our aim is the quantification of the effects of these on the prevalence and prediction of the future burden of diabetes. RESEARCH DESIGN AND METHODS From population-based registers of Denmark, we derived diabetes incidence and mortality rates and mortality rates for persons without diabetes for the period 1996-2016. Rates were modeled by smooth parametric terms using Poisson regression. Estimated rates were used to assess the relative contribution of incidence and mortality to changes in prevalence over the study period as well as for prediction of future rates and prevalence 2017-2040. RESULTS The major contributors to prevalence was increasing incidence (22%) and epidemiological imbalance between incidence and mortality (27%). The decrease in mortality rates over the period 1996-2016 contributes only 9% of the prevalent cases at 2016. We estimated that 467 000 persons in Denmark would be living with diabetes in 2030. The age distribution of patients in the period 2017-2030 is predicted to change toward older ages. The total number of persons needing diabetes care will increase by 67% over the next 13 years, an average annual increase of 4.0%. CONCLUSIONS Lowering mortality among patients with diabetes even further is not likely to influence the prevalence substantially. Since the size and the increase in incidence of diabetes are major drivers of the increasing prevalence, the prevention of new cases of diabetes is required.
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Affiliation(s)
- Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Pernille Falberg Rønn
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
- Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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40
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Jørgensen ME, Pedersen ML. [Diabetes in Greenland]. Ugeskr Laeger 2020; 182:V12190696. [PMID: 32515333] [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: 06/11/2023]
Abstract
Three population studies of more than 4,000 Greenlanders found a notably high prevalence of diabetes (9% in 1999-2001 rising to 16% in 2018) in the adult population. In this review, we argue that this is due to genetic factors, rapid social changes, ageing of the population and changes in diet and physical activity. A national diabetes programme was implemented in 2008, aiming to improve care for patients with diabetes in Greenland. As a result of this, diagnostic activity and quality of diabetes care have improved. The incidence of diabetic complications is comparable to the one of western countries, but this notion warrants further studies.
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41
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Jensen AD, Andersen ST, Charles M, Bjerg L, Witte DR, Gram B, Jørgensen ME, Sandbæk A, Dalsgaard EM. Factors associated with attendance at clinical follow-up of a cohort with screen-detected type 2 diabetes: ADDITION-Denmark. Prim Care Diabetes 2020; 14:239-245. [PMID: 31587895 DOI: 10.1016/j.pcd.2019.09.001] [Citation(s) in RCA: 2] [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: 07/03/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
AIMS To determine the association between concurrent overall burden of disease, cardiovascular disease, cancer, self-rated health, HbA1c levels, and attendance at clinical follow-up of the Danish arm of the ADDITION-study. METHODS Logistic regression models were used to study factors proposed being associated with attendance in clinical follow-up. We used data from clinical examinations, questionnaires and national registers at a time-point near the follow-up examination. RESULTS A total of 1119 participants were eligible for the follow-up conducted a median of 12.8 years (IQR 11.6; 13.4) after type 2 diabetes diagnosis by screening. Concurrent high burden of disease was associated with lower attendance (OR 0.6 (95% CI: 0.4; 0.9) for high-versus no burden of disease). Concurrent cardiovascular disease and cancer showed no statistically significant association with attendance (OR 1.0 (95% CI: 0.7; 1.4)) and (OR 0.8 (95% CI: 0.6; 1.1) for (disease versus no disease). Similarly, self-rated health (OR 0.7 (95% CI: 0.5; 1.0) poor-versus good self-rated health) and HbA1c levels (OR 1.0 (95% CI: 0.9; 1.2 unit=10mmol/mol)) were not statistically significant associated with attendance. CONCLUSIONS This study showed a lower attendance in clinical follow-up after nearly 13years among individuals with concurrent high burden of disease. No associations were found between concurrent CVD, cancer, self-rated health and Hba1c levels and attendance.
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Affiliation(s)
| | | | | | - Lasse Bjerg
- Department of Public Health, Aarhus University, Denmark; Steno Diabetes Center Copenhagen, Glostrup, Denmark; Danish Diabetes Academy, Odense, Denmark
| | - Daniel Rinse Witte
- Department of Public Health, Aarhus University, Denmark; Danish Diabetes Academy, Odense, Denmark
| | - Bibi Gram
- Research Unit of Health Sciences, Hospital of Southwest Jutland, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark; National Institute of Public Health, University of Southern Denmark, Denmark
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Carstensen B, Rønn PF, Jørgensen ME. Prevalence, incidence and mortality of type 1 and type 2 diabetes in Denmark 1996-2016. BMJ Open Diabetes Res Care 2020; 8:8/1/e001071. [PMID: 32475839 PMCID: PMC7265004 DOI: 10.1136/bmjdrc-2019-001071] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/03/2020] [Accepted: 04/28/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The objective of this study was to give an overview of prevalence, incidence and mortality of type 1 (T1D) and type 2 diabetes (T2D) in Denmark, and their temporal trends. RESEARCH DESIGN AND METHODS We constructed a diabetes register from existing population-based healthcare registers, including a classification of patients as T1D or T2D, with coverage from 1996 to 2016. Using complete population records for Denmark, we derived prevalence, incidence, mortality and standardized mortality ratio (SMR). RESULTS The overall prevalence of diabetes at 2016 was 0.5% for T1D and 4.4% for T2D, with annual increases since 1996 of 0.5% for T1D and 5.5% for T2D. Incidence rates of T1D decreased by 3.5% per year, with increase for persons under 25 years of age and a decrease for older persons. T2D incidence increased 2.5% per year until 2011, decreased until 2014 and increased after that, similar in all ages. The annual decrease in mortality was 0.3% for T1D and 2.9% for T2D. The mortality rate ratio between T1D and T2D was 1.9 for men and 1.6 for women. SMR decreased annually 2% for T1D and 0.5% for T2D. CONCLUSIONS Incidence and prevalence of diabetes is increasing, but mortality among patients with diabetes in Denmark is decreasing faster than the mortality among persons without diabetes. T1D carries a 70% higher mortality than T2D.
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Affiliation(s)
- Bendix Carstensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Pernille Falberg Rønn
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Hovedstaden, Denmark
- Center for Health Research in Greenland, University of Southern Denmark Faculty of Health Sciences, Odense, Denmark
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Christensen MMB, Hommel EE, Jørgensen ME, Fleischer J, Hansen CS. Glycemic Variability and Diabetic Neuropathy in Young Adults With Type 1 Diabetes. Front Endocrinol (Lausanne) 2020; 11:644. [PMID: 33071962 PMCID: PMC7538646 DOI: 10.3389/fendo.2020.00644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Glycemic variability (GV) may attribute to the pathogenesis of diabetic neuropathy. The aim of this cross-sectional study was to investigate the association between GV and distal symmetric polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN) in a Danish population of young adults with type 1 diabetes. Methods: Young adults between 18 and 24 years with type 1 diabetes were included in this cross-sectional study. CAN was assessed by cardiovascular autonomic reflex tests (CARTs) and heart rate variability (HRV). DSPN was assessed by light pressure, pain and vibration perception, electrochemical skin conductance, sural nerve conduction velocity (SNCV), and amplitude potential (SNAP). GV were obtained by continuous glucose monitoring including coefficient of variation (CV), SD, continuous overall net glycemic action (CONGA), and mean amplitude of glucose excursions (MAGE). Results: The study comprised 133 young adults (43.6% males), mean age of 22 years (SD 1.6). Unadjusted, higher CV was associated with a decreased risk of sural nerve conduction (P = 0.03), abnormal SNAP (P = 0.04) and incidents of definite CAN (P = 0.04). Likewise, higher CONGA was associated with increasing incidents of subclinical DSPN (P = 0.03), abnormal SNAP (P = 0.01), and SNCV (P = 0.02). However, both associations were not statistically significant in the fully adjusted model. Higher MAGE was associated with slightly increasing measures of HRV (P = 0.03) but only when fully adjusted. When correcting for multiple tests significance was lost. A significant association was found between HbA1c and measures of both DSPN (P < 0.02) and HRV (P < 0.03) in fully adjusted models. Conclusions: No significant associations between GV and diabetic neuropathy were found after adjusting for risk factors and multiple tests. This suggests that GV may not be a risk factor for diabetic neuropathy in young adults with type 1 diabetes. However, long-term effects of GV excursions may still play a role in the pathogenic mechanisms leading to neuropathy in later life.
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Affiliation(s)
- Marie Mathilde Bjerg Christensen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- *Correspondence: Marie Mathilde Bjerg Christensen
| | | | - Marit Eika Jørgensen
- Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Population Health and Morbidity, Health in Greenland, University of Southern Denmark, Odense, Denmark
- Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
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Vistisen D, Andersen GS, Hulman A, Persson F, Rossing P, Jørgensen ME. Progressive Decline in Estimated Glomerular Filtration Rate in Patients With Diabetes After Moderate Loss in Kidney Function-Even Without Albuminuria. Diabetes Care 2019; 42:1886-1894. [PMID: 31221677 DOI: 10.2337/dc19-0349] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/24/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Persons with diabetes but no chronic kidney disease (CKD) and without albuminuria have the same age-related decline in kidney function as the background population. Whether this also applies following moderate loss in kidney function is unknown. We quantified the impact of albuminuria status on the development of estimated glomerular filtration rate (eGFR) trajectories following CKD stage 3 (CKD3) and assessed potential heterogeneous development patterns among the subgroup with normoalbuminuria. RESEARCH DESIGN AND METHODS We used repeated clinical measures during up to 16 years of follow-up in 935 persons with type 1 diabetes and 1,984 with type 2 diabetes. Trajectories of eGFR by diabetes type and albuminuria status following CKD3 were estimated with spline mixed-effects models with adjustment for relevant confounders. Latent class trajectory modeling was used to find distinct patterns of eGFR development in the subgroups with normoalbuminuria. RESULTS Mean annual declines in eGFR for normo-, micro- and macroalbuminuria the first 10 years following CKD3 were 1.9, 2.3, and 3.3 mL/min/1.73 m2 in type 1 diabetes and 1.9, 2.1, and 3.0 in type 2 diabetes, respectively. For normoalbuminuria, two distinct eGFR patterns were found, one with accelerated declining eGFR levels. This specific progression pattern was associated with less use of lipid-lowering treatment, renin-angiotensin system blockers, and other antihypertensive treatment. CONCLUSIONS Our results support a diabetes-dependent decline in kidney function without albuminuria following CKD3, with a subgroup showing a progressive decline. Furthermore, this group seems to be undertreated in terms of cardioprotective and renal protective treatment and suggests that increased attention should be drawn to normoalbuminuric diabetic kidney disease.
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Affiliation(s)
| | | | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus, Denmark.,Aarhus University, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | | | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark
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45
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Faerch K, Quist JS, Hulman A, Witte DR, Tabak AG, Brunner EJ, Kivimäki M, Jørgensen ME, Panda S, Vistisen D. Prospective association between late evening food consumption and risk of prediabetes and diabetes: the Whitehall II cohort study. Diabet Med 2019; 36:1256-1260. [PMID: 30897241 PMCID: PMC6754814 DOI: 10.1111/dme.13951] [Citation(s) in RCA: 3] [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] [Accepted: 03/18/2019] [Indexed: 12/15/2022]
Abstract
AIMS We examined whether late evening food consumption was prospectively associated with the risk of developing prediabetes or diabetes in a large observational study of individuals with normoglycaemia. METHODS Participants were 2642 men and women with normoglycaemia (HbA1c < 39 mmol/mol; < 5.7%) from the Whitehall II study. Time of last eating episode (TLEE) before the examination day was assessed at baseline. We studied the associations of TLEE with 5-year changes in HbA1c and risk of developing prediabetes or diabetes (HbA1c ≥ 39 mmol/mol; ≥ 5.7%). Potential heterogeneity in the association between TLEE and prediabetes or diabetes was examined using recursive partitioning modelling for time-to-event outcomes. RESULTS There was a tendency of an overall association of TLEE with change in HbA1c but with little effect size [β per 1-h increase in TLEE = 0.2 mmol/mol, 95% CI -0.0 to 0.3 (0.01%, -0.00 to 0.03); P = 0.055] and no association with the risk of developing prediabetes/diabetes (risk ratio per 1-h increase in TLEE = 1.03, 95% CI 0.94 to 1.13; P = 0.511). According to the recursive partitioning modelling, women with HbA1c ≤ 36 mmol/mol and TLEE after 21:00 had a 1.51 times (95% CI 1.16 to 1.93) higher 5-year risk of developing prediabetes or diabetes than those having their TLEE between 16:00 and 21:00 (35.4% vs. 23.5%; P = 0.003). CONCLUSIONS There was no overall association of TLEE with the development of prediabetes or diabetes in the Whitehall II population. However, explorative analyses suggested that eating late in the evening was associated with increased risk of developing prediabetes/diabetes among women with good glycaemic control. Whether restricting late evening food consumption is effective and feasible for the prevention of Type 2 diabetes needs testing in randomized controlled trials.
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Affiliation(s)
- K Faerch
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - J S Quist
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A Hulman
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - D R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - A G Tabak
- 1st Department of Internal Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - E J Brunner
- Department of Epidemiology & Public Health, University College London, London, UK
| | - M Kivimäki
- Department of Epidemiology & Public Health, University College London, London, UK
| | - M E Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Copenhagen, Denmark
| | - S Panda
- Salk Institute for Biological Studies, La Jolla, CA, USA
| | - D Vistisen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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46
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Hansen CS, Færch K, Jørgensen ME, Malik M, Witte DR, Brunner EJ, Tabák AG, Kivimäki M, Vistisen D. Heart Rate, Autonomic Function, and Future Changes in Glucose Metabolism in Individuals Without Diabetes: The Whitehall II Cohort Study. Diabetes Care 2019; 42:867-874. [PMID: 30940642 PMCID: PMC6905499 DOI: 10.2337/dc18-1838] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 08/31/2018] [Accepted: 01/22/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Autonomic nervous system dysfunction is associated with impaired glucose metabolism, but the temporality of this association remains unclear in individuals without diabetes. We investigated the association of autonomic function with 5-year changes in glucose metabolism in individuals without diabetes. RESEARCH DESIGN AND METHODS Analyses were based on 9,000 person-examinations for 3,631 participants without diabetes in the Whitehall II cohort. Measures of autonomic function included 5-min resting heart rate and six heart rate variability (HRV) indices. Associations between baseline autonomic function measures and 5-year changes in fasting and 2-h plasma glucose, serum insulin concentrations, insulin sensitivity (insulin sensitivity index [ISI0-120] and HOMA of insulin sensitivity), and β-cell function (HOMA of β-cell function) were estimated in models adjusting for age, sex, ethnicity, metabolic factors, and medication. RESULTS A 10-bpm higher resting heart rate was associated with 5-year changes in fasting and 2-h insulin and ISI0-120 of 3.3% change (95% CI 1.8; 4.8), P < 0.001; 3.3% change (1.3; 5.3), P = 0.001; and -1.4% change (-2.4; -0.3), P = 0.009, respectively. In models adjusted for age, sex, and ethnicity, higher baseline values of several HRV indices were associated with a 5-year decrease in fasting and 2-h insulin and ISI0-120. However, significance was lost by full adjustment. A majority of HRV indices exhibited a trend toward higher values being associated with lower insulin levels and higher insulin sensitivity. CONCLUSIONS Higher resting heart rate in individuals without diabetes is associated with future unfavorable changes in insulin levels and insulin sensitivity. Associations may be mediated via autonomic function; however, results are inconclusive. Resting heart rate may be a risk marker for future pathophysiological changes in glucose metabolism.
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Affiliation(s)
| | | | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- National Institute of Public Health, Southern Denmark University, Odense, Denmark
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, U.K
| | - Daniel R Witte
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, U.K
| | - Adam G Tabák
- Department of Epidemiology and Public Health, University College London, London, U.K
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, U.K
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Pedersen ML, Lind O, Abelsen T, Olesen J, Jørgensen ME. Gestational diabetes and macrosomia among Greenlanders. Time to change diagnostic strategy? Int J Circumpolar Health 2019; 77:1528126. [PMID: 30300118 PMCID: PMC6179052 DOI: 10.1080/22423982.2018.1528126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a serious condition associated to both maternal and offspring complications. Yet, no globally accepted consensus exists on how to test and diagnose GDM. In Greenland, the clinical criteria for testing and diagnosing GDM are adapted from Danish guidelines. The aim of this study was to estimate the prevalence of GDM among Greenlanders using both the current clinical GDM criteria and the recent WHO 2013 criteria and, further, to study the association between GDM, pre-pregnant overweight or obesity and macrosomia. A cross-sectional study of all 450 Greenlandic women who gave birth to a singleton in Nuuk within 1 year was performed. Based on an oral glucose tolerance test measuring capillary whole blood glucose, 119 women were categorised as having clinical GDM, WHO 2013 GDM or not GDM. Macrosomia defined as birth weight above 4,000 g was used as outcome variable. The prevalence of clinical GDM and WHO 2013 GDM was 0.4% (95% CI; 0-1.1) and 6.9% (95% CI; 4.5-9.2). WHO 2013 GDM, fasting blood glucose, pre-pregnant maternal overweight and obesity were associated with macrosomia. WHO 2013 GDM criteria were superior to clinical criteria in predicting macrosomia indicating that it may be time to consider the diagnostic strategy used in Greenland. Pre-pregnant overweight may also need more intensified lifestyle-intervention. ABBREVIATIONS GDM: Gestational diabetes mellitus; VP: venous plasma; CWB: capillary whole blood; OGTT: oral glucose tolerance test; WHO: World Health Organisation; FIGO: The International Federation of Gynaecology and Obstetrics; BMI: body mass index; GA: gestational age.
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Affiliation(s)
- Michael Lynge Pedersen
- a Queen Ingrid Primary Health Care Center , Nuuk , Greenland.,b Greenland Center of Health Research, Institute of Nursing and Health Science , University of Greenland , Nuuk , Greenland
| | - Ole Lind
- c Department of Gynaecology and Obstetrics , Queen Ingrid Hospital , Nuuk , Greenland
| | - Trine Abelsen
- a Queen Ingrid Primary Health Care Center , Nuuk , Greenland
| | - Jesper Olesen
- a Queen Ingrid Primary Health Care Center , Nuuk , Greenland
| | - Marit Eika Jørgensen
- b Greenland Center of Health Research, Institute of Nursing and Health Science , University of Greenland , Nuuk , Greenland.,d Steno Diabetes Center Copenhage , Gentofte , Denmark
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48
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Rønn PF, Jørgensen ME, Smith LS, Bjerregaard P, Dahl-Petersen IK, Larsen CVL, Grarup N, Andersen GS. Associations between birth weight and glucose intolerance in adulthood among Greenlandic Inuit. Diabetes Res Clin Pract 2019; 150:129-137. [PMID: 30851284 DOI: 10.1016/j.diabres.2019.03.005] [Citation(s) in RCA: 4] [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: 10/04/2018] [Revised: 02/15/2019] [Accepted: 03/01/2019] [Indexed: 01/09/2023]
Abstract
AIMS To examine the association between birth weight and glucose intolerance in adult Greenlandic Inuit. METHODS We examined 1429 participants aged 18-56 years from two population-based, cross-sectional studies in Greenland with information on birth weight. Oral glucose tolerance tests, anthropometric measures and ultrasound of abdominal tissue were performed. Associations of birth weight with glucose markers were analysed using linear or logistic regressions. Spline analyses were conducted to examine u-shaped associations. Adjustments were done for age, sex, birth place, family history of diabetes, genetic admixture, TBC1D4 p.Arg684Ter carrier status, BMI and visceral adipose tissue. RESULTS The median birthweight was 3300 g and 3.9% had type 2 diabetes, T2DM. Spline analyses indicated overall linear associations. In fully adjusted analyses, an increase in birth weight of 1 kg was associated with a change in fasting plasma glucose of -0.06 mmol/L (95%CI: -0.11, -0.01), 2-h plasma glucose of -0.16 mmol/L (95%CI: -0.35, 0.02), HOMA-IR of -5.45% (95%CI: -10.34, -0.29), insulin sensitivity index of 7.04% (95%CI: 1.88, 12.45) and a trend towards a reduced risk of hyperglycaemia and T2DM, although statistically insignificant. CONCLUSIONS Birth weight was inversely associated with hepatic and peripheral insulin resistance independently of adult adiposity. Thus, the findings support low birth weight as a contributing factor for glucose intolerance in adult Inuit in Greenland.
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Affiliation(s)
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; University of Greenland, Greenland
| | | | - Peter Bjerregaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; University of Greenland, Greenland
| | - Inger Katrine Dahl-Petersen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; University of Greenland, Greenland
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Dalsgaard EM, Witte DR, Charles M, Jørgensen ME, Lauritzen T, Sandbæk A. Validity of Danish register diagnoses of myocardial infarction and stroke against experts in people with screen-detected diabetes. BMC Public Health 2019; 19:228. [PMID: 30795763 PMCID: PMC6387546 DOI: 10.1186/s12889-019-6549-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/09/2018] [Accepted: 02/15/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Administrative patient registers are often used to estimate morbidity in epidemiological studies. The validity of register data is thus important. This study aims to assess the positive predictive value of myocardial infarction and stroke registered in the Danish National Patient Register, and to examine the association between cardiovascular risk factors and cardiovascular disease based on register data or validated diagnoses in a well-defined diabetes population. METHODS We included 1533 individuals found with screen-detected type 2 diabetes in the ADDITION-Denmark study in 2001-2006. All individuals were followed for cardiovascular outcomes until the end of 2014. Hospital discharge codes for myocardial infarction and stroke were identified in the Danish National Patient Register. Hospital medical records and other clinically relevant information were collected and an independent adjudication committee evaluated all possible events. The positive predictive value for myocardial infarction and stroke were calculated as the proportion of cases recorded in the Danish National Patient Register confirmed by the adjudication committee. RESULTS The positive predictive value was 75% (95% CI: 64;84) for MI and 70% (95% CI: 54;80) for stroke. The association between cardiovascular risk factors and incident cardiovascular disease did not depend on using register-based or verified diagnoses. However, a tendency was seen towards stronger associations when using verified diagnoses. CONCLUSIONS Our results show that studies using only register-based diagnoses are likely to misclassify cardiovascular outcomes. Moreover, the results suggest that the magnitude of associations between cardiovascular risk factors and cardiovascular outcomes may be underestimated when using register-based diagnoses.
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Affiliation(s)
- Else-Marie Dalsgaard
- Department of Public Health, Aarhus University, Bartholins allé 2, DK-8000, Aarhus C, Denmark.
| | - Daniel Rinse Witte
- Department of Public Health, Aarhus University and Danish Diabetes Academy, Odense, Denmark
| | - Morten Charles
- Department of Public Health, Aarhus University, Bartholins allé 2, DK-8000, Aarhus C, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Copenhagen, Denmark
| | - Torsten Lauritzen
- Department of Public Health, Aarhus University, Bartholins allé 2, DK-8000, Aarhus C, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University and Steno Diabetes Center, Aarhus, Denmark
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50
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Tvermosegaard M, Rønn PF, Pedersen ML, Bjerregaard P, Dahl Pedersen I, Larsen CVL, Jørgensen ME. Validation of cardiovascular diagnoses in the Greenlandic Hospital Discharge Register for epidemiological use. Int J Circumpolar Health 2019; 77:1422668. [PMID: 29384037 PMCID: PMC5795743 DOI: 10.1080/22423982.2017.1422668] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Cardiovascular disease (CVD) is one of the leading causes of death worldwide. In Greenland, valid estimates of prevalence and incidence of CVD do not exist and can only be calculated if diagnoses of CVD in the Greenlandic Hospital Discharge Register (GHDR) are correct. Diagnoses of CVD in GHDR have not previously been validated specifically. The objective of the study was to validate diagnoses of CVD in GHDR. The study was conducted as a validation study with primary investigator comparing information in GHDR with information in medical records. Diagnoses in GHDR were considered correct and thus valid if they matched the diagnoses or the medical information in the medical records. A total of 432 online accessible medical records with a cardiovascular diagnosis according to GHDR from Queen Ingrid's Hospital from 2001 to 2013 (n=291) and from local health care centres from 2007 to 2013 (n=141) were reviewed. Ninety-nine and ninety-two percent of discharge diagnosis in GHDR from Queen Ingrid's Hospital and local health care centres were correct in comparison with diagnoses in the medical record indicating valid registration practice. The correctness of cardiovascular diagnoses in GHDR was considered high in terms of acceptable agreement between medical records and diagnoses in GHDR. Cardiovascular diagnoses are valid for epidemiological use.
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Affiliation(s)
- Maria Tvermosegaard
- a Centre for Health Research in Greenland, National Institute of Public Health , Faculty of Health Science, University of Southern Denmark , Copenhagen , Denmark.,b Steno Diabetes Centre Copenhagen , Gentofte , Denmark
| | - Pernille Falberg Rønn
- b Steno Diabetes Centre Copenhagen , Gentofte , Denmark.,c Arctic Research Centre , Aarhus University , Aarhus , Denmark
| | - Michael Lynge Pedersen
- d Greenland Centre of Health Research , University of Greenland , Nuuk , Greenland.,e Queen Ingrid Primary Health Care Centre , Nuuk , Greenland
| | - Peter Bjerregaard
- a Centre for Health Research in Greenland, National Institute of Public Health , Faculty of Health Science, University of Southern Denmark , Copenhagen , Denmark.,d Greenland Centre of Health Research , University of Greenland , Nuuk , Greenland
| | - Inger Dahl Pedersen
- a Centre for Health Research in Greenland, National Institute of Public Health , Faculty of Health Science, University of Southern Denmark , Copenhagen , Denmark
| | - Christina Viskum Lytken Larsen
- a Centre for Health Research in Greenland, National Institute of Public Health , Faculty of Health Science, University of Southern Denmark , Copenhagen , Denmark
| | - Marit Eika Jørgensen
- a Centre for Health Research in Greenland, National Institute of Public Health , Faculty of Health Science, University of Southern Denmark , Copenhagen , Denmark.,b Steno Diabetes Centre Copenhagen , Gentofte , Denmark.,d Greenland Centre of Health Research , University of Greenland , Nuuk , Greenland
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