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Medici BB, Nygaard B, la Cour JL, Grand MK, Siersma V, Nicolaisdottir DR, Lind B, Olivarius NDF, Andersen CL. Changes in Prescription Routines for Treating Hypothyroidism Between 2001 and 2015: An Observational Study of 929,684 Primary Care Patients in Copenhagen. Thyroid 2019; 29:910-919. [PMID: 31017048 DOI: 10.1089/thy.2018.0539] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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] [Indexed: 12/11/2022]
Abstract
Background: Increased public attention toward health and quality-of-life issues has led to more intensified screening for various medical conditions, including hypothyroidism. A falling serum thyrotropin (s-TSH) at initiation of levothyroxine (LT4) treatment has been reported in the United Kingdom between 2001 and 2009, indicating a falling TSH threshold, which may lead to less benefit from therapy and possibly overtreatment. The aim of this study was to investigate changes in s-TSH threshold used by general practitioners to initiate LT4 therapy between 2001 and 2015 in Copenhagen. Methods: Retrospective analysis was conducted of all s-TSH measurements between 2001 and 2015 performed at the general practitioners' joint laboratory merged with The Danish Register of Medicinal Products Statistics and The Danish National Patient Registry. For each year, both the median s-TSH at therapy initiation and the estimated treatment threshold were calculated from all s-TSH measurements performed in that year, representing the s-TSH level where the estimated probability of starting LT4 therapy was 50%. Results: A total of 929,684 individuals with 2,975,277 s-TSH measurements were included in the calculations. The size and composition of the study population remained virtually unchanged. During the study period, the number of performed s-TSH measurements increased from 110,886 to 292,911 (164%), and the number of patients initiating LT4 therapy increased from 786 to 1825 (132%), though this was comparably unchanged from 2010 to 2015. The median s-TSH at therapy initiation decreased from 10 mIU/L (interquartile range 5.2-29.7 mIU/L) in 2001 to 6.8 mIU/L (interquartile range 5.1-11 mIU/L) in 2015, while the estimated treatment threshold decreased from 28.3 mIU/L [confidence interval 21.0-40.2 mIU/L] in 2001 to 14.2 mIU/L [confidence interval 12.0-18.0 mIU/L] in 2007. In 2015, 25% of patients started LT4 therapy with s-TSH ≤5 mIU/L, and during the entire period, 50% of patients started therapy with a single s-TSH measurement >5 mIU/L. Conclusions: This study performed on a sizeable primary care population demonstrates a considerable fall in the threshold for initiating LT4 therapy in hypothyroid patients. This increases the risk of futile treatment as well as overtreatment.
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Affiliation(s)
- Bjarke Borregaard Medici
- 1Center for Endocrinology and Metabolism, Department Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Birte Nygaard
- 1Center for Endocrinology and Metabolism, Department Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Jeppe Lerche la Cour
- 1Center for Endocrinology and Metabolism, Department Internal Medicine, Herlev and Gentofte Hospitals, Herlev, Denmark
| | - Mia Klinten Grand
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dagny Ros Nicolaisdottir
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Lind
- 3Department of Clinical Biochemistry, Amager Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Niels de Fine Olivarius
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- 2The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- 4Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
- 5Department of Hematology, Rigshospitalet, Copenhagen, Denmark
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Abstract
BACKGROUND Survival from many cancer types is steadily increasing, and as a result, a growing number of cancer patients will live with other chronic diseases, of which diabetes is one of the most prevalent. This study aims to describe the impact of cancer on health outcomes in patients with type 2 diabetes and to compare the effectiveness of a multifactorial intervention in diabetes patients with and without cancer. METHODS The randomized controlled trial Diabetes Care in General Practice (DCGP) included 1381 patients newly diagnosed with type 2 diabetes. Patients were randomized to either six years of structured personal diabetes care or routine care. In a post hoc analysis, we followed patients for 19 years in Danish national registries for the occurrence of diabetes-related outcomes. We used Cox regression models to estimate hazard ratios for outcomes. RESULTS At diagnosis 48 patients had cancer, and 243 patients were diagnosed with cancer during follow up. Patients with diabetes and cancer had excess all-cause mortality (HR 3.33; 95%CI 2.72-4.06), as well as an increased incidence of myocardial infarction (HR 1.76; 95%CI 1.29-2.39) and any diabetes-related outcome (HR 1.36; 95%CI 1.07-1.71). The intervention reduced the risk of both these endpoints in patients without cancer. Furthermore, there was no statistically significant difference in the effectiveness of the intervention among patients with and without cancer. CONCLUSIONS Diabetes patients with cancer had an increased risk of myocardial infarction and any diabetes-related outcome. The observed positive effect of structured personal diabetes care on clinical outcomes did not differ between patients with and without cancer. Attention to and prevention of diabetes complications in patients with both type 2 diabetes and cancer is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01074762 (February 24, 2010).
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Affiliation(s)
- Anne Beiter Arreskov
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Maria Å. Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Sandra Sinius Pouplier
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Christen L. Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014 Copenhagen K, Denmark
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Hejl JL, Grand MK, Siersma V, Goetze JP, de Fine Olivarius N, Andersen CL, Lind B. In Reply. Clin Chem 2019; 65:812-813. [PMID: 30917971 DOI: 10.1373/clinchem.2019.302034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Julie L Hejl
- Department of Clinical Biochemistry Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Mia K Grand
- The Copenhagen Primary Care Laboratory (CopLab) Database Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen, Denmark
| | - Volkert Siersma
- The Copenhagen Primary Care Laboratory (CopLab) Database Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Biomedical Sciences Faculty of Health and Medical Sciences University of Copenhagen Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Copenhagen Primary Care Laboratory (CopLab) Database Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen, Denmark
| | - Christen L Andersen
- The Copenhagen Primary Care Laboratory (CopLab) Database Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen, Denmark
| | - Bent Lind
- Department of Clinical Biochemistry Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Kjaer LK, Grand MK, Siersma V, Broedbaek K, Jorgensen A, de Fine Olivarius N, Poulsen HE. The effect of structured personal care on RNA oxidation: A 19-year follow-up of the randomized trial Diabetes Care in General Practice (DCGP). J Diabetes Complications 2019; 33:202-207. [PMID: 30638771 DOI: 10.1016/j.jdiacomp.2018.12.004] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 12/12/2022]
Abstract
AIMS The urinary marker of RNA oxidation, 8‑oxo‑7,8‑dihydroguanosine (8-oxoGuo), but not the corresponding marker of DNA oxidation, 8‑oxo‑7,8‑dihydro‑2'‑deoxyguanosine (8-oxodG), is a prognostic biomarker in patients with type 2 diabetes (T2D). The aim of the present study was to investigate the effect of structured personal care (individualized multifactorial treatment) versus standard care on RNA oxidation level in patients with T2D and to assess if the effect of structured personal care on all-cause and diabetes-related mortality was modified by RNA oxidation level. METHODS Urine samples were analyzed for 8-oxoGuo/8-oxodG from 1381 newly diagnosed T2D patients from the cluster randomized trial Diabetes Care in General Practice cohort, and 970 patients were reexamined after six years of intervention. RESULTS The yearly variation in RNA oxidation levels were not significantly different between the structured personal care group and standard care group. The effect of treatment on all-cause and diabetes-related mortality was not modified by the level of RNA oxidation. No changes in DNA oxidation were seen. CONCLUSIONS Structured personal care does not influence RNA oxidation level nor is it better for patients with high RNA oxidation level. Thus, structured personal care may not impact the disease-related aspects identified by RNA oxidation level in T2D patients.
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Affiliation(s)
- Laura Kofoed Kjaer
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Mia Klinten Grand
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Broedbaek
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Anders Jorgensen
- Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region of Denmark, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Siersma V, Køster-Rasmussen R, Bruun C, Olivarius NDF, Brunes A. Visual impairment and mortality in patients with type 2 diabetes. BMJ Open Diabetes Res Care 2019; 7:e000638. [PMID: 31749968 PMCID: PMC6827812 DOI: 10.1136/bmjdrc-2018-000638] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To evaluate whether visual acuity impairment was an independent predictor of mortality in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS This is a 19-year follow-up of a cohort of 1241 patients newly diagnosed with type 2 diabetes and aged 40 years or over. Visual acuity was assessed by practicing ophthalmologists both at diabetes diagnosis and after 6 years. The logarithmic value of the visual acuity (logMAR) was the exposure. Multivariable Cox regression models were adjusted for multiple potential confounders including cardiovascular disease, and censored for potential mediators, that is, fractures/trauma. Primary outcomes were from national registers: all-cause mortality and diabetes-related mortality. RESULTS Visual impairment at diabetes diagnosis was robustly associated with subsequent 6-year all-cause mortality. Per 1 unit reduced logMAR acuity the incidence rate of all-cause mortality increased with 51% (adjusted HR: 1.51; 95% CI 1.12 to 2.03) and of fractures/trauma with 59% (HR: 1.59; 95% CI 1.18 to 2.15), but visual acuity was not associated with diabetes-related mortality. After censoring for fractures/trauma, visual acuity was still an independent risk factor for all-cause mortality (HR: 1.68; 95% CI 1.23 to 2.30). In contrast, visual acuity 6 years after diabetes diagnosis was not associated with the subsequent 13 years' incidence of any of the outcomes, as an apparent association with all-cause mortality and diabetes-related mortality was explained by confounding from comorbidity. CONCLUSIONS Visual acuity measured by ophthalmologists in patients newly diagnosed with type 2 diabetes was an independent predictor of mortality in the short term.
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Affiliation(s)
- Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Køster-Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christine Bruun
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Audun Brunes
- Section for Trauma, Catastrophes and Forced Migration–Adults and Elderly, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
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Hejl JL, Grand MK, Siersma V, Goetze JP, de Fine Olivarius N, Andersen CL, Lind B. Brain Natriuretic Peptide in Plasma as Predictor of All-Cause Mortality in a Large Danish Primary Health Care Population Suspected of Heart Failure. Clin Chem 2018; 64:1723-1731. [DOI: 10.1373/clinchem.2018.293480] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/21/2018] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Measurement of B-type natriuretic peptide (BNP) in plasma may have its greatest potential in primary care, as general practitioners need to rapidly identify patients who warrant further medical review. The aim of the present study was to examine the prognostic information of BNP measurement on all-cause mortality in a large Danish primary care cohort.
METHODS
This study covered a cohort of Danish primary care patients (n = 61665) with a median follow-up period of 4.36 years (interquartile range, 2.29–6.62 years). BNP was measured in plasma using the ADVIA Centaur/CentaurXP platform. The association of BNP with mortality was assessed with a hazard ratio for all-cause mortality from a multivariable Cox proportional hazards model.
RESULTS
Kaplan–Meier curves showed decreasing survival probability with increasing BNP (P < 0.001). Each doubling of BNP increased mortality by 32.3% (95% CI, 30.8–33.8) when adjusted for sex and age, and by 25.3% (95% CI, 23.8–26.8) when further adjusted for Charlson comorbidity index, hemoglobin, estimated glomerular filtration rate, glycohemoglobin, and thyroid-stimulating hormone. Also, in a subcohort (n = 10824) without biochemical signs of severe kidney failure, anemia, polycythemia, hypothyroidism or hyperthyroidism, or dysregulated diabetes, each doubling of BNP increased mortality by 28.6% (95% CI, 22.8–34.7).
CONCLUSIONS
Our results show that even in a primary care population, BNP measurements contain prognostic information regarding all-cause mortality.
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Affiliation(s)
- Julie L Hejl
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Mia K Grand
- Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen L Andersen
- Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bent Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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Pouplier S, Olsen MÅ, Willadsen TG, Sandholdt H, Siersma V, Andersen CL, Olivarius NDF. The development of multimorbidity during 16 years after diagnosis of type 2 diabetes. J Comorb 2018; 8:2235042X18801658. [PMID: 30363325 PMCID: PMC6169975 DOI: 10.1177/2235042x18801658] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
Abstract
Objective: The aims of this study were to (1) quantify the development and composition
of multimorbidity (MM) during 16 years following the diagnosis of type 2
diabetes and (2) evaluate whether the effectiveness of structured personal
diabetes care differed between patients with and without MM. Research design and methods: One thousand three hundred eighty-one patients with newly diagnosed type 2
diabetes were randomized to receive either structured personal diabetes care
or routine diabetes care. Patients were followed up for 19 years in Danish
nationwide registries for the occurrence of outcomes. We analyzed the
prevalence and degree of MM based on 10 well-defined disease groups. The
effect of structured personal care in diabetes patients with and without MM
was analyzed with Cox regression models. Results: The proportion of patients with MM increased from 31.6% at diabetes diagnosis
to 80.4% after 16 years. The proportion of cardiovascular and
gastrointestinal diseases in surviving patients decreased, while, for
example, musculoskeletal, eye, and neurological diseases increased. The
effect of the intervention was not different between type 2 diabetes
patients with or without coexisting chronic disease. Conclusions: In general, the proportion of patients with MM increased after diabetes
diagnosis, but the composition of chronic disease changed during the 16
years. We found cardiovascular and musculoskeletal disease to be the most
prevalent disease groups during all 16 years of follow-up. The post hoc
analysis of the intervention showed that its effectiveness was not different
among patients who developed MM compared to those who continued to have
diabetes alone.
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Affiliation(s)
- Sandra Pouplier
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Åhlander Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Håkon Sandholdt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Willadsen TG, Siersma V, Nielsen ABS, Køster-Rasmussen R, Guassora AD, Jarbøl DE, Eusebi P, Malterud K, Reventlow S, de Fine Olivarius N. The effect of structured personal care on diabetes symptoms and self-rated health over 14 years after diabetes diagnosis. Prim Care Diabetes 2018; 12:354-363. [PMID: 29705674 DOI: 10.1016/j.pcd.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
Abstract
AIMS To explore the effect of structured personal care on diabetes symptoms and self-rated health over 14 years after diabetes diagnosis while patients are gradually diagnosed with other chronic conditions (multimorbidity). METHODS Post hoc analysis of the Danish randomized controlled trial Diabetes Care in General Practice including 1381 patients newly diagnosed with type 2 diabetes. The effect of structured personal care compared with routine care on diabetes symptoms and self-rated health was analysed 6 and 14 years after diagnosis with a generalized multilevel Rasch model. RESULTS Structured personal care reduced the overall likelihood of reporting diabetes symptoms at the end of the intervention (OR 0.79; 95% CI: 0.64-0.97), but this effect was not explained by glycaemic control or multimorbidity. There was no effect of the intervention on diabetes symptoms after 14 years or on self-rated health after 6 years or 14 years. CONCLUSIONS Structured personal care had a beneficial effect on diabetes symptoms 6 years after diagnosis, but not on self-rated health at either follow up point. To optimally manage patients over time it is important to supplement clinical information by information provided by the patients.
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Affiliation(s)
- Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anni Brit Sternhagen Nielsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Køster-Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Paolo Eusebi
- Section of Neurology, Department of Medicine, University of Perugia, Perugia, Italy; Health Planning Service, Department of Epidemiology, Regional Health Authority of Umbria, Perugia, Italy
| | - Kirsti Malterud
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Research Unit for General Practice, Uni Research Health, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Jorgensen A, Siersma V, Davidsen AS, Weimann A, Henriksen T, Poulsen HE, Olivarius NDF. Markers of DNA/RNA damage from oxidation as predictors of a registry-based diagnosis of psychiatric illness in type 2 diabetic patients. Psychiatry Res 2018; 259:370-376. [PMID: 29120845 DOI: 10.1016/j.psychres.2017.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 12/18/2022]
Abstract
Oxidative stress is a potential biological mediator of the higher rates of psychiatric illness (PI) observed after the onset of type 2 diabetes (T2DM). We investigated validated urinary markers of systemic DNA/RNA damage from oxidation (8-oxodG/8-oxoGuo respectively) as predictors of incident PI in a cohort of 1381 newly diagnosed T2DM patients, who were followed prospectively for a total of 19 years after diagnosis. Psychiatric diagnoses were from Danish national registries. Patients were examined at the time of diagnosis and at a 6-year follow-up. At baseline, 8-oxodG was slightly lower in PI vs. non-PI patients, while at 6-year follow-up, 8-oxoGuo was significantly higher in PI patients. Using Cox proportional hazard models, we found that higher levels of 8-oxodG at 6-year follow-up significantly predicted lower incidence of PI after the adjustment for confounders. In a subgroup analysis, this association was most predominant in minor PIs (unipolar depression and anxiety) compared to major PIs such as schizophrenia and bipolar disorder. These observations indicate that higher levels of systemic oxidative stress are not associated with a higher risk of PI after T2DM onset. Only PI patients treated in hospital care were included in the registries, and the conclusion thus only applies to these individuals.
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Affiliation(s)
- Anders Jorgensen
- Psychiatric Center Copenhagen (Rigshospitalet), Mental Health Services of the Capital Region, Copenhagen, Denmark.
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Annette S Davidsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Allan Weimann
- Laboratory of Clinical Pharmacology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Trine Henriksen
- Laboratory of Clinical Pharmacology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Henrik E Poulsen
- Laboratory of Clinical Pharmacology, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Pharmacology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Denmark
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Heltberg A, Siersma V, Andersen JS, Ellervik C, Brønnum-Hansen H, Kragstrup J, de Fine Olivarius N. Socio-demographic determinants and effect of structured personal diabetes care: a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP). BMC Endocr Disord 2017; 17:75. [PMID: 29216868 PMCID: PMC5721594 DOI: 10.1186/s12902-017-0227-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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated how four aspects of socio-demography influence the effectiveness of an intervention with structured personal diabetes care on long-term outcomes. METHODS The Diabetes Care in General Practice (DCGP) study is a cluster-randomized trial involving a population-based sample of 1381 patients with newly diagnosed type 2-diabetes mellitus. We investigated how education, employment, cohabitation status and residence influenced the effectiveness of 6 years of intervention with structured personal diabetes care, resembling present day recommendations. Outcomes were incidence of any diabetes-related endpoint and death during 19 years after diagnosis, and cardiovascular risk factors, behaviour, attitudes and process-of-care variables 6 years after diagnosis. RESULTS Structured personal care reduced the risk of any diabetes-related endpoint and the effect of the intervention was modified by geographical area (interaction p = 0.034) with HR of 0.71 (95%CI: 0.60-0.85) and of 1.07 (95%CI: 0.77-1.48), for patients in urban and rural areas, respectively. Otherwise, there was no effect modification of education, employment and civil status on the intervention for the final endpoints. There were no noticeable socio-demographic differences in the effect of the intervention on cardiovascular risk factors, behaviour, attitudes, and process-of-care. CONCLUSION Structured personal care reduced the aggregate outcome of any diabetes-related endpoint and independent of socio-demographic factors similar effect on cardiovascular risk factors, behaviour, attitudes and process of care, but the intervention did not change the existing inequity in mortality and morbidity. Residence modified the uptake of the intervention with patients living in urban areas having more to gain of the intervention than rural patients, further investigations is warranted. TRIAL REGISTRATION ClinicalTrials.gov registration no. NCT01074762 (February 24, 2010).
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Affiliation(s)
- Andreas Heltberg
- Section of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Production, Research, and Innovation, Sorø, Region Zealand Denmark
| | - Volkert Siersma
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Sahl Andersen
- Section of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - Christina Ellervik
- Department of Production, Research, and Innovation, Sorø, Region Zealand Denmark
- Department of Laboratory Medicine, Boston Children’s Hospital Study, Boston, MA USA
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Kragstrup
- Section of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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11
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Hansen JW, Sandholdt H, Siersma V, Ørskov AD, Holmberg S, Bjerrum OW, Hasselbalch HC, Olivarius NDF, Grønbaek K, Andersen CL. Anemia is present years before myelodysplastic syndrome diagnosis: Results from the pre-diagnostic period. Am J Hematol 2017; 92:E130-E132. [PMID: 28383148 DOI: 10.1002/ajh.24757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Jakob Werner Hansen
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Håkon Sandholdt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Andreas Due Ørskov
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Staffan Holmberg
- Department of Hematology; Herlev Hospital, University of Copenhagen; Copenhagen Denmark
| | - Ole Weis Bjerrum
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Hans Carl Hasselbalch
- Department of Hematology; Roskilde Hospital, University of Copenhagen; Copenhagen Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Kirsten Grønbaek
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Christen Lykkegaard Andersen
- Department of Hematology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health; University of Copenhagen; Copenhagen Denmark
- Department of Hematology; Roskilde Hospital, University of Copenhagen; Copenhagen Denmark
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Broedbaek K, Køster-Rasmussen R, Siersma V, Persson F, Poulsen HE, de Fine Olivarius N. Urinary albumin and 8-oxo-7,8-dihydroguanosine as markers of mortality and cardiovascular disease during 19 years after diagnosis of type 2 diabetes - A comparative study of two markers to identify high risk patients. Redox Biol 2017; 13:363-369. [PMID: 28666207 PMCID: PMC5491453 DOI: 10.1016/j.redox.2017.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/10/2017] [Accepted: 06/14/2017] [Indexed: 10/27/2022] Open
Abstract
Urinary albumin is an important biomarker used to identify high risk patients with diabetes, but there is a need for new biomarkers that alone or in combination with urinary albumin could give an even better prediction of clinical patient outcomes. One promising biomarker is 8-oxo-7,8-dihydroguanosine (8-oxoGuo) that represents intracellular oxidative stress. We investigated the ability of microalbuminuria (MA) and urinary 8-oxoGuo, alone and in combination, to predict mortality and cardiovascular disease (CVD) in patients with type 2 diabetes. We used data from 1381 newly diagnosed diabetes patients, and urinary albumin and 8-oxoGuo were assessed in morning urine collected at the time of diabetes diagnosis and at a follow-up visit 6 years later. Associations between the urinary markers and mortality and CVD were assessed in Cox proportional hazards regression models. Test performance was assessed using sensitivity, specificity, positive predictive value and negative predictive value for 10-year mortality and 10-year incidence of CVD. Both 8-oxoGuo and urinary albumin were statistically significantly associated with all-cause mortality at diagnosis as well as at 6-year follow-up. At diagnosis only urinary albumin was associated with CVD. In contrast, only 8-oxoGuo was associated with CVD at 6-year follow-up. When investigating test performance, we found that by combining information from MA and 8-oxoGuo the ability to correctly identify patients at risk could be improved. The findings suggest that measurement of urinary 8-oxoGuo provides additional information about risk to that obtained from urinary albumin, and that the combined use of 8-oxoGuo and urinary albumin could be useful for a better identification of patients at risk of CVD and death.
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Affiliation(s)
- Kasper Broedbaek
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark; Denmark Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark.
| | - Rasmus Køster-Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik E Poulsen
- Denmark Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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13
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Willadsen TG, Bebe A, Køster-Rasmussen R, Jarbøl DE, Guassora AD, Waldorff FB, Reventlow S, Olivarius NDF. The role of diseases, risk factors and symptoms in the definition of multimorbidity - a systematic review. Scand J Prim Health Care 2016; 34:112-21. [PMID: 26954365 PMCID: PMC4977932 DOI: 10.3109/02813432.2016.1153242] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
UNLABELLED Objective is to explore how multimorbidity is defined in the scientific literature, with a focus on the roles of diseases, risk factors, and symptoms in the definitions. DESIGN Systematic review. METHODS MEDLINE (PubMed), Embase, and The Cochrane Library were searched for relevant publications up until October 2013. One author extracted the information. Ambiguities were resolved, and consensus reached with one co-author. Outcome measures were: cut-off point for the number of conditions included in the definitions of multimorbidity; setting; data sources; number, kind, duration, and severity of diagnoses, risk factors, and symptoms. We reviewed 163 articles. In 61 articles (37%), the cut-off point for multimorbidity was two or more conditions (diseases, risk factors, or symptoms). The most frequently used setting was the general population (68 articles, 42%), and primary care (41 articles, 25%). Sources of data were primarily self-reports (56 articles, 42%). Out of the 163 articles selected, 115 had individually constructed multimorbidity definitions, and in these articles diseases occurred in all definitions, with diabetes as the most frequent. Risk factors occurred in 98 (85%) and symptoms in 71 (62%) of the definitions. The severity of conditions was used in 26 (23%) of the definitions, but in different ways. The definition of multimorbidity is heterogeneous and risk factors are more often included than symptoms. The severity of conditions is seldom included. Since the number of people living with multimorbidity is increasing there is a need to develop a concept of multimorbidity that is more useful in daily clinical work. Key points The increasing number of multimorbidity patients challenges the healthcare system. The concept of multimorbidity needs further discussion in order to be implemented in daily clinical practice. Many definitions of multimorbidity exist and most often a cut-off point of two or more is applied to a range of 4-147 different conditions. Diseases are included in all definitions of multimorbidity. Risk factors are often included in existing definitions, whereas symptoms and the severity of the conditions are less frequently included.
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Affiliation(s)
- Tora Grauers Willadsen
- a The Research Unit for General Practice and Department of General Practice , Department of Public Health, University of Copenhagen , Copenhagen , Denmark
- b The Lolland Falster Population Study (LOFUS) , Nykøbing F , Denmark
| | - Anna Bebe
- a The Research Unit for General Practice and Department of General Practice , Department of Public Health, University of Copenhagen , Copenhagen , Denmark
- b The Lolland Falster Population Study (LOFUS) , Nykøbing F , Denmark
| | - Rasmus Køster-Rasmussen
- a The Research Unit for General Practice and Department of General Practice , Department of Public Health, University of Copenhagen , Copenhagen , Denmark
| | - Dorte Ejg Jarbøl
- c The Research Unit of General Practice, Department of Public Health , University of Southern Denmark , Odense , Denmark
| | - Ann Dorrit Guassora
- a The Research Unit for General Practice and Department of General Practice , Department of Public Health, University of Copenhagen , Copenhagen , Denmark
| | - Frans Boch Waldorff
- a The Research Unit for General Practice and Department of General Practice , Department of Public Health, University of Copenhagen , Copenhagen , Denmark
- c The Research Unit of General Practice, Department of Public Health , University of Southern Denmark , Odense , Denmark
| | - Susanne Reventlow
- a The Research Unit for General Practice and Department of General Practice , Department of Public Health, University of Copenhagen , Copenhagen , Denmark
- b The Lolland Falster Population Study (LOFUS) , Nykøbing F , Denmark
| | - Niels de Fine Olivarius
- a The Research Unit for General Practice and Department of General Practice , Department of Public Health, University of Copenhagen , Copenhagen , Denmark
- b The Lolland Falster Population Study (LOFUS) , Nykøbing F , Denmark
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Krag MØ, Hasselbalch L, Siersma V, Nielsen ABS, Reventlow S, Malterud K, de Fine Olivarius N. The impact of gender on the long-term morbidity and mortality of patients with type 2 diabetes receiving structured personal care: a 13 year follow-up study. Diabetologia 2016; 59:275-85. [PMID: 26607637 DOI: 10.1007/s00125-015-3804-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/19/2015] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess gender differences in mortality and morbidity during 13 follow-up years after 6 years of structured personal care in patients with type 2 diabetes mellitus. METHODS In the Diabetes Care in General Practice (DCGP) multicentre, cluster-randomised, controlled trial (ClinicalTrials.gov registration no. NCT01074762), 1,381 patients newly diagnosed with type 2 diabetes were randomised to receive 6 years of either structured personal care or routine care. The intervention included regular follow-up, individualised goal setting and continuing medical education of general practitioners participating in the intervention. Patients were re-examined at the end of intervention. This observational analysis followed 970 patients for 13 years thereafter using national registries. Outcomes were all-cause mortality, incidence of diabetes-related death, any diabetes-related endpoint, myocardial infarction, stroke, peripheral vascular disease and microvascular disease. RESULTS In women, but not men, a lower HR for structured personal care vs routine care emerged for any diabetes-related endpoint (0.65, p = 0.004, adjusted; 73.4 vs 107.7 events per 1,000 patient-years), diabetes-related death (0.70, p = 0.031; 34.6 vs 45.7), all-cause mortality (0.74, p = 0.028; 55.5 vs 68.5) and stroke (0.59, p = 0.038; 15.6 vs 28.9). This effect was different between men and women for diabetes-related death (interaction p = 0.015) and all-cause mortality (interaction p = 0.005). CONCLUSIONS/INTERPRETATION Compared with routine care, structured personal diabetes care reduced all-cause mortality and diabetes-related death in women but not in men. This gender difference was also observed for any diabetes-related outcome and stroke but was not statistically significant after extensive multivariate adjustment. These observational results from a post hoc analysis of a randomised controlled trial cannot be explained by intermediate outcomes like HbA1c alone, but involves complex social and cultural issues of gender. There is a need to rethink treatment schemes for both men and women to gain benefit from intensified treatment efforts.
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Affiliation(s)
- Marlene Ø Krag
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen K, Denmark.
| | - Lotte Hasselbalch
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen K, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen K, Denmark
| | - Anni B S Nielsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen K, Denmark
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen K, Denmark
| | - Kirsti Malterud
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen K, Denmark
- Research Unit for General Practice, Uni Health Research, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen K, Denmark
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15
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Køster-Rasmussen R, Simonsen MK, Siersma V, Henriksen JE, Heitmann BL, de Fine Olivarius N. Intentional Weight Loss and Longevity in Overweight Patients with Type 2 Diabetes: A Population-Based Cohort Study. PLoS One 2016; 11:e0146889. [PMID: 26808532 PMCID: PMC4726824 DOI: 10.1371/journal.pone.0146889] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 12/24/2015] [Indexed: 11/19/2022] Open
Abstract
Objective This study examined the influence of weight loss on long-term morbidity and mortality in overweight (BMI≥25kg/m2) patients with type 2 diabetes, and tested the hypothesis that therapeutic intentional weight loss supervised by a medical doctor prolongs life and reduces the risk for cardiovascular disease in these patients. Methods This is a 19 year cohort study of patients in the intervention arm of the randomized clinical trial Diabetes Care in General Practice. Weight and prospective intentions for weight loss were monitored every third month for six years in 761 consecutive patients (≥40 years) newly diagnosed with diabetes in general practices throughout Denmark in 1989–92. Multivariable Cox regression was used to estimate the association between weight change during the monitoring period (year 0 to 6) and the outcomes during the succeeding 13 years (year 6 to 19) in 444 patients who were overweight at diagnosis and alive at the end of the monitoring period (year 6). The analysis was adjusted for age, sex, education, BMI at diagnosis, change in smoking, change in physical activity, change in medication, and the Charlson comorbidity 6-year score. Outcomes were from national registers. Results Overall, weight loss regardless of intention was an independent risk factor for increased all-cause mortality (P<0.01). The adjusted hazard ratio for all-cause mortality, cardiovascular mortality, and cardiovascular morbidity attributable to an intentional weight loss of 1 kg/year was 1.20 (95%CI 0.97–1.50, P = 0.10), 1.26 (0.93–1.72, P = 0.14), and 1.06 (0.79–1.42, P = 0.71), respectively. Limiting the analysis to include only those patients who survived the first 2 years after the monitoring period did not substantially change these estimates. A non-linear spline estimate indicated a V-like association between weight change and all-cause mortality, suggesting the best prognosis for those who maintained their weight. Conclusions In this population-based cohort of overweight patients with type 2 diabetes, successful therapeutic intentional weight loss, supervised by a doctor over six years, was not associated with reduced all-cause mortality or cardiovascular morbidity/mortality during the succeeding 13 years.
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Affiliation(s)
- Rasmus Køster-Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | | | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jan Erik Henriksen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies, The Parker Institute and Institute of Preventive Medicine, Capital Region, Bispebjerg and Frederiksberg University Hospitals, Frederiksberg, Denmark
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Larsen JR, Siersma VD, Davidsen AS, Waldorff FB, Reventlow S, de Fine Olivarius N. The excess mortality of patients with diabetes and concurrent psychiatric illness is markedly reduced by structured personal diabetes care: A 19-year follow up of the randomized controlled study Diabetes Care in General Practice (DCGP). Gen Hosp Psychiatry 2016; 38:42-52. [PMID: 26602087 DOI: 10.1016/j.genhosppsych.2015.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/06/2015] [Accepted: 10/13/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of an intervention in Type 2 diabetic patients with concurrent psychiatric illness (PI) and compare this with the effectiveness in patients without PI. METHOD In the Diabetes Care in General Practice trial, 1381 patients newly diagnosed with Type 2 diabetes were randomized to 6 years of structured personal diabetes care or routine diabetes care (ClinicalTrials.gov NCT01074762). In this observational post-hoc analysis, the effectiveness of the intervention for diabetes in 179 patients with concurrent PI was analyzed. RESULTS During the 19-year follow-up period, patients with PI in the structured personal care group experienced a lower risk for all-cause mortality [105.3 vs. 140.4 events per 1000 patient-years; hazard ratio (HR): 0.63, P=0.023, multivariably adjusted], diabetes-related death (66.0 vs. 95.1; HR: 0.57, P=0.015), any diabetes-related endpoint (169.5 vs. 417.5; HR: 0.47, P=0.0009) and myocardial infarction (54.1 vs. 104.4; HR: 0.48, P=0.013), compared to patients with PI in the routine care group. This translates into a number needed to treat over 10 years of three or lower for these outcomes. CONCLUSION These findings suggest that in primary care, structured diabetes care allowing for individualization was highly effective among diabetic patients with co-occurring PI.
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Affiliation(s)
- Julie Rask Larsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen K, Denmark; Psychiatric Centre Copenhagen and Department of Neuroscience and Pharmacology, University of Copenhagen, DK-2100 Copenhagen Ø, Denmark
| | - Volkert D Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen K, Denmark
| | - Annette S Davidsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen K, Denmark
| | - Frans B Waldorff
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen K, Denmark
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen K, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen K, Denmark.
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Andersen CL, Eskelund CW, Siersma VD, Felding P, Lind B, Palmblad J, Bjerrum OW, Friis S, Hasselbalch HC, de Fine Olivarius N. Is thrombocytosis a valid indicator of advanced stage and high mortality of gynecological cancer? Gynecol Oncol 2015; 139:312-8. [PMID: 26407478 DOI: 10.1016/j.ygyno.2015.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/14/2015] [Accepted: 09/21/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Christen L Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Hematology, Roskilde University Hospital, Roskilde, Denmark.
| | | | - Volkert D Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Peter Felding
- The Elective Laboratory of the Capital Region, Copenhagen, Denmark
| | - Bent Lind
- The Elective Laboratory of the Capital Region, Copenhagen, Denmark
| | - Jan Palmblad
- Departments of Hematology and Medicine, The Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ole W Bjerrum
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Hans C Hasselbalch
- Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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18
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Søndergaard E, Willadsen TG, Guassora AD, Vestergaard M, Tomasdottir MO, Borgquist L, Holmberg-Marttila D, Olivarius NDF, Reventlow S. Problems and challenges in relation to the treatment of patients with multimorbidity: General practitioners' views and attitudes. Scand J Prim Health Care 2015; 33:121-6. [PMID: 26158584 PMCID: PMC4834499 DOI: 10.3109/02813432.2015.1041828] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore views and attitudes among general practitioners (GPs) and researchers in the field of general practice towards problems and challenges related to treatment of patients with multimorbidity. SETTING A workshop entitled Patients with multimorbidity in general practice held during the Nordic Congress of General Practice in Tampere, Finland, 2013. SUBJECTS A total of 180 GPs and researchers. DESIGN Data for this summary report originate from audio-recorded, transcribed verbatim plenary discussions as well as 76 short questionnaires answered by attendees during the workshop. The data were analysed using framework analysis. RESULTS (i) Complex care pathways and clinical guidelines developed for single diseases were identified as very challenging when handling patients with multimorbidity; (ii) insufficient cooperation between the professionals involved in the care of multimorbid patients underlined the GPs' impression of a fragmented health care system; (iii) GPs found it challenging to establish a good dialogue and prioritize problems with patients within the timeframe of a normal consultation; (iv) the future role of the GP was discussed in relation to diminishing health inequality, and current payment systems were criticized for not matching the treatment patterns of patients with multimorbidity. CONCLUSION The participants supported the development of a future research strategy to improve the treatment of patients with multimorbidity. Four main areas were identified, which need to be investigated further to improve care for this steadily growing patient group.
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Affiliation(s)
- Elisabeth Søndergaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Correspondence: Elisabeth Søndergaard, The Research Unit for General Practice, Department of Public Health, University of Copenhagen, CSS, Øster Farimagsgade 5, DK-1014 Copenhagen, Denmark. E-mail:
| | - Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Vestergaard
- The Research Unit for General Practice and Department of General Practice, Institute of Public Health, University of Aarhus, Aarhus, Denmark
| | | | - Lars Borgquist
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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19
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Nielsen ABS, Jensen P, Gannik D, Reventlow S, Hollnagel H, Olivarius NDF. Change in self-rated general health is associated with perceived illness burden: a 1-year follow up of patients newly diagnosed with type 2 diabetes. BMC Public Health 2015; 15:439. [PMID: 25924731 PMCID: PMC4431173 DOI: 10.1186/s12889-015-1790-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/22/2015] [Indexed: 11/15/2022] Open
Abstract
Background Diabetic patients’ lifestyle adaptations to improve glycaemic control are not always followed by improvements in self-rated general health (SRH). The perceived impact of diabetes on patients’ daily lives may influence changes in their SRH. This paper examines the association of illness severity, treatment, behavioural, and coping-related factors with changes in SRH from diagnosis of type 2 diabetes until one year later, in a population-based sample of 599 patients aged 40 years or over who were treated in general practice. Methods Change in SRH was estimated by a cumulative probit model with the inclusion of covariates related to SRH (e.g. illness severity at diagnosis, behaviour, treatment, and the perceived impact of diabetes on patients’ daily lives one year later). Results At diagnosis, 11.6% of patients reported very good, 35.1% good, 44.6% fair and 8.5% poor SRH. Physical inactivity, many diabetes-related symptoms, and cardiovascular disease were related to lower SRH ratings. On average SRH improved by 0.46 (95% CI: 0.37; 0.55) during the first year after diagnosis without inclusion of covariates. Mental and practical illness burden was the only factor associated with change in SRH, independent of patients’ diabetes severity and medical treatment (p = 0.03, multivariate analysis). Compared to otherwise similar patients without illness burden, increase in SRH was marginally smaller among patients who expressed minor illness burden, but much smaller among patients with more pronounced illness burden. Conclusions Much as one would expect, many patients increased their SRH during the first year after diabetes diagnosis. This increase in SRH was not associated with indicators of illness severity or factors reflecting socio-demographic circumstances, but patients experiencing illness burden had a smaller increase than those who reported no illness burden. We suggest that during the diabetes consultation, general practitioners explore further how patients manage their illness burden. We further suggest that diabetes guidelines extend their current focus on clinical and social aspects of diabetes to include questions on patient’s perceived illness burden and SRH. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1790-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anni Brit Sternhagen Nielsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Per Jensen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
| | - Dorte Gannik
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Hanne Hollnagel
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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de Fine Olivarius N, Siersma VD, Køster-Rasmussen R, Heitmann BL, Waldorff FB. Weight changes following the diagnosis of type 2 diabetes: the impact of recent and past weight history before diagnosis. results from the Danish Diabetes Care in General Practice (DCGP) study. PLoS One 2015; 10:e0122219. [PMID: 25876061 PMCID: PMC4398495 DOI: 10.1371/journal.pone.0122219] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 02/19/2015] [Indexed: 11/29/2022] Open
Abstract
Aims The association between recent and more distant weight changes before and after the diagnosis of type 2 diabetes has been little researched. The aim of this study is to determine the influence of patients’ weight history before diabetes diagnosis on the observed 6-year weight changes after diagnosis. Methods A clinical cohort study combined with self-reported past weight history. In total 885 patients aged ≥40 years and newly diagnosed with clinical type 2 diabetes were included. Body weight was measured immediately after diabetes diagnosis and again at the 6-year follow up examination (median, 5.7 years). At diagnosis patients reported their weight 1 year and 10 years previously, and also at the age of 20. Multivariate linear regression analyses controlled for 20 baseline patient characteristics. Results The median (interquartile range) age at diagnosis was 63.2 (53.9; 71.4) years. Median body weight was 80.0 (72.0; 90.0) kg 10 years before diagnosis, 85.0 (75.0; 95.0) kg 1 year before diagnosis, 82.4 (72.0; 94.0) kg at diagnosis, and 80.0 (70.0; 91.1) kg at 6-year follow up. Each kg of weight gain during the year preceding the diagnosis was associated with a weight change (95% CI) of -0.20 (-0.28; -0.13) kg during the follow up period. In all models age and body mass index at diagnosis predicted future weight changes, while the weight at age 20 (-0.01 (-0.06; 0.03) kg/kg), and the weight change from 10 years to 1 year before diagnosis (-0.01 (-0.06; 0.04) kg/kg), did not predict weight change after diagnosis. Conclusions During the first on average 5.7 years after diagnosis of type 2 diabetes, patients generally follow a course of declining average weight, and these weight developments are related primarily to recent weight changes, body mass index, and age, but not to the more distant weight history.
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Affiliation(s)
- Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Dirk Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Køster-Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Berit Lilienthal Heitmann
- Institute of Preventive Medicine, Research Unit for Dietary Studies, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Frans Boch Waldorff
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Broedbaek K, Siersma V, Henriksen T, Weimann A, Petersen M, Andersen JT, Jimenez-Solem E, Hansen LJ, Henriksen JE, Bonnema SJ, de Fine Olivarius N, Friis S, Poulsen HE. Urinary markers of nucleic acid oxidation and cancer in type 2 diabetes. Redox Biol 2014; 4:34-9. [PMID: 25498965 PMCID: PMC4309851 DOI: 10.1016/j.redox.2014.11.010] [Citation(s) in RCA: 28] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022] Open
Abstract
AIMS/HYPOTHESIS We investigated whether urinary markers of nucleic acid oxidation are associated with an increased risk of cancer in type 2 diabetes patients. METHODS Urine samples from 1381 newly diagnosed diabetes patients were assayed for the oxidatively modified guanine nucleosides 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) and 8-oxo-7,8-dihydroguanosine (8-oxoGuo). Cox proportional hazards regression was used to examine the relationship between the urinary markers and cancer incidence. RESULTS The crude analyses showed an association between overall cancer and urinary excretion of the RNA oxidation marker 8-oxoGuo (unadjusted hazard ratio for cancer per natural log increase in 8-oxoGuo 1.35 [95% CI, 1.01-1.81]), however, in the adjusted analyses, no significant associations between 8-oxodG or 8-oxoGuo and overall cancer were found. For site-specific cancers 8-oxodG was associated with breast cancer in the crude analyses (unadjusted hazard ratio for breast cancer per natural log increase in 8-oxodG was 2.37 [95% CI, 1.07-5.26]), although the association was attenuated in the adjusted analyses (sex- and age-adjusted hazard ratio 2.15 [95% CI, 0.92-5.02] and multivariate adjusted hazard ratio1.98 [95% CI, 0.95-4.10]). CONCLUSIONS Urinary excretion of the nucleic acid oxidation markers 8-oxodG and 8-oxoGuo at the time of diagnosis was not associated with cancer overall in type 2 diabetes patients. For site-specific cancers, risk elevations were seen for breast cancer (8-oxodG). These findings should be examined in future and larger studies.
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Affiliation(s)
- Kasper Broedbaek
- Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark.
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Trine Henriksen
- Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Allan Weimann
- Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Morten Petersen
- Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jon T Andersen
- Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Espen Jimenez-Solem
- Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Lars J Hansen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jan Erik Henriksen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Steen J Bonnema
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Henrik E Poulsen
- Laboratory of Clinical Pharmacology Q7642, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Andersen CL, Siersma VD, Hasselbalch HC, Lindegaard H, Vestergaard H, Felding P, de Fine Olivarius N, Bjerrum OW. Eosinophilia in routine blood samples as a biomarker for solid tumor development - A study based on the Copenhagen Primary Care Differential Count (CopDiff) Database. Acta Oncol 2014; 53:1245-50. [PMID: 24913152 DOI: 10.3109/0284186x.2014.887857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Eosinophilia may represent an early paraclinical sign of malignant disease and a host anti-tumor effect. The association between eosinophilia and the development of solid tumors has never before been examined in an epidemiological setting. The aim of the present study was to investigate eosinophilia in routine blood samples as a potential biomarker of solid tumor development in a prospective design. MATERIAL AND METHODS From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356 196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (< 0.5 × 10(9)/l), mild (≥ 0.5-1.0 × 10(9)/l) or severe (≥ 1.0 × 10(9)/l) eosinophilia. From the Danish Civil Registration System and the Danish Cancer Registry we ascertained all-cause death and solid tumors within the first three years following the DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for previous eosinophilia, sex, age, year, month, C-reactive protein, previous cancer and Charlson's Comorbidity Index. RESULTS The risk of bladder cancer was increased with mild eosinophilia [OR 1.93 (CI 1.29-2.89), p = 0.0013]. No associations with eosinophilia were observed for the remaining solid cancers. CONCLUSION We demonstrate that eosinophilia in routine blood samples associates with an increased risk of bladder cancer. Our data emphasize that additional preclinical studies are needed in order to shed further light on the role of eosinophils in carcinogenesis, where it is still unknown whether the cells contribute to tumor immune surveillance or neoplastic evolution.
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Andersen CL, Siersma VD, Karlslund W, Hasselbalch HC, Felding P, Bjerrum OW, de Fine Olivarius N. The Copenhagen Primary Care Differential Count (CopDiff) database. Clin Epidemiol 2014; 6:199-211. [PMID: 24966694 PMCID: PMC4062550 DOI: 10.2147/clep.s60991] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The differential blood cell count provides valuable information about a person’s state of health. Together with a variety of biochemical variables, these analyses describe important physiological and pathophysiological relations. There is a need for research databases to explore associations between these parameters, concurrent comorbidities, and future disease outcomes. Methods and results The Copenhagen General Practitioners’ Laboratory is the only laboratory serving general practitioners in the Copenhagen area, covering approximately 1.2 million inhabitants. The Copenhagen General Practitioners’ Laboratory has registered all analytical results since July 1, 2000. The Copenhagen Primary Care Differential Count database contains all differential blood cell count results (n=1,308,022) from July 1, 2000 to January 25, 2010 requested by general practitioners, along with results from analysis of various other blood components. This data set is merged with detailed data at a person level from The Danish Cancer Registry, The Danish National Patient Register, The Danish Civil Registration System, and The Danish Register of Causes of Death. Conclusion This paper reviews methodological issues behind the construction of the Copenhagen Primary Care Differential Count database as well as the distribution of characteristics of the population it covers and the variables that are recorded. Finally, it gives examples of its use as an inspiration to peers for collaboration.
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Affiliation(s)
- Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark ; Department of Hematology, Roskilde University Hospital, Copenhagen, Denmark
| | - Volkert Dirk Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Willy Karlslund
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Felding
- The Elective Laboratory of the Capital Region, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Andersen CL, Lindegaard H, Vestergaard H, Siersma VD, Hasselbalch HC, de Fine Olivarius N, Bjerrum OW, Junker P. Risk of lymphoma and solid cancer among patients with rheumatoid arthritis in a primary care setting. PLoS One 2014; 9:e99388. [PMID: 24914777 PMCID: PMC4051682 DOI: 10.1371/journal.pone.0099388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/14/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Several studies have demonstrated an association between rheumatoid arthritis (RA) and lymphoproliferative malignancies, but pathogenic mechanisms remain unclear. We investigated 1) the risk of lymphoproliferative malignancies and solid tumors in adults with RA identified in primary care and 2) the possible mediating role of blood eosinophilia in the clonal evolution of cancer in these patients. METHODS From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count between 2000-2007. From these, one DIFF was randomly chosen (the index DIFF). By linking to the Danish National Patient Register, we categorized the selected individuals according to known longstanding (≥3 years) or recent onset (<3 years) RA prior to the index DIFF. In addition, the cohort was stratified according to management in primary or secondary care. From the Danish Cancer Registry we ascertained malignancies within four years following the index DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for sex, age, year, month, eosinophilia, comorbid conditions and C-reactive protein (CRP). RESULTS 921 patients had recent onset RA and 2,578 had longer disease duration. Seventy three percent of RA patients were managed in primary care. After adjustment for sex, age, year, and month, neither recent onset nor long-standing RA was associated with incident lymphoproliferative malignancies or solid cancers. These risk estimates did not change when eosinophilia, CRP, and comorbidities were included in the models. CONCLUSIONS In this large cohort of patients with RA of short or long duration recruited from a primary care resource, RA was not associated with an increased risk of lymphoproliferative or solid cancers during 4 years of follow-up, when the models were adjusted for confounders. Blood eosinophilia could not be identified as a mediator of cancer development in the present setting.
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Affiliation(s)
- Christen Lykkegaard Andersen
- Department of Hematology, Roskilde University Hospital, Roskilde, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Hanne Lindegaard
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Hanne Vestergaard
- Department of Hematology, Odense University Hospital, Odense, Denmark
| | - Volkert Dirk Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ole Weis Bjerrum
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Junker
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
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Lundström H, Siersma V, Nielsen ABS, Brodersen J, Reventlow S, Andersen PK, de Fine Olivarius N. The effectiveness of structured personal care of type 2 diabetes on recurrent outcomes: a 19 year follow-up of the study Diabetes Care in General Practice (DCGP). Diabetologia 2014; 57:1119-23. [PMID: 24599111 DOI: 10.1007/s00125-014-3204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS The estimation of effect size in clinical trials commonly disregards recurrent outcomes. We investigated the effectiveness of a complex intervention on recurrent outcomes in patients with type 2 diabetes. METHODS In the Diabetes Care in General Practice (DCGP) randomised controlled trial, 1,381 patients newly diagnosed with type 2 diabetes were randomised to 6 years of structured personal care or routine care (ClinicalTrials.gov NCT01074762). The trial had 19 years of registry-based follow-up and was analysed with Cox regression models. Repeated occurrences in the same patient of outcomes (any diabetes-related endpoint, myocardial infarction [MI], stroke, peripheral vascular disease and microvascular disease) were accounted for with the Wei, Lin and Weissfeld method. RESULTS As previously shown, the intervention reduced the rates of first occurrence of both MI and any diabetes-related endpoint. However, for all outcomes, the HR for a second event showed a statistically non-significant tendency to be increased. We estimated a combined HR for all marginal failure times, regardless of whether they were first, second or later events. This showed that the intervention had no effect on the rate of any of the outcomes, including MI (HR 0.89, 95% CI 0.76, 1.05) and any diabetes-related endpoint (HR 0.98, 95% CI 0.87, 1.09). CONCLUSIONS/INTERPRETATION In the DCGP study, a smaller proportion of patients who received structured care experienced a first occurrence of MI or any diabetes-related endpoint compared with patients who received routine care. However, the patients who received structured care tended to experience more recurrent outcomes, so the total outcome rate was not affected by the intervention.
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Affiliation(s)
- Hanna Lundström
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014, Copenhagen K, Denmark
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Andersen CL, Siersma VD, Hasselbalch HC, Lindegaard H, Vestergaard H, Felding P, Olivarius NDF, Bjerrum OW. Eosinophilia in routine blood samples as a biomarker for solid tumor development - A study based on The Copenhagen Primary Care Differential Count (CopDiff) Database. Acta Oncol 2013. [PMID: 24358991 DOI: 10.3109/0284186x.2013.866270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background. Eosinophilia may represent an early paraclinical sign of malignant disease and a host anti-tumor effect. The association between eosinophilia and the development of solid tumors has never before been examined in an epidemiological setting. The aim of the present study was to investigate eosinophilia in routine blood samples as a potential biomarker of solid tumor development in a prospective design. Material and methods. From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356 196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (< 0.5 × 10(9)/l), mild (≥ 0.5-1.0 × 10(9)/l) or severe (≥ 1.0 × 10(9)/l) eosinophilia. From the Danish Cancer Registry we ascertained solid tumors within the first three years following the DIFF. Using multivariable logistic regression, odds ratios (OR) were calculated and adjusted for previous eosinophilia, sex, age, year, month, C-reactive protein, previous cancer and Charlson's comorbidity index. Results. The risk for breast cancer was significantly lower in individuals exhibiting mild eosinophilia than in individuals with normal eosinophil counts [OR (95% confidence intervals) = 0.51 (0.35-0.76), p = 0.0005]. The risk of bladder cancer, however, increased with severity of eosinophilia [2.27 (1.53-3.39), p < 0.0001 and 2.62 (0.96-7.14), p = 0.0592 for mild and severe eosinophilia, respectively]. No associations with eosinophilia were observed for remaining solid cancers. Conclusion. We demonstrate that eosinophilia in routine blood samples associate with a decreased risk of breast cancer and an increased risk of bladder cancer. Our data emphasize that additional preclinical studies are needed in order to shed further light on the role of eosinophils in carcinogenesis, where it is still unknown whether the cells contribute to tumor immune surveillance or neoplastic evolution.
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Andersen CL, Siersma VD, Hasselbalch HC, Lindegaard H, Vestergaard H, Felding P, de Fine Olivarius N, Bjerrum OW. Eosinophilia in routine blood samples and the subsequent risk of hematological malignancies and death. Am J Hematol 2013; 88:843-7. [PMID: 23765950 DOI: 10.1002/ajh.23515] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/31/2013] [Accepted: 06/04/2013] [Indexed: 12/20/2022]
Abstract
Eosinophilia may represent an early paraclinical sign of hematological malignant disease, but no reports exist on its predictive value for hematological malignancies. From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count (DIFF) encompassing the eosinophil count during 2000-2007. From these, one DIFF was randomly chosen and categorized according to no (<0.5 × 10(9) /L), mild (≥ 0.5-1.0 × 10(9) /L) or severe (≥ 1.0 × 10(9) /L) eosinophilia. From the Danish Cancer Registry and the Danish Civil Registration System, we ascertained hematological malignancies and death within 3 years following the DIFF. Using multivariable logistic regression odds ratios (ORs) were calculated and adjusted for previous eosinophilia in a DIFF, sex, age, year, month, C-reactive protein, previous cancer, and comorbidity. ORs for developing Hodgkin's lymphoma (HL) was significantly increased in individuals exhibiting severe eosinophilia, OR = 9.09 (C.I. 2.77-29.84), P = 0.0003. The association with classical myeloproliferative neoplasms (cMPNs) showed an increasing risk with OR = 1.65 (1.04-2.61) P = 0.0322 and OR = 3.87 (1.67-8.96) P = 0.0016 for mild and severe eosinophilia. Eosinophilia was in a similar fashion associated with chronic lymphatic leukemia (CLL), OR = 2.57 (1.50-4.43), P = 0.0006 and OR = 5.00 (1.57-15.94), P = 0.0065, and all-cause death, OR of 1.16 (1.09-1.24), P < 0.0001 and 1.60 (1.35-1.91), P < 0.0001. We confirm associations between eosinophilia and HL and cMPNs, and in addition for the first time demonstrate a dose-dependent association between eosinophilia and CLL as well as death. Unexplained eosinophilia should prompt clinicians to consider conditions where early diagnosis may improve prognosis.
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Affiliation(s)
- Christen Lykkegaard Andersen
- Department of Hematology; Roskilde University Hospital; Denmark
- The Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Denmark
| | - Volkert Dirk Siersma
- The Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Denmark
| | | | | | | | - Peter Felding
- Copenhagen General Practitioners' Laboratory; Copenhagen Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Denmark
| | - Ole Weis Bjerrum
- Department of Hematology; Copenhagen University Hospital; Denmark
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Reventlow S, Kragstrup J, Guassora AD, Bjerrum L, Olivarius NDF. [Multimorbidity in a health care system which is adapted to individual diseases]. Ugeskr Laeger 2013; 175:1093. [PMID: 23651744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Broedbaek K, Siersma V, Henriksen T, Weimann A, Petersen M, Andersen JT, Jimenez-Solem E, Hansen LJ, Henriksen JE, Bonnema SJ, de Fine Olivarius N, Poulsen HE. Association between urinary markers of nucleic acid oxidation and mortality in type 2 diabetes: a population-based cohort study. Diabetes Care 2013; 36:669-76. [PMID: 23150279 PMCID: PMC3579372 DOI: 10.2337/dc12-0998] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We recently showed that RNA oxidation, estimated by urinary excretion of 8-oxo-7,8-dihydroguanosine (8-oxoGuo), independently predicted mortality in a cohort of 1,381 treatment-naive patients with newly diagnosed type 2 diabetes. In the present investigation, we analyzed urine collected 6 years after the diagnosis to assess the association between urinary markers of nucleic acid oxidation and mortality in patients with established and treated diabetes. RESEARCH DESIGN AND METHODS We used data from the 970 patients who attended the screening for diabetes complications 6 years after the diagnosis. Cox proportional hazards regression was used to examine the relationship between urinary markers of DNA oxidation (8-oxo-7,8-dihydro-2'-deoxyguanosine [8-oxodG] [n = 938]) and RNA oxidation (8-oxoGuo [n = 936]) and mortality. RESULTS During a median of 9.8 years of follow-up, 654 patients died. Urinary 8-oxoGuo assessed 6 years after the diagnosis was significantly associated with mortality. The multivariate-adjusted hazard ratios for all-cause and diabetes-related mortality of patients with 8-oxoGuo levels in the highest quartile compared with those in the lowest quartile were 1.86 (95% CI 1.34-2.58) and 1.72 (1.11-2.66), respectively. Conversely, 8-oxodG was not associated with mortality. In addition, we found an association between changes in 8-oxoGuo from diagnosis to 6-year follow-up and mortality, with increased risk in patients with an increase and decreased risk in patients with a decrease in 8-oxoGuo. CONCLUSIONS The RNA oxidation marker 8-oxoGuo is an independent predictor of mortality in patients with established and treated type 2 diabetes, and changes in 8-oxoGuo during the first 6 years after diagnosis are associated with mortality.
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Affiliation(s)
- Kasper Broedbaek
- Laboratory of Clinical Pharmacology, Rigshospitalet, Copenhagen, Denmark.
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de Fine Olivarius N, Siersma V. The astonishing hypothesis. Prim Care Diabetes 2012; 6:341-342. [PMID: 22917774 DOI: 10.1016/j.pcd.2012.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/26/2012] [Indexed: 11/21/2022]
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Køster-Rasmussen R, Simonsen MK, de Fine Olivarius N. [Uncertain whether weight-reducing diet lowers the risk of early death in hypertensive patients]. Ugeskr Laeger 2012; 174:1979-1981. [PMID: 22929574] [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: 06/01/2023]
Abstract
The Cochrane review "Long-term effects of weight-reducing diets in hypertensive patients" fails to evaluate the primary outcomes of mortality and morbidity. It is uncertain whether weight loss in general reduces the risk of cardiovascular disease and death as the relation between intentional weight loss and mortality is biased by reverse causation. Weight loss is a potent risk factor of weight regain and weight cycling is associated to early death. Recommendations on weight loss should be individualized and focused on promotion of a healthy and active lifestyle rather than counting kilos.
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de Fine Olivarius N. [No evidence for population-based screening for type 2-diabetes]. Ugeskr Laeger 2012; 174:2032-2026. [PMID: 23094285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Niels de Fine Olivarius
- Forskningsenheden for Almen Praksis og Afdeling for Almen Medicin, Institut for Folkesundhedsvidenskab, Københavns Universitet, Denmark.
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Broedbaek K, Siersma V, Henriksen T, Weimann A, Petersen M, Andersen JT, Jimenez-Solem E, Stovgaard ES, Hansen LJ, Henriksen JE, Bonnema SJ, Olivarius NDF, Poulsen HE. Urinary markers of nucleic acid oxidation and long-term mortality of newly diagnosed type 2 diabetic patients. Diabetes Care 2011; 34:2594-6. [PMID: 21994431 PMCID: PMC3220837 DOI: 10.2337/dc11-1620] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We analyzed data from a cohort of 1,381 newly diagnosed type 2 diabetic patients to test the hypothesis that urinary markers of nucleic acid oxidation are independent predictors of mortality. RESEARCH DESIGN AND METHODS We examined the relationship between urinary excretion of markers of DNA oxidation (8-oxo-7,8-dihydro-2'-deoxyguanosine [8-oxodG]) and RNA oxidation (8-oxo-7,8-dihydroguanosine [8-oxoGuo]) and long-term mortality using Cox proportional hazards regression. RESULTS After multivariate adjustment, the hazard ratios for all-cause and diabetes-related mortality of patients with 8-oxoGuo levels in the highest quartile compared with those in the lowest quartile were 1.44 (1.12-1.85) and 1.54 (1.13-2.10), respectively. Conversely, no significant associations between 8-oxodG and mortality were found in the adjusted analyses. CONCLUSIONS Urinary excretion of the RNA oxidation marker 8-oxoGuo measured shortly after diagnosis of type 2 diabetes predicts long-term mortality independently of conventional risk factors. This finding suggests that 8-oxoGuo could serve as a new clinical biomarker in diabetes.
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Affiliation(s)
- Kasper Broedbaek
- Laboratory of Clinical Pharmacology, Rigshospitalet, Copenhagen, Denmark.
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Abstract
OBJECTIVE Improving glycaemic control is generally supposed to reduce symptoms experienced by type 2 diabetic patients, but the relationships between glycated haemoglobin (HbA(1c)), diabetes-related symptoms, and self-rated health (SRH) are unclarified. This study explored the relationships between these aspects of diabetes control. DESIGN A cross-sectional study one year after diagnosis of type 2 diabetes. SUBJECTS A population-based sample of 606 type 2 diabetic patients, median age 65.6 years at diagnosis, regularly reviewed in primary care. MAIN OUTCOME MEASURES The relationships between HbA(1c), diabetes-related symptoms, and SRH. RESULTS The patients' median HbA(1c) was 7.8 (reference interval: 5.4-7.4 % at the time of the study). 270 (45.2%) reported diabetes-related symptoms within the past 14 days. SRH was associated with symptom score (γ = 0.30, p < 0.001) and HbA(1c) (γ = 0.17, p = 0.038) after correction for covariates. The relation between HbA(1c) and symptom score was explained by SRH together with other confounders, e.g. hypertension (γ = 0.02, p = 0.40). The relation between the symptom fatigue and SRH was not explained by symptom score and significantly modified the direct association between symptom score and SRH. CONCLUSIONS Symptom relief may not occur even when HbA(1c) level is at its lowest average level in the natural history of diabetes, and symptoms and SRH are closely linked. Monitoring symptoms in the clinical encounter to extend information on disease severity, as measured e.g. by HbA(1c), may help general practitioners and patients to understand the possible impact of treatments and of disease manifestations in order to obtain optimum disease control.
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Affiliation(s)
- Anni B S Nielsen
- Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, Denmark.
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Heldgaard PE, Henriksen JE, Sidelmann JJ, Olivarius NDF, Siersma VD, Gram JB. Similar cardiovascular risk factor profile in screen-detected and known type 2 diabetic subjects. Scand J Prim Health Care 2011; 29:85-91. [PMID: 21438763 PMCID: PMC3347946 DOI: 10.3109/02813432.2011.565164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE. To compare the cardiovascular disease (CVD) risk factor profile in subjects with screen-detected type 2 diabetes (SDM) and subjects with known type 2 diabetes (KDM). DESIGN. Population-based, cross-sectional survey. SETTING AND SUBJECTS. In a single, semi-rural general practice 2082 subjects were between 20 and 69 years. Of those, 1970 subjects were invited, and a total of 1374 (69.7%) subjects were examined by blood tests, anthropometric measures, and self-administered questionnaires. RESULTS. Before the survey 19 persons were known to have type 2 diabetes. The screening revealed another 31 individuals with type 2 diabetes, diagnosed according to the 1999 World Health Organization criteria. Age, levels of blood pressure, BMI, and dyslipidaemia, and markers of haemostasis and inflammation were comparable in the two groups. Median age in the KDM group was 58 vs. 57 years in the SDM group, p = 0.82, 79% were male vs. 61%, p = 0.23. In both groups 74% had blood pressure ≥ 130/85 mmHg, p = 1.00. In both groups 90% had BMI ≥ 25, p = 1.00, and about half in both groups had BMI ≥ 30, p = 0.56. In the KDM group 63% had dyslipidaemia (low HDL cholesterol or elevated triglycerides) vs. 80% in the SDM group, p = 0.32. Median levels of plasminogen-activator-inhibitor (PAI-1), tissue plasminogen activator (t-PA), as well as fibrinogen and C-reactive protein (CRP) were without statistically significant differences in the two groups, p > 0.1. In contrast, in markers of glycaemic regulation statistically significant differences were found between groups. Median HbA1 was 8.0 vs. 6.5, p < 0.001. Median fasting whole blood glucose level was 8.8 mmol/L vs. 6.3 mmol/L, p < 0.001, and glucose at two hours during OGTT was 16.9 mmol/L vs. 11.2 mmol/L, p < 0.001. Median fasting serum insulin level was 52 pmol/L vs. 80 pmol/L, p = 0.039 and at two hours 127 pmol/L vs. 479 pmol/L, p < 0.001. CONCLUSIONS. The CVD risk-factor profile of SDM patients was similar to the expected adverse profile of patients with KDM. This indicates an already increased risk of cardiovascular disease in diabetic patients before the diabetes becomes clinically manifest, supporting the need for early diagnosis.
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de Fine Olivarius N, Siersma V, Almind GJ, Nielsen NV. Prevalence and progression of visual impairment in patients newly diagnosed with clinical type 2 diabetes: a 6-year follow up study. BMC Public Health 2011; 11:80. [PMID: 21294871 PMCID: PMC3045948 DOI: 10.1186/1471-2458-11-80] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 02/04/2011] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Many diabetic patients fear visual loss as the worst consequence of diabetes. In most studies the main eye pathology is assigned as the cause of visual impairment. This study analysed a broad range of possible ocular and non-ocular predictors of visual impairment prospectively in patients newly diagnosed with clinical type 2 diabetes. METHODS Data were from a population-based cohort of 1,241 persons newly diagnosed with clinical, often symptomatic type 2 diabetes aged ≥ 40 years. After 6 years, 807 patients were followed up. Standard eye examinations were done by practising ophthalmologists. RESULTS At diabetes diagnosis median age was 65.5 years. Over 6 years, the prevalence of blindness (visual acuity of best seeing eye ≤ 0.1) rose from 0.9% (11/1,241) to 2.4% (19/807) and the prevalence of moderate visual impairment (> 0.1; < 0.5) rose from 5.4% (67/1,241) to 6.7% (54/807). The incidence (95% confidence interval) of blindness was 40.2 (25.3-63.8) per 10,000 patient-years. Baseline predictors of level of visual acuity (age, age-related macular degeneration (AMD), cataract, living alone, low self-rated health, and sedentary life-style) and speed of continued visual loss (age, AMD, diabetic retinopathy (DR), cataract, living alone, and high fasting triglycerides) were identified. CONCLUSIONS In a comprehensive assessment of predictors of visual impairment, even in a health care system allowing self-referral to free eye examinations, treatable eye pathologies such as DR and cataract emerge together with age as the most notable predictors of continued visual loss after diabetes diagnosis. Our results underline the importance of eliminating barriers to efficient eye care by increasing patients' and primary care practitioners' awareness of the necessity of regular eye examinations and timely surgical treatment.
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Affiliation(s)
- Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Olivarius NDF, Siersma V, Dyring-Andersen B, Drivsholm T, Hansen LJ, Henriksen JE. Patients Newly Diagnosed with Clinical Type 2 Diabetes during Oral Glucocorticoid Treatment and Observed for 14 Years: All-Cause Mortality and Clinical Developments. Basic Clin Pharmacol Toxicol 2010; 108:285-8. [DOI: 10.1111/j.1742-7843.2010.00650.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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de Fine Olivarius N, Siersma V, Nielsen ABS, Hansen LJ, Rosenvinge L, Mogensen CE. Predictors of mortality of patients newly diagnosed with clinical type 2 diabetes: a 5-year follow up study. BMC Endocr Disord 2010; 10:14. [PMID: 20698977 PMCID: PMC2928228 DOI: 10.1186/1472-6823-10-14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 08/10/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND At diabetes diagnosis major decisions about life-style changes and treatments are made based on characteristics measured shortly after diagnosis. The predictive value for mortality of these early characteristics is widely unknown. We examined the predictive value of patient characteristics measured shortly after diabetes diagnosis for 5-year all-cause and cardiovascular mortality with special reference to self-rated general health. METHODS Data were from a population-based sample of 1,323 persons newly diagnosed with clinical diabetes and aged 40 years or over. Possible predictors of mortality were investigated in Cox regression models. RESULTS Multivariately patients who rated their health less than excellent experienced increased all-cause and cardiovascular mortality. These end-points also increased with sedentary life-style, relatively young age at diagnosis and presence of cardiovascular disease (CVD) at diagnosis. Further predictors of all-cause mortality were male sex, low body mass index and cancer, while cardiovascular mortality increased with urinary albumin concentration. CONCLUSIONS We found that patients who rated their health as less than excellent had increased 5-year mortality, similar to that of patients with prevalent CVD, even when biochemical, clinical and life-style variables were controlled for. This finding could motivate doctors to discuss perceptions of health with newly diagnosed diabetic patients and be attentive to patients with suboptimal health ratings. Our findings also confirm that life-style changes and optimizing treatment are particularly relevant for relatively young and inactive patients and those who already have CVD or (micro)albuminuria at the time of diabetes diagnosis.
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Affiliation(s)
- Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anni BS Nielsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars J Hansen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Rosenvinge
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Carl Erik Mogensen
- Medical Department M, Århus Kommunehospital, Århus University Hospital, Århus, Denmark
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Olivarius NDF, Siersma V, Hansen LJ, Drivsholm T, Hørder M. Changes in levels of haemoglobin A1c during the first 6 years after diagnosis of clinical type 2 diabetes. Scand J Clin Lab Invest 2010; 69:851-7. [PMID: 19929282 DOI: 10.3109/00365510903323191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the variability in levels of glycosylated haemoglobin (HbA(1c)) during the first six years after diagnosis of clinical type 2 diabetes in relation to possible predictors. MATERIAL AND METHODS Data were from a population-based sample from general practice of 581 newly diagnosed diabetic patients aged 40 or over. Estimation of HbA(1c) was centralized. The changes in levels of HbA(1c) were described by HbA(1c) at diagnosis and a regression line fitted to the HbA(1c) measurements after 1-year follow-up for each patient. The predictive effect of patient characteristics for changes in HbA(1c) was investigated in a multivariate mixed model. RESULTS During the first year after diabetes diagnosis, HbA(1c) dropped to near normal average level and then started rising almost linearly. A sharp rise in long-term glycaemic level was observed in approximately a quarter of the patients, especially the relatively young. Of 581 patients, 156 (26.9%) patients, however, experienced a fall in HbA(1c) after 1-year follow-up and another quarter showed constant or only slowly rising HbA(1c). The changes in levels of HbA(1c) were only predicted by diagnostic HbA(1c) and age. CONCLUSIONS During the first 6 years after the diagnosis of clinical type 2 diabetes, changes in levels of HbA(1c) show considerable inter-individual variability with age as the only long-term predictor. The results indicate that it is important to monitor changes in HbA(1c) more closely and intensify treatment of those often relatively young patients who actually experience the beginning of an apparently relentless deterioration of their glycaemic control.
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Affiliation(s)
- Niels de Fine Olivarius
- The Research Unit and Department for General Practice, University of Copenhagen, Copenhagen, Denmark
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Hansen LJ, Olivarius NDF, Siersma V. 16-year excess all-cause mortality of newly diagnosed type 2 diabetic patients: a cohort study. BMC Public Health 2009; 9:400. [PMID: 19878574 PMCID: PMC2777164 DOI: 10.1186/1471-2458-9-400] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Accepted: 10/31/2009] [Indexed: 01/22/2023] Open
Abstract
Background Studies have shown that type 2 diabetic patients have higher all-cause mortality than people without diabetes, but it is less clear how diabetes affects mortality in elderly patients and to what degree mortality differs between diabetic men and women. The aim of the present study is to investigate the age- and sex-specific all-cause mortality pattern in patients with type 2 diabetes in comparison with the Danish background population. Methods Population-based cohort study of 1323 patients, diagnosed with clinical type 2 diabetes in 1989-92 and followed for 16 years. Median (interquartile range) age at diagnosis was 65.3 (55.8-73.6) years. The age- and sex-specific hazard rates were estimated for the cohort using the life table method and compared with the expected hazard rates calculated with Danish register data from the general population. Results In comparison with the general population, diabetic patients had a 1.5-2.5 fold higher risk of dying depending on age. The over-mortality was higher for men than for women. It decreased with age in both sexes, and among patients over 80 years at diagnosis the difference between the observed and the expected survival was small. Conclusion We found an excess mortality of type 2 diabetic patients compared with the background population in all age groups. The excess mortality was most pronounced in men and in young patients.
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Affiliation(s)
- Lars J Hansen
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark.
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de Fine Olivarius N, Richelsen B, Siersma V, Andreasen AH, Beck-Nielsen H. [Weight history of patients with newly diagnosed type 2 diabetes--secondary publication]. Ugeskr Laeger 2008; 170:3640-3643. [PMID: 18988367] [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: 05/27/2023]
Abstract
The aim was to estimate and illustrate the weight history of 1,320 newly diagnosed diabetic patients according to patient characteristics at diagnosis. The median recalled weight gain from age 20 to diabetes diagnosis at a median age of 65.3 years was 14.7 kg. The average weight gain from 10 years prior to diabetes diagnosis until diagnosis, however, was only 1 kg and varied with e.g. age, sex, diagnostic plasma glucose, and presence of diabetic retinopathy. The findings contribute to the evidence basis of general practitioners' weight advice both before and after diabetes diagnosis.
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Affiliation(s)
- Niels de Fine Olivarius
- Forskningsenheden for Almen Praksis i København, Københavns Universitet, Center for Sundhed og Samfund, DK-1014 København K.
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Nielsen ABS, Olivarius NDF, Gannik D, Hindsberger C, Hollnagel H. [Six years structured individualised treatment of patients with type 2-diabetes in general practice. Secondary publication]. Ugeskr Laeger 2007; 169:2428-31. [PMID: 17594836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
We examined whether a multifactorial intervention with personal treatment goals had a different effect on men's and women's HbA1c, knowledge, attitude towards illness, lifestyle, and social support in a randomized controlled trial including 874 newly-diagnosed patients with diabetes > or = 40 years. After six years women who received routine care had 1.10 times higher HbA1c and fewer consultations than women in the intervention group. No difference was found among men. Neither consultations, knowledge, lifestyle, attitudes nor social support explained the gendered result.
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de Fine Olivarius N, Andreasen AH, Siersma V, Richelsen B, Beck-Nielsen H. [Weight changes and the effect of anti-diabetes treatment in the first 5 years after diabetes diagnosis - secondary publication]. Ugeskr Laeger 2006; 168:3913-6. [PMID: 17118255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We monitored changes in patients' weight during the first 5 years after diabetes diagnosis. Data were from 711 newly diagnosed diabetic patients aged 40 or over managed in general practice. Patients whose only treatment was advice on diet generally maintained an initial weight loss of 5-7 kg over the 5 years. Patients receiving metformin or sulfonylureas maintained an average weight loss of 2-4 kg depending on age and sex, while an acceptable average glycaemic control was achieved. The results indicate that weight reduction is a practicable treatment in diabetic patients.
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Affiliation(s)
- Niels de Fine Olivarius
- Forskningsenheden for Almen Praksis i København, Københavns Universitet, Center for Sundhed og Samfund, Øster Farimagsgade 5, Postboks 2099, DK-1014 København K.
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Nielsen ABS, de Fine Olivarius N, Gannik D, Hindsberger C, Hollnagel H. Structured personal diabetes care in primary health care affects only women's HbA1c. Diabetes Care 2006; 29:963-9. [PMID: 16644621 DOI: 10.2337/diacare.295963] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetic men and women differ in lifestyle and attitudes toward diabetes and may benefit differently from interventions to improve glycemic control. We explored the relation between HbA1c (A1C), sex, treatment allocation, and their interactions with behavioral and attitudinal characteristics in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Six years after their diabetes diagnosis, a population-based sample of 874 primary care patients cluster-randomized to receive structured personal care or routine care reported lifestyle, medication, social support, diabetes-related consultations, and attitudes toward diabetes. Multivariate analyses were applied, split by sex. RESULTS A marked intervention effect on A1C was confined to the structured personal care women. The median A1C was 8.4% in structured personal care women and 9.2% in routine care women (P < 0.0001) and 8.5% in structured personal care men and 8.9% in routine care men (P = 0.052). Routine care women had a 1.10 times higher A1C than structured personal care women, (P < 0.0001, adjusted analysis). Structured personal care women had relatively more consultations than routine care women, but neither number of consultations nor other covariates helped to explain the sex difference in A1C. Irrespective of treatment allocation, women had more adaptive attitudes toward diabetes but lacked support compared with men. CONCLUSIONS In this study, the observed effect of structured personal care on A1C was present only among women, possibly because they were more inclined to comply with regular follow-up and had a tendency to have a more adaptive attitude toward diabetes.
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Affiliation(s)
- Anni B S Nielsen
- The Research Unit for General Practice in Copenhagen, Oster Farimagsgade 5, P.O. Box 2099, DK-1014, Copenhagen K, Denmark.
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Abstract
BACKGROUND Continuity of care may not only save time and money for the health care system, but may also be beneficial for the individual patient. How well GPs know their patients may potentially lead to an early diagnosis of a slowly progressive chronic disease like type 2 diabetes mellitus (T2DM). The aim of this paper is to investigate this hypothesis. METHODS A cross-sectional, population-based study of 1136 patients newly diagnosed with T2DM by their GP. Our main outcomes were how well the GPs' knew their patients (questionnaire) and centralized analysis of glycosylated haemoglobin A(1c). Multivariate linear regression models were used to allow adjustment for confounding variables. RESULTS GPs classified how well they knew their patients as being not well for 13.5% (153/1136) of their patients, as fairly well for 38.6% (438/1136) and as very well for 48.0% (545/1136). Patients whom the GPs classified as not knowing well had relatively high glycaemic levels compared with levels among other patients, a finding that was confirmed in multivariate linear regression models. CONCLUSIONS Our data show that the glycaemic level among patients whom the GP characterize as knowing well or fairly well is relatively low compared with among patients whom the GP characterize as not knowing well. We suggest that this reflects a late diagnosis in these patients, and that GPs should be especially aware of undiagnosed T2DM among patients whom they do not know well.
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Affiliation(s)
- Thomas Drivsholm
- The Research Unit and Department of General Practice, University of Copenhagen, Denmark.
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Olivarius NDF, Reventlow SD, Ertmann RK. [General practice research supervision]. Ugeskr Laeger 2006; 168:574-7. [PMID: 16476218] [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: 05/06/2023]
Abstract
INTRODUCTION General practice is a subject with a relatively short scientific tradition. The purpose of this study was to elucidate who gives long-cycle general practice research supervision in Denmark, who is supervised and how research students get on. MATERIALS AND METHODS All research students with research advisers in the field of general practice filled out a questionnaire in 1997 (n = 50) and 2003 (n = 52). There were questions about project/research training, professional education, advisers and the students' attitude to taking on advisory functions in the future. In 2003, 48 of those from the 1997 cohort also answered a follow-up questionnaire. RESULTS The number of research students with a connection to the general practice research field was fairly constant from 1997 to 2003. The number of permanently employed general practice advisers, on the other hand, has doubled, and these now undertake more of the advisory functions. The great majority of research students complete their projects, most of them at PhD level. Most of the research students surveyed indicated that they are prepared to take on advisory functions when they have acquired the competence to do so. DISCUSSION The general practice research students vary greatly with regard to age, interests and career paths, but almost all complete their research studies. This may be due to the flexible framework for research in general practice and the increase in recent years of advisory capacity in general practice. This positive development is expected to continue through the development of networks, course activities and continuing follow-up of the advisory functions.
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Affiliation(s)
- Niels de Fine Olivarius
- Københavns Universitet, Forskningsenheden for Almen Praksis, Center for Sundhed og Samfund og Dansk selskab for almen medicin, Forskningsudvalget, København.
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Hansen LJ, Olivarius NDF, Siersma V. General practitioners need to pay more attention to their poorly controlled type 2 diabetic patients. Eur J Gen Pract 2006; 11:81-3. [PMID: 16392783 DOI: 10.3109/13814780509178244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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de Fine Olivarius N, Andreasen AH, Vestbo E, Holstein-Rathlou NH, Jørgensen LGM, Mogensen CE. Urinary creatinine concentration is inversely related to glycaemic control and the presence of some diabetic complications in patients with newly diagnosed Type 2 diabetes. J Diabetes Complications 2006; 20:45-50. [PMID: 16389167 DOI: 10.1016/j.jdiacomp.2005.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Revised: 05/11/2005] [Accepted: 05/24/2005] [Indexed: 11/29/2022]
Abstract
BACKGROUND The ratio between urinary albumin concentration (UAC) and urinary creatinine concentration (UCC) is widely used to estimate renal involvement. We examined how UAC and UCC associate with each other, with other risk factors, and with diabetic complications in a population-based sample of Type 2 diabetic patients. METHODS A freshly voided morning urine specimen was provided by 1,284 consecutive, newly diagnosed diabetic patients aged 40 years or over in general practice. Albumin was measured by a polyethyleneglycol radioimmunoassay and creatinine by a modified Jaffe method. RESULTS In a multivariate model including UAC, UCC, age, sex, HbA1c, and urinary glucose concentration, UAC increased with both age (P=.042) and HbA1c (P=.014), while UCC decreased (P<.001 and P<.001, respectively). In two regression models, the prevalence of diabetic retinopathy (P<.001) and relatively high resting heart rate (P<.001) increased with increasing UAC but decreased with increasing UCC (P=.002 and P=.005, respectively). CONCLUSION The use of albumin/creatinine ratio (ACR) may introduce bias of unpredictable size and direction in comparisons of ACR with variables that are associated with UCC in their own right. In daily clinical practice, renal involvement in the individual patient can be estimated reliably with UAC or ACR measured in a freshly voided morning urine specimen, especially when considered together. However, the associations of the combined measure ACR should be interpreted with great caution in clinical and epidemiological research.
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Affiliation(s)
- Niels de Fine Olivarius
- The Research Unit and Department for General Practice, University of Copenhagen, Copenhagen, Denmark.
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de Fine Olivarius N, Palmvig B, Andreasen AH, Thorgersen JT, Hundrup C. An educational model for improving diet counselling in primary care A case study of the creative use of doctors' own diet, their attitudes to it and to nutritional counselling of their patients with diabetes. Patient Educ Couns 2005; 58:199-202. [PMID: 16009297 DOI: 10.1016/j.pec.2004.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2004] [Revised: 08/03/2004] [Accepted: 08/23/2004] [Indexed: 05/03/2023]
Abstract
Aiming to improve the quality of diet recording and instruction in primary care, we developed a simple semi-quantitative food frequency questionnaire for type 2 diabetic patients and had doctors record each other's diet habits with the same questionnaire. The analysis of the diet composition was given to the doctors who considered the educational model to be fun, instructive and thought-provoking. Doctors with a relatively unhealthy diet and a relatively high body weight tended to show dissatisfaction with their own diet, had poor self-assessed knowledge about nutrition, and even a wish to improve their own diet after having seen the result of the diet interview. The proportion of diabetic patients being treated with diet alone tended to decrease with their doctors' decreasing diet counselling skills, which indicates that doctors' attitudes may exert an effect at patient level.
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Astrup K, Olivarius NDF. [Frequency of postmenopausal bleedings--secondary publication]. Ugeskr Laeger 2005; 167:521-4. [PMID: 15745176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Karen Astrup
- København Universitet, Forskningsenheden for Almen Praksis i København.
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