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Posch MG, Walther N, Ferrannini E, Powell DR, Banks P, Wason S, Dahmen R. Metabolic, Intestinal, and Cardiovascular Effects of Sotagliflozin Compared With Empagliflozin in Patients With Type 2 Diabetes: A Randomized, Double-Blind Study. Diabetes Care 2022; 45:2118-2126. [PMID: 35817022 PMCID: PMC9472498 DOI: 10.2337/dc21-2166] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Received: 10/18/2021] [Accepted: 05/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Inhibiting sodium-glucose cotransporters (SGLTs) improves glycemic and cardiovascular outcomes in patients with type 2 diabetes (T2D). We investigated the differential impact of selective SGLT2 inhibition and dual inhibition of SGLT1 and SGLT2 on multiple parameters. RESEARCH DESIGN AND METHODS Using a double-blind, parallel-group design, we randomized 40 patients with T2D and hypertension to receive the dual SGLT1 and SGLT2 inhibitor sotagliflozin 400 mg or the selective SGLT2 inhibitor empagliflozin 25 mg, with preexisting antihypertensive treatment, for 8 weeks. In an in-house testing site, mixed-meal tolerance tests (MMTTs) and other laboratory and clinical evaluations were used to study metabolic, intestinal, cardiovascular, and urinary parameters over 24 h. RESULTS Changes from baseline in glycemic and blood pressure control; intestinal, urine, and metabolic parameters; and cardiovascular biomarkers were generally similar with sotagliflozin and empagliflozin. During the breakfast MMTT, sotagliflozin significantly reduced incremental area under the curve (AUC) values for postprandial glucose, insulin, and glucose-dependent insulinotropic polypeptide (GIP) and significantly increased incremental AUCs for postprandial glucagon-like peptide 1 (GLP-1) relative to empagliflozin, consistent with sotagliflozin-mediated inhibition of intestinal SGLT1. These changes waned during lunch and dinner MMTTs. Both treatments significantly lowered GIP incremental AUCs relative to baseline over the 14 h MMTT interval; the most vigorous effect was seen with sotagliflozin soon after start of the first meal of the day. No serious or severe adverse events were observed. CONCLUSIONS Changes from baseline in glycemic and blood pressure control, cardiovascular biomarkers, and other parameters were comparable between sotagliflozin and empagliflozin. However, sotagliflozin but not empagliflozin inhibited intestinal SGLT1 after breakfast as shown by larger changes in postprandial glucose, insulin, GIP, and GLP-1 AUCs, particularly after breakfast. Additional study is warranted to assess the clinical relevance of transient SGLT1 inhibition and differences in incretin responses (NCT03462069).
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Affiliation(s)
| | | | - Ele Ferrannini
- National Research Council Institute of Clinical Physiology, Pisa, Italy
| | | | | | - Suman Wason
- Lexicon Pharmaceuticals, Inc., The Woodlands, TX
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Prick JCM, van Schaik SM, Deijle IA, Dahmen R, Brouwers PJAM, Hilkens PHE, Garvelink MM, Engels N, Ankersmid JW, Keus SHJ, The R, Takahashi A, van Uden-Kraan CF, van der Wees PJ, Van den Berg-Vos RM, van Schaik S, Brouwers P, Hilkens P, van Dijk G, Gons R, Saxena R, Schut E. Development of a patient decision aid for discharge planning of hospitalized patients with stroke. BMC Neurol 2022; 22:245. [PMID: 35790912 PMCID: PMC9254531 DOI: 10.1186/s12883-022-02679-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/11/2022] [Indexed: 10/13/2023] Open
Abstract
Abstract
Background
Patient involvement in discharge planning of patients with stroke can be accomplished by providing personalized outcome information and promoting shared decision-making. The aim of this study was to develop a patient decision aid (PtDA) for discharge planning of hospitalized patients with stroke.
Methods
A convergent mixed methods design was used, starting with needs assessments among patients with stroke and health care professionals (HCPs). Results of these assessments were used to develop the PtDA with integrated outcome information in several co-creation sessions. Subsequently, acceptability and usability were tested to optimize the PtDA. Development was guided by the International Patient Decision Aids Standards (IPDAS) criteria.
Results
In total, 74 patients and 111 HCPs participated in this study. A three-component PtDA was developed, consisting of:
1) a printed consultation sheet to introduce the options for discharge destinations, containing information that can be specified for each individual patient;
2) an online information and deliberation tool to support patient education and clarification of patient values, containing an integrated “patients-like-me” model with outcome information about discharge destinations;
3) a summary sheet to support actual decision-making during consultation, containing the patient’s values and preferences concerning discharge planning.
In the acceptability test, all qualifying and certifying IPDAS criteria were fulfilled. The usability test showed that patients and HCPs highly appreciated the PtDA with integrated outcome information.
Conclusions
The developed PtDA was found acceptable and usable by patients and HCPs and is currently under investigation in a clinical trial to determine its effectiveness.
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Prick JCM, Zonjee VJ, van Schaik SM, Dahmen R, Garvelink MM, Brouwers PJAM, Saxena R, Keus SHJ, Deijle IA, van Uden-Kraan CF, van der Wees PJ, Van den Berg-Vos RM. Experiences with information provision and preferences for decision making of patients with acute stroke. Patient Educ Couns 2022; 105:1123-1129. [PMID: 34462248 DOI: 10.1016/j.pec.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/23/2021] [Accepted: 08/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to gain insight into experiences of patients with acute stroke regarding information provision and their preferred involvement in decision-making processes during the initial period of hospitalisation. METHODS A sequential explanatory design was used in two independent cohorts of patients with stroke, starting with a survey after discharge from hospital (cohort 1) followed by observations and structured interviews during hospitalisation (cohort 2). Quantitative data were analysed descriptively. RESULTS In total, 72 patients participated in this study (52 in cohort 1 and 20 in cohort 2). During hospitalisation, the majority of the patients were educated about acute stroke and their treatment. Approximately half of the patients preferred to have an active role in the decision-making process, whereas only 21% reported to be actively involved. In cohort 2, 60% of the patients considered themselves capable to carefully consider treatment options. CONCLUSIONS Active involvement in the acute decision-making process is preferred by approximately half of the patients with acute stroke and most of them consider themselves capable of doing so. However, they experience a limited degree of actual involvement. PRACTICE IMPLICATIONS Physicians can facilitate patient engagement by explicitly emphasising when a decision has to be made in which the patient's opinion is important.
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Affiliation(s)
- J C M Prick
- Department of Neurology, OLVG, Amsterdam, The Netherlands; Santeon, Utrecht, The Netherlands.
| | - V J Zonjee
- Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - S M van Schaik
- Department of Neurology, OLVG, Amsterdam, The Netherlands
| | - R Dahmen
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - M M Garvelink
- Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - P J A M Brouwers
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - R Saxena
- Department of Neurology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - S H J Keus
- Department of Quality and Improvement, OLVG, Amsterdam, The Netherlands
| | - I A Deijle
- Department of Quality and Improvement, OLVG, Amsterdam, The Netherlands
| | | | - P J van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, The Netherlands; Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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Azzabi A, THABET N, Sahtout W, Dahmen R, Mrabet S, Aounallah A, Boukadia R, Fradi A, Sabri F, Ben amor S, Zellama D, Denguezli M, Guedri Y, Achour A. POS-796 Cutaneous leishmaniasis in a kidney transplant patient: a case report. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bode D, Semmler L, Wakula P, Hegemann N, Primessnig U, Beindorff N, Powell D, Dahmen R, Ruetten H, Oeing C, Alogna A, Messroghli D, Pieske BM, Heinzel FR, Hohendanner F. Dual SGLT-1 and SGLT-2 inhibition improves left atrial dysfunction in HFpEF. Cardiovasc Diabetol 2021; 20:7. [PMID: 33413413 PMCID: PMC7792219 DOI: 10.1186/s12933-020-01208-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/27/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sodium-glucose linked transporter type 2 (SGLT-2) inhibition has been shown to reduce cardiovascular mortality in heart failure independently of glycemic control and prevents the onset of atrial arrhythmias, a common co-morbidity in heart failure with preserved ejection fraction (HFpEF). The mechanism behind these effects is not fully understood, and it remains unclear if they could be further enhanced by additional SGLT-1 inhibition. We investigated the effects of chronic treatment with the dual SGLT-1&2 inhibitor sotagliflozin on left atrial (LA) remodeling and cellular arrhythmogenesis (i.e. atrial cardiomyopathy) in a metabolic syndrome-related rat model of HFpEF. METHODS 17 week-old ZSF-1 obese rats, a metabolic syndrome-related model of HFpEF, and wild type rats (Wistar Kyoto), were fed 30 mg/kg/d sotagliflozin for 6 weeks. At 23 weeks, LA were imaged in-vivo by echocardiography. In-vitro, Ca2+ transients (CaT; electrically stimulated, caffeine-induced) and spontaneous Ca2+ release were recorded by ratiometric microscopy using Ca2+-sensitive fluorescent dyes (Fura-2) during various experimental protocols. Mitochondrial structure (dye: Mitotracker), Ca2+ buffer capacity (dye: Rhod-2), mitochondrial depolarization (dye: TMRE) and production of reactive oxygen species (dye: H2DCF) were visualized by confocal microscopy. Statistical analysis was performed with 2-way analysis of variance followed by post-hoc Bonferroni and student's t-test, as applicable. RESULTS Sotagliflozin ameliorated LA enlargement in HFpEF in-vivo. In-vitro, LA cardiomyocytes in HFpEF showed an increased incidence and amplitude of arrhythmic spontaneous Ca2+ release events (SCaEs). Sotagliflozin significantly reduced the magnitude of SCaEs, while their frequency was unaffected. Sotagliflozin lowered diastolic [Ca2+] of CaT at baseline and in response to glucose influx, possibly related to a ~ 50% increase of sodium sodium-calcium exchanger (NCX) forward-mode activity. Sotagliflozin prevented mitochondrial swelling and enhanced mitochondrial Ca2+ buffer capacity in HFpEF. Sotagliflozin improved mitochondrial fission and reactive oxygen species (ROS) production during glucose starvation and averted Ca2+ accumulation upon glycolytic inhibition. CONCLUSION The SGLT-1&2 inhibitor sotagliflozin ameliorated LA remodeling in metabolic HFpEF. It also improved distinct features of Ca2+-mediated cellular arrhythmogenesis in-vitro (i.e. magnitude of SCaEs, mitochondrial Ca2+ buffer capacity, diastolic Ca2+ accumulation, NCX activity). The safety and efficacy of combined SGLT-1&2 inhibition for the treatment and/or prevention of atrial cardiomyopathy associated arrhythmias should be further evaluated in clinical trials.
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MESH Headings
- Animals
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/metabolism
- Arrhythmias, Cardiac/physiopathology
- Arrhythmias, Cardiac/prevention & control
- Atrial Function, Left/drug effects
- Atrial Remodeling/drug effects
- Calcium Signaling/drug effects
- Disease Models, Animal
- Glycosides/pharmacology
- Heart Atria/drug effects
- Heart Atria/metabolism
- Heart Atria/physiopathology
- Heart Failure/drug therapy
- Heart Failure/etiology
- Heart Failure/metabolism
- Heart Failure/physiopathology
- Metabolic Syndrome/complications
- Mitochondria, Heart/drug effects
- Mitochondria, Heart/metabolism
- Mitochondria, Heart/pathology
- Mitochondrial Dynamics/drug effects
- Mitochondrial Swelling/drug effects
- Rats, Inbred WKY
- Rats, Zucker
- Reactive Oxygen Species/metabolism
- Sodium-Calcium Exchanger/metabolism
- Sodium-Glucose Transporter 1/antagonists & inhibitors
- Sodium-Glucose Transporter 1/metabolism
- Sodium-Glucose Transporter 2/metabolism
- Sodium-Glucose Transporter 2 Inhibitors/pharmacology
- Rats
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Affiliation(s)
- David Bode
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Lukas Semmler
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Paulina Wakula
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Niklas Hegemann
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Uwe Primessnig
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Nicola Beindorff
- Berlin Experimental Radionuclide Imaging Center (BERIC), Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - David Powell
- Lexicon Pharmaceuticals, Metabolism Research, Houston, TX, USA
| | - Raphael Dahmen
- Sanofi-Aventis Deutschland GmbH, Research & Development, 65926, Frankfurt am Main, Germany
| | - Hartmut Ruetten
- Sanofi-Aventis Deutschland GmbH, Research & Development, 65926, Frankfurt am Main, Germany
| | - Christian Oeing
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Daniel Messroghli
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, 13353, Berlin, Germany
| | - Burkert M Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, 13353, Berlin, Germany
| | - Frank R Heinzel
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Felix Hohendanner
- Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
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Dahmen R, Konings-Pijnappels A, Kerkhof S, Verberne S, Boers M, Roorda LD, van der Leeden M. Higher body mass index is associated with lower foot health in patients with rheumatoid arthritis: baseline results of the Amsterdam-Foot cohort. Scand J Rheumatol 2020; 49:186-194. [PMID: 32154754 DOI: 10.1080/03009742.2019.1663920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Obesity is highly prevalent in patients with rheumatoid arthritis (RA), with likely impact on weight-bearing foot joints. We explored the associations between body mass index (BMI) and measures of foot health in patients with RA and foot complaints.Method: We examined patients with RA presenting for their first custom-made therapeutic footwear or foot orthoses. Domains of foot health comprised: foot pain, foot-related activity limitations, forefoot plantar pressure, foot synovitis, and foot deformity. In regression analyses, BMI was the independent variable and foot health domains were the dependent variables.Results: The cohort at baseline comprised 230 patients [mean ± sd age 58 ± 13 years, 80% female, mean ± sd disease duration 10 ± 9 years, and median (interquartile range) BMI 26.7 (23.5-30.1) kg/m2]. Small to modest statistically significant associations were found in the majority of the measures studied between a higher BMI and more foot pain, more foot-related activity limitations, higher in-shoe measured forefoot plantar pressure, and the presence of foot synovitis. No relationships were found between BMI and barefoot measured forefoot plantar pressure or foot deformity.Conclusion: BMI is negatively associated with foot health in patients with RA. Although the clinical relevance of our findings for an individual patient is not immediately obvious, future research should consider BMI as a potential therapeutic target to improve foot health.
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Affiliation(s)
- R Dahmen
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | | | - S Kerkhof
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - S Verberne
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - M Boers
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.,Rheumatology, Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre, Amsterdam, The Netherlands
| | - L D Roorda
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - M van der Leeden
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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Konings-Pijnappels APM, Tenten-Diepenmaat M, Dahmen R, Verberne SK, Dekker J, Twisk JWR, Roorda LD, van der Leeden M. Forefoot pathology in relation to plantar pressure distribution in patients with rheumatoid arthritis: A cross-sectional study in the Amsterdam Foot cohort. Gait Posture 2019; 68:317-322. [PMID: 30566899 DOI: 10.1016/j.gaitpost.2018.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/27/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In patients with rheumatoid arthritis (RA), both high and low forefoot plantar pressures have been reported. Better understanding of pathology in the forefoot associated with altered pressure distribution in patients with RA could help to better formulate and specify goals for treatment with foot orthoses or therapeutic footwear. OBJECTIVES To investigate the association of plantar pressure with disease activity and deformity in the forefoot in patients with rheumatoid arthritis and forefoot symptoms. METHODS A cross sectional study, using data of 172 patients with rheumatoid arthritis and forefoot symptoms, was conducted. Peak pressure (PP) and pressure time integral (PTI) in the forefoot were measured with a pressure platform. Forefoot deformity was assessed using the Platto score. Forefoot disease activity was defined as swelling and/or pain assessed by palpation of the metatarsophalangeal joints. The forefoot was divided in a medial, central and lateral region, in which the following conditions could be present: 1) no pathology, 2) disease activity, 3) deformity or 4) disease activity and deformity. A multilevel analysis was performed using condition per forefoot region as independent variable and PP or PTI in the corresponding region as dependent variable. RESULTS Statistically significant higher plantar pressures were found in forefoot regions with deformities (RR 1.2, CI 1.1-1.3, P<0.0001), compared to forefoot regions without forefoot pathology. No significant differences in plantar pressures were found when solely forefoot disease activity was present in forefoot regions. SIGNIFICANCE Forefoot deformities are related to higher plantar pressures measured in the corresponding forefoot regions. The absence of an association between local disease activity and plantar pressure might be explained by the low prevalence of metatarsophalangeal joint pain or swelling. Future research with sensitive imaging measures to detect disease activity is recommended to reveal the effect of forefoot disease activity on plantar pressure.
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Affiliation(s)
- A P M Konings-Pijnappels
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - M Tenten-Diepenmaat
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - R Dahmen
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - S K Verberne
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - J Dekker
- VU University Medical Center, Department of Rehabilitation Medicine, PO 7057, 1007 MB, Amsterdam, the Netherlands; Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - J W R Twisk
- Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1089a, 1081 HV Amsterdam, the Netherlands.
| | - L D Roorda
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - M van der Leeden
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands; VU University Medical Center, Department of Rehabilitation Medicine, PO 7057, 1007 MB, Amsterdam, the Netherlands; Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
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Bailey T, Pettus J, Roussel R, Schmider W, Maroccia M, Nassr N, Klein O, Bolli G, Dahmen R. Morning administration of 0.4 U/kg/day insulin glargine 300 U/mL provides less fluctuating 24-hour pharmacodynamics and more even pharmacokinetic profiles compared with insulin degludec 100 U/mL in type 1 diabetes. Diabetes & Metabolism 2018; 44:15-21. [DOI: 10.1016/j.diabet.2017.10.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/04/2017] [Accepted: 10/08/2017] [Indexed: 12/19/2022]
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Rüppel D, Dahmen R, Boss A, Jäger R, Grant M, Baughman R, Klabunde T. A Population Dose-Response Model for Inhaled Technosphere Insulin Administered to Healthy Subjects. CPT Pharmacometrics Syst Pharmacol 2017; 6:365-372. [PMID: 28568813 PMCID: PMC5488128 DOI: 10.1002/psp4.12189] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/24/2017] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
Technosphere insulin (TI), an inhaled insulin with a fast onset of action, provides a novel option for the control of prandial glucose. A euglycemic glucose clamp study was performed to compare the effects of TI and regular human insulin (RHI) on the induced glucose infusion rate (GIR) in healthy volunteers. Generation of a dose–response relationship between insulin dose and effect (expressed as AUC of GIR) was not possible from the clinical data directly. The GIR recording time was too short to capture the full effect and higher doses were not tested. Thus, a pharmacokinetic‐GIR model was developed to simulate GIR for a sufficient time window of 20 h and for higher doses. A dose–response model was then generated from the simulated GIR profiles. The resulting model provides an ED50 for TI that is 5‐fold higher than for RHI, a ratio that can be used as conversion factor for equivalent doses of RHI and TI.
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Affiliation(s)
- D Rüppel
- Sanofi-Aventis Deutschland GmbH, R&D Frankfurt, Germany
| | - R Dahmen
- Sanofi-Aventis Deutschland GmbH, R&D Frankfurt, Germany
| | - A Boss
- Sanofi US, Bridgewater, New Jersey, USA
| | - R Jäger
- Sanofi-Aventis Deutschland GmbH, R&D Frankfurt, Germany
| | - M Grant
- MannKind Corporation, Danbury, Connecticut, USA
| | - R Baughman
- MannKind Corporation, Danbury, Connecticut, USA
| | - T Klabunde
- Sanofi-Aventis Deutschland GmbH, R&D Frankfurt, Germany
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Ritzel R, Bailey T, Dahmen R, Pettus J, Roussel R, Bergmann K, Maroccia M, Nassr N, Klein O, Bolli G, Heise T. Insulin glargin 300 E/ml (Gla-300) liefert stabilere und gleichmäßiger verteilte Steady-State pharmakodynamische/pharmakokinetische Profile verglichen mit Insulin degludec bei Typ-1-Diabetes (T1DM). DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- R Ritzel
- Städt. Klinikum München, Klinikum Schwabing, Klinik für Endokrinologie, Diabetologie und Suchtmedizin, München, Germany
| | - T Bailey
- AMCR Institute Inc., Escondido, United States
| | - R Dahmen
- Sanofi, Frankfurt am Main, Germany
| | - J Pettus
- Center for Metabolic Research, University of California, San Diego, United States
| | - R Roussel
- Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
| | | | | | - N Nassr
- Sanofi, Frankfurt am Main, Germany
| | - O Klein
- Profil Institut für Stoffwechselforschung, Neuss, Germany
| | - G Bolli
- University of Perugia, Perugia, Italy
| | - T Heise
- Profil Institut für Stoffwechselforschung, Neuss, Germany
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Pohlmeier H, Berard L, Brulle-Wohlhueter C, Wu J, Dahmen R, Nowotny I, Klonoff D. Ease of Use of the Insulin Glargine 300 U/mL Pen Injector in Insulin-Naïve People With Type 2 Diabetes. J Diabetes Sci Technol 2017; 11:263-269. [PMID: 27664062 PMCID: PMC5478028 DOI: 10.1177/1932296816668877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insulin glargine 300 U/mL (Gla-300) contains the same active ingredient as glargine 100 U/mL (Gla-100), and provides the same number of units in one-third of the volume. The SoloSTAR® injector pen has been modified to ensure accurate administration of this reduced volume and to improve user experience. METHODS Insulin- and pen-naïve adults with type 2 diabetes (T2DM) inadequately controlled with oral antihyperglycemic drugs, who had glycated hemoglobin (HbA1c) levels of 7.0-11.0 % (53-97 mmol/mol) were studied. They received once-daily Gla-300 in this 4-week, multicenter, open-label, single-arm study (NCT02227212). Ease of use/ease of learning (the primary endpoint), glycemic control, safety, and reliability of the disposable (prefilled) Gla-300 injector pen (secondary endpoints) were evaluated. RESULTS At week 4, 95.0% of 40 participating subjects assessed the pen as excellent/good and none as poor/very poor; 97.5% would recommend it to others. Total Diabetes Treatment Satisfaction Questionnaire scores were stable throughout the study. Mean (SD) fasting plasma glucose levels decreased from 166.1 (35.0) mg/dL at baseline to 124.2 (41.1) mg/dL at week 4. No product technical complaints (PTCs) or adverse events (AEs) related to PTCs were reported. The number of subjects experiencing hypoglycemic events of any kind and the incidence of AEs were low. No serious AEs were reported. CONCLUSIONS The Gla-300 injector pen is easy to use and easy to learn to use, with demonstrable reliability and high degrees of acceptance and treatment satisfaction. Once-daily Gla-300 basal insulin treatment was well tolerated and effective in pen- and insulin-naïve adult T2DM subjects.
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Affiliation(s)
- Harald Pohlmeier
- Center for Diabetes and Vascular Disease, Muenster, Germany
- Harald Pohlmeier, Center for Diabetes and Vascular disease, Hohenzollernring 70, Muenster, 48145, Germany.
| | - Lori Berard
- Winnipeg Regional Health Authority Health Sciences Centre, Winnipeg, MB, Canada
| | | | | | - Raphael Dahmen
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Irene Nowotny
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - David Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, CA, USA
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12
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Dahmen R, Oerter R. Das Doege-Potter Syndrom – eine seltene Tumorerkrankung. Zentralbl Chir 2016. [DOI: 10.1055/s-0036-1587481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Visentin R, Giegerich C, Jäger R, Dahmen R, Boss A, Grant M, Dalla Man C, Cobelli C, Klabunde T. Improving Efficacy of Inhaled Technosphere Insulin (Afrezza) by Postmeal Dosing: In-silico Clinical Trial with the University of Virginia/Padova Type 1 Diabetes Simulator. Diabetes Technol Ther 2016; 18:574-85. [PMID: 27333446 PMCID: PMC5035370 DOI: 10.1089/dia.2016.0128] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Technosphere(®) insulin (TI), an inhaled human insulin with a fast onset of action, provides a novel option for the control of prandial glucose. We used the University of Virginia (UVA)/Padova simulator to explore in-silico the potential benefit of different dosing regimens on postprandial glucose (PPG) control to support the design of further clinical trials. Tested dosing regimens included at-meal or postmeal dosing, or dosing before and after a meal (split dosing). METHODS Various dosing regimens of TI were compared among one another and to insulin lispro in 100 virtual type-1 patients. Individual doses were identified for each regimen following different titration rules. The resulting postprandial glucose profiles were analyzed to quantify efficacy and the risk for hypoglycemic events. RESULTS This approach allowed us to assess the benefit/risk for each TI dosing regimen and to compare results with simulations of insulin lispro. We identified a new titration rule for TI that could significantly improve the efficacy of treatment with TI. CONCLUSION In-silico clinical trials comparing the treatment effect of different dosing regimens with TI and of insulin lispro suggest that postmeal dosing or split dosing of TI, in combination with an appropriate titration rule, can achieve a superior postprandial glucose control while providing a lower risk for hypoglycemic events than conventional treatment with subcutaneously administered rapid-acting insulin products.
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Affiliation(s)
- Roberto Visentin
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Robert Jäger
- Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | | | | | | | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
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14
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Arts MLJ, de Haart M, Waaijman R, Dahmen R, Berendsen H, Nollet F, Bus SA. Data-driven directions for effective footwear provision for the high-risk diabetic foot. Diabet Med 2015; 32:790-7. [PMID: 25763659 DOI: 10.1111/dme.12741] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 01/20/2023]
Abstract
AIMS Custom-made footwear is used to offload the diabetic foot to prevent plantar foot ulcers. This prospective study evaluates the offloading effects of modifying custom-made footwear and aims to provide data-driven directions for the provision of effectively offloading footwear in clinical practice. METHODS Eighty-five people with diabetic neuropathy and a recently healed plantar foot ulcer, who participated in a clinical trial on footwear effectiveness, had their custom-made footwear evaluated with in-shoe plantar pressure measurements at three-monthly intervals. Footwear was modified when peak pressure was ≥ 200 kPa. The effect of single and combined footwear modifications on in-shoe peak pressure at these high-pressure target locations was assessed. RESULTS All footwear modifications significantly reduced peak pressure at the target locations compared with pre-modification levels (range -6.7% to -24.0%, P < 0.001). The metatarsal heads were most frequently targeted. Repositioning an existing (trans-)metatarsal pad in the shoe insole (-15.9% peak pressure relief), applying local cushioning to the insole (-15.0%) and replacing the insole top cover with Plastazote (-14.2%) were the most effective single modifications. Combining a new Plastazote top cover with a trans-metatarsal bar (-24.0% peak pressure relief) or with local cushioning (-22.0%) were the most effective combined modifications. CONCLUSIONS In people with diabetic neuropathy and a recently healed plantar foot ulcer, significant offloading can be achieved at high-risk foot regions by modifying custom-made footwear. These results provide data-driven directions for the design and evaluation of custom-made footwear for high-risk people with diabetes, and essentially mean that each shoe prescribed should incorporate those design features that effectively offload the foot.
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Affiliation(s)
- M L J Arts
- Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M de Haart
- Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Waaijman
- Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Dahmen
- Department of Rehabilitation Medicine, Slotervaart Hospital, Amsterdam, The Netherlands
| | - H Berendsen
- Department of Rehabilitation Medicine, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - F Nollet
- Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S A Bus
- Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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15
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Becker RHA, Dahmen R, Bergmann K, Lehmann A, Jax T, Heise T. New insulin glargine 300 Units · mL-1 provides a more even activity profile and prolonged glycemic control at steady state compared with insulin glargine 100 Units · mL-1. Diabetes Care 2015; 38:637-43. [PMID: 25150159 DOI: 10.2337/dc14-0006] [Citation(s) in RCA: 250] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To characterize the pharmacokinetics (PK) and pharmacodynamics (PD) of a new insulin glargine comprising 300 units · mL(-1) (Gla-300), compared with insulin glargine 100 units · mL(-1) (Gla-100) at steady state in people with type 1 diabetes. RESEARCH DESIGN AND METHODS A randomized, double-blind, crossover study (N = 30) was conducted, applying the euglycemic clamp technique over a period of 36 h. In this multiple-dose to steady-state study, participants received once-daily subcutaneous administrations of either 0.4 (cohort 1) or 0.6 units · kg(-1) (cohort 2) Gla-300 for 8 days in one treatment period and 0.4 units · kg(-1) Gla-100 for 8 days in the other. Here we focus on the results of a direct comparison between 0.4 units · kg(-1) of each treatment. PK and PD assessments performed on the last treatment day included serum insulin measurements using a radioimmunoassay and the automated euglycemic glucose clamp technique over 36 h. RESULTS At steady state, insulin concentration (INS) and glucose infusion rate (GIR) profiles of Gla-300 were more constant and more evenly distributed over 24 h compared with those of Gla-100 and lasted longer, as supported by the later time (∼ 3 h) to 50% of the area under the serum INS and GIR time curves from time zero to 36 h post dosing. Tight blood glucose control (≤ 105 mg · dL(-1)) was maintained for approximately 5 h longer (median of 30 h) with Gla-300 compared with Gla-100. CONCLUSIONS Gla-300 provides more even steady-state PK and PD profiles and a longer duration of action than Gla-100, extending blood glucose control well beyond 24 h.
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Affiliation(s)
| | - Raphael Dahmen
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Karin Bergmann
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Anne Lehmann
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
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16
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Shiramoto M, Eto T, Irie S, Fukuzaki A, Teichert L, Tillner J, Takahashi Y, Koyama M, Dahmen R, Heise T, Becker RHA. Single-dose new insulin glargine 300 U/ml provides prolonged, stable glycaemic control in Japanese and European people with type 1 diabetes. Diabetes Obes Metab 2015; 17:254-60. [PMID: 25425297 PMCID: PMC4342764 DOI: 10.1111/dom.12415] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/06/2014] [Accepted: 11/17/2014] [Indexed: 12/22/2022]
Abstract
AIMS Two single-dose studies were conducted in Japan and Europe to compare the pharmacokinetic (PK) and pharmacodynamic (PD) profiles of new insulin glargine 300 U/ml (Gla-300) and insulin glargine 100 U/ml (Gla-100) in people with type 1 diabetes mellitus. METHODS In two double-blind, randomized, crossover studies, 18 Japanese participants (aged 20-65 years) and 24 European participants (aged 18-65 years) with glycated haemoglobin levels ≤9.0% (≤75 mmol/mol) received single subcutaneous doses of Gla-300, 0.4, 0.6 and 0.9 U/kg (0.9 U/kg in the European study only), and Gla-100, 0.4 U/kg. A 36-h euglycaemic clamp procedure was performed after each dosing. RESULTS The serum insulin glargine concentration (INS) and glucose infusion rate (GIR) developed more gradually into more constant and prolonged profiles with Gla-300 than with Gla-100. In support of this, the times to 50% of glargine exposure and insulin activity were longer for all Gla-300 doses than for Gla-100 during the 36-h clamp period, indicating a more evenly distributed exposure and metabolic effect beyond 24 h. Exposure to insulin glargine and glucose utilization were lower with the 0.4 and 0.6 U/ml Gla-300 doses in both studies compared with the 0.4 U/ml Gla-100 dose. Glucose-lowering activity was detected for up to 36 h with all doses of Gla-300. CONCLUSIONS Single-dose injections of Gla-300 present more constant and prolonged PK and PD profiles compared with Gla-100, maintaining blood glucose control for up to 36 h in euglycaemic clamp settings in Japanese and European participants with type 1 diabetes.
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Affiliation(s)
- M Shiramoto
- Hakata Clinic, LTA Clinical Pharmacology Center, Fukuoka, Japan
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17
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Wagener MN, van Opstal SEM, Miedema HS, Brandjes DPM, Dahmen R, van Gorp ECM, Roelofs PDDM. Employment-related concerns of HIV-positive people in the Netherlands: input for a multidisciplinary guideline. J Occup Rehabil 2014; 24:790-797. [PMID: 24806772 DOI: 10.1007/s10926-014-9510-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Finding and keeping employment is difficult for people with HIV. To improve supportive care for people with HIV and employment-related problems, a multidisciplinary guideline was developed in the Netherlands in 2010/2011. To identify the employment-related concerns of people with HIV and to formulate the key questions for the guideline, we conducted a qualitative study. The results of this study are described in this article. METHODS This study was performed in three HIV-treatment centers in the Netherlands. In total 18 participants participated in three focus-group interviews and nine participants were interviewed individually. The data were transcribed ad verbatim and were analyzed according to the principle of constant comparison. RESULTS Our findings indicate that people with HIV in the Netherlands face many work-related concerns. The themes which emerged from this study were disclosure, stigma and discrimination, knowledge about HIV, physical and psychological factors, working conditions, absenteeism, reintegration, and dismissal and counselling. CONCLUSIONS This study provides insight into employment-related concerns for people with HIV living in a Western country. It formed the basis for the key questions which were addressed in a multidisciplinary, evidence-based guideline "HIV and work". Finally, it gives leads for further scientific research and opportunities for improving the vocational guidance of people with HIV.
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Affiliation(s)
- M N Wagener
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001 HA, Rotterdam, The Netherlands,
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18
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Oerter R, Bigalke C, Kaltenecker K, Dahmen R. Die Segmentresektion der Lunge als präzises anatomisches Dissektionsverfahren. Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1389316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Steinstraesser A, Schmidt R, Bergmann K, Dahmen R, Becker RHA. Investigational new insulin glargine 300 U/ml has the same metabolism as insulin glargine 100 U/ml. Diabetes Obes Metab 2014; 16:873-6. [PMID: 24571126 PMCID: PMC4237557 DOI: 10.1111/dom.12283] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/20/2014] [Indexed: 01/14/2023]
Abstract
Insulin glargine is processed in vivo into soluble 21(A) -Gly-human insulin (M1), the principal moiety responsible for metabolic effects, and subsequently into M2. This sub-study compared metabolism and metabolite pharmacokinetic (PK) profiles of investigational new insulin glargine U300 (Gla-300) with insulin glargine 100 U/ml (Gla-100, Lantus®, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany) in people with type 1 diabetes. Participants received 0.4 (n = 18) or 0.6 U/kg Gla-300 (n = 12), and 0.4 U/kg Gla-100 (n = 30) once daily in randomized order for 8 days prior to a 36-h euglycaemic clamp. Metabolites were quantified using immunoaffinity enrichment and liquid chromatography tandem mass spectrometry (LC-MS/MS). Glargine metabolism was the same regardless of Gla-100 or Gla-300 administration; M1 was confirmed as the principal active moiety circulating in blood. Steady state concentrations of M1 were achieved after 2 days for Gla-100, and 4 days for Gla-300. Steady state M1 values defined prolonged and even flatter PK profiles after Gla-300 administration compared with M1 profiles after Gla-100.
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20
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Ben Mansour N, Barakett N, Hajlaoui N, Haggui A, Filali T, Dahmen R, Fehri W, Haouala H. [Acute myocarditis complicating Mediterranean spotted fever. A case report]. Ann Cardiol Angeiol (Paris) 2014; 63:55-57. [PMID: 21664598 DOI: 10.1016/j.ancard.2011.05.003] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 05/02/2011] [Indexed: 05/30/2023]
Abstract
Mediterranean spotted fever (MSF) due to Rickettsia conorii is the most important tick-borne disease occurring in North Africa. The first description of MSF was made by Conor and Brush in 1910 in Tunisia. Clinical diagnosis relies on the association of fever, rash and inoculation's scar during summertime. Prognosis in MSF is usually good, however malignant forms were described. These forms occur in patients with comorbidities. G6PD deficiency is a classic ground for severe forms of MSF. Myocarditis is an uncommon complication in MSF; only few cases were reported in the literature. We report a new case of myocarditis complicating MSF in a 15-year-old patient with G6PD deficiency. The patient presented with fever and rash, evocative of MSF; he reported chest pain and the electrocardiogram showed ST segment elevation in anterior leads. Troponin level was elevated. Echocardiogram showed left ventricular dysfunction with 40% ejection fraction. Serologic tests confirmed R. conorii recent infection. Antibiotic treatment with vibramycine and rifadine was started. Patient also received classic treatment of myocarditis with left ventricular dysfunction associating CEI, ß-bloquers and diuretics. Evolution was favourable with complete recovery of left ventricular function. Myocarditis is an uncommon but severe complication of MSF. Early diagnosis and treatment allow favorable evolution.
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Affiliation(s)
- N Ben Mansour
- Service de cardiologie du Professeur Haouala, hôpital militaire d'instruction, Tunis, Tunisie.
| | - N Barakett
- Service de cardiologie du Professeur Haouala, hôpital militaire d'instruction, Tunis, Tunisie
| | - N Hajlaoui
- Service de cardiologie du Professeur Haouala, hôpital militaire d'instruction, Tunis, Tunisie
| | - A Haggui
- Service de cardiologie du Professeur Haouala, hôpital militaire d'instruction, Tunis, Tunisie
| | - T Filali
- Service de cardiologie du Professeur Haouala, hôpital militaire d'instruction, Tunis, Tunisie
| | - R Dahmen
- Service de cardiologie du Professeur Haouala, hôpital militaire d'instruction, Tunis, Tunisie
| | - W Fehri
- Service de cardiologie du Professeur Haouala, hôpital militaire d'instruction, Tunis, Tunisie
| | - H Haouala
- Service de cardiologie du Professeur Haouala, hôpital militaire d'instruction, Tunis, Tunisie
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Bolli GB, Hahn AD, Schmidt R, Eisenblaetter T, Dahmen R, Heise T, Becker RHA. Plasma exposure to insulin glargine and its metabolites M1 and M2 after subcutaneous injection of therapeutic and supratherapeutic doses of glargine in subjects with type 1 diabetes. Diabetes Care 2012; 35:2626-30. [PMID: 23093664 PMCID: PMC3507590 DOI: 10.2337/dc12-0270] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 07/10/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In vivo, after subcutaneous injection, insulin glargine (21(A)-Gly-31(B)-Arg-32(B)-Arg-human insulin) is enzymatically processed into 21(A)-Gly-human insulin (metabolite 1 [M1]). 21(A)-Gly-des-30(B)-Thr-human insulin (metabolite 2 [M2]) is also found. In vitro, glargine exhibits slightly higher affinity, whereas M1 and M2 exhibit lower affinity for IGF-1 receptor, as well as mitogenic properties, versus human insulin. The aim of the study was to quantitate plasma concentrations of glargine, M1, and M2 after subcutaneous injection of glargine in male type 1 diabetic subjects. RESEARCH DESIGN AND METHODS Glargine, M1, and M2 were determined in blood samples obtained from 12, 11, and 11 type 1 diabetic subjects who received single subcutaneous doses of 0.3, 0.6, or 1.2 units · kg(-1) glargine in a euglycemic clamp study. Glargine, M1, and M2 were extracted using immunoaffinity columns and quantified by a specific liquid chromatography-tandem mass spectrometry assay. Lower limit of quantification was 0.2 ng · mL(-1) (33 pmol · L(-1)) per analyte. RESULTS Plasma M1 concentration increased with increasing dose; geometric mean (percent coefficient of variation) M1-area under the curve between time of dosing and 30 h after dosing (AUC(0-30h)) was 1,261 (66), 2,867 (35), and 4,693 (22) pmol · h · L(-1) at doses of 0.3, 0.6, and 1.2 units · kg(-1), respectively, and correlated with metabolic effect assessed as pharmacodynamics-AUC(0-30h) of the glucose infusion rate following glargine administration (r = 0.74; P < 0.01). Glargine and M2 were detectable in only one-third of subjects and at a few time points. CONCLUSIONS After subcutaneous injection of glargine in male subjects with type 1 diabetes, exposure to glargine is marginal, if any, even at supratherapeutic doses. Glargine is rapidly and nearly completely processed to M1 (21(A)-Gly-human insulin), which mediates the metabolic effect of injected glargine.
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Affiliation(s)
- Geremia B Bolli
- Department of Internal Medicine, University of Perugia, Perugia, Italy.
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22
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Comer C, White D, Conaghan P, Redmond AC, Muller S, Thomas E, Peat G, Backhouse MR, Pickles DA, Mathieson HR, Edgson L, Emery P, Bird H, Helliwell P, Redmond AC, van der Leeden M, Dahmen R, Ursum J, Roorda LD, van Schaardenburg D, Knol DL, Steultjens MP, Dekker J. Mobility in musculokeletal disease: compromise and compensations: IP76. Why do People with Neurogenic Claudication Like Shopping? Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Müller MW, Friess H, Martin DJ, Hinz U, Dahmen R, Büchler MW. Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis. Br J Surg 2008; 95:350-6. [PMID: 17933005 DOI: 10.1002/bjs.5960] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Duodenum-preserving pancreatic head resection according to Beger and the pylorus-preserving Whipple (ppWhipple) procedure were compared in patients with chronic pancreatitis (CP) in a randomized clinical trial. Perioperative data and short-term outcome have been reported previously. The present study evaluated long-term follow-up. METHODS Forty patients were enrolled originally, 20 in each group. Long-term follow-up included mortality, morbidity, pain status, occupational rehabilitation, quality of life (QoL), and endocrine and exocrine function at median follow-up of 7 and 14 years. RESULTS One patient who had a ppWhipple procedure was lost to follow-up. There were five late deaths in each group. No differences were noted in pain status and exocrine pancreatic function. Loss of appetite was significantly worse in the ppWhipple group at 14 years' follow-up, but there were no other differences in QoL parameters examined. After 14 years, diabetes mellitus was present in seven of 15 patients who had the Beger procedure and 11 of 14 patients after ppWhipple resection (P = 0.128). CONCLUSION After long-term follow-up of up to 14 years early advantages of the Beger procedure were no longer present.
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Affiliation(s)
- M W Müller
- Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany
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Abstract
Neuropathy may bring about changes in form and function of the foot, which may lead to ulceration and progressive deformity. These manifestations often require specially adapted footwear. A comprehensive concept of the medical, functional, and technical requirements for this type of footwear is still lacking to date. In this article, We present an algorithm that should facilitate prescription and manufacture of adequate shoes. This algorithm attempts to establish a link between the requirements from a medical and functional point of view and the technical possibilities of orthopedic shoe technology.
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Affiliation(s)
- R Dahmen
- Department of Rehabilitation Medicine, Slotervaartziekenhuis and Jan van Breemen Institute, The Netherlands.
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25
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de Jong BA, Dahmen R, Hogeweg JA, Marti RK. Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens. Clin Rehabil 1998; 12:211-5. [PMID: 9688036 DOI: 10.1191/026921598673772420] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND PURPOSE Although corticosteroid injections have been reported to be effective in capsulitis of the shoulder, the optimal dose has not been established. The purpose of this study was to compare relief of symptoms following a lower dose with that following a higher dose of triamcinolone acetonide given intra-articularly. SUBJECTS Thirty-two patients were given low dose suspension; 25 patients were given high dose suspension. METHOD Randomized, double-blind clinical trial. Each patient was given a course of three injections. Pain, sleep disturbance, functional impairment and passive range of motion (ROM) were assessed at intake and at one, three and six weeks after the initial injection. Data were analysed by independent sample t-tests and nonparametric Mann-Whitney U-tests. RESULTS The group which received the 40 mg dose showed significantly greater improvement than the group receiving the 10 mg dose. CONCLUSIONS The study shows that in the treatment of frozen shoulder greater symptom relief is obtained with a dose of 40 mg triamcinolone acetonide intra-articularly than with a dose of 10 mg. The effect on pain and sleep disturbance was more marked than on ROM. Intra-articular injections with triamcinolone acetonide appear to be an effective method to obtain symptom relief for patients with painful capsulitis of the shoulder.
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Affiliation(s)
- B A de Jong
- Department of Rehabilitation Medicine, Academic Medical Centre, University of Amsterdam, The Netherlands
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van der Windt DA, Pieterson I, van der Eijken JW, Hollander AP, Dahmen R, de Jong BA. Energy expenditure during walking in subjects with tibial rotationplasty, above-knee amputation, or hip disarticulation. Arch Phys Med Rehabil 1992; 73:1174-80. [PMID: 1463383] [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: 12/27/2022]
Abstract
The surgical treatment of osteosarcoma with a tibial rotationplasty seems to offer functional advantages in comparison with an above-knee amputation. It has not been established whether the functional advantages are accompanied by a lower rate of energy expenditure during walking. In children with a tibial rotationplasty (n = 15), an above-knee amputation (n = 6), or a hip disarticulation (n = 5), energy expenditure was measured during treadmill walking at various walking velocities. The subjects with a tibial rotationplasty were able to walk faster, but there were no differences between the groups in energy expenditure per unit time or per unit distance. Correction for confounding variables including age, sex, height, time since operation, level of activity, and support during walking in a multiple linear regression model did not reveal any significant differences in energy expenditure during walking between groups. 1992 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.
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Affiliation(s)
- D A van der Windt
- Department of Exercise Physiology and Biophysics, Vrije Universiteit, Amsterdam, The Netherlands
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