door bhrw | okt 31, 2023 | diabetes, gezondheidszorg
Objectives: Cardiovascular disease (CVD) is a precarious complication of type 1 diabetes (T1D). Alongside glycaemic control, lipid and blood pressure (BP) management are essential for the prevention of CVD. However, age-specific differences in lipid and BP between individuals with T1D and the general population are relatively unknown.
Design: Cross-sectional study.
Setting: Six diabetes outpatient clinics and individuals from the Lifelines cohort, a multigenerational cohort from the Northern Netherlands.
Participants: 2178 adults with T1D and 146 22 individuals without diabetes from the general population.
Primary and secondary outcome measures: Total cholesterol, low-density lipoprotein cholesterol (LDL-cholesterol), systolic BP (SBP) and diastolic BP (DBP), stratified by age group, glycated haemoglobin category, medication use and sex.
Results: In total, 2178 individuals with T1D and 146 822 without diabetes were included in this study. Total cholesterol and LDL-cholesterol were lower and SBP and DBP were higher in individuals with T1D in comparison to the background population. When stratified by age and medication use, total cholesterol and LDL-cholesterol were lower and SBP and DBP were higher in the T1D population. Men with T1D achieved lower LDL-cholesterol levels both with and without medication in older age groups in comparison to women. Women with T1D had up to 8 mm Hg higher SBP compared with the background population, this difference was not present in men.
Conclusions: Lipid and BP measurements are not comparable between individuals with T1D and the general population and are particularly unfavourable for BP in the T1D group. There are potential sex differences in the management of LDL-cholesterol and BP.
Read the full article at: https://bmjopen.bmj.com/content/13/10/e073690.long
door bhrw | mei 10, 2023 | diabetes, gezondheidszorg
Al jaren wordt getracht om de heterogeniteit van type 2 diabetes beter in kaart te brengen. Recentelijk zijn verschillende manieren van subtypering van type 2 diabetes gepubliceerd. De meeste aandacht gaat naar een onderverdeling in 5 subtypen, vlak na het stellen van de diagnose. Twee van deze subtypen worden gekenmerkt door insulinedeficiëntie; circa de helft van deze patiënten moet relatief vroeg beginnen met insuline. Eén subtype wordt gekenmerkt door ernstige insulineresistentie en een verhoogd risico op nierschade en niet-alcoholische leverziekte.
Subtypering kan leiden tot beter inzicht in de pathofysiologische achtergronden bij een specifiek individu, tot een beter onderbouwde aanpassing van de leefstijl, een betere inschatting van het risico op late complicaties en persoonsgerichte medicamenteuze behandeling. Er is ook meer aandacht voor specifieke factoren die de individuele respons op medicatie beïnvloeden, zoals geslacht, leeftijd en relatief lichaamsgewicht.
Het is te hopen dat deze ontwikkelingen in de nabije toekomst leiden tot een beter op het individu gerichte begeleiding en behandeling van type 2 diabetes.
Het volledige artikel vindt u HIER. (mogelijk moet u eerst inloggen)
door bhrw | apr 15, 2023 | diabetes, gezondheidszorg
Introduction: SURE Netherlands (NCT03929679) evaluated the use of once-weekly (OW) semaglutide, a glucagon-like peptide 1 receptor agonist (GLP-1RA), in routine clinical care for individuals with type 2 diabetes (T2D).
Methods: Adults (age ≥ 18 years) with T2D were enrolled into the single-arm study. The primary endpoint was change from baseline to end of study (EOS; approx. 30 weeks) in glycated haemoglobin (HbA1c). Secondary endpoints were change from baseline to EOS in body weight (BW) and waist circumference (WC). Proportions of participants achieving predefined HbA1c targets and weight-loss responses at EOS, safety, health-related quality of life (HRQoL) and treatment satisfaction were assessed.
Results: In total, 211 participants (mean age 60.5 years; diabetes duration 13.3 years) initiated semaglutide; most were receiving metformin (82.9%) and/or basal insulin (59.2%) at baseline, and 6.2% switched from another GLP-1RA. Mean baseline HbA1c, BW and WC were 8.6%, 105.2 kg and 118.8 cm. In the 186 (88.2%) participants receiving semaglutide at EOS, mean reduction in HbA1c with semaglutide was – 1.2%-points (95% [confidence interval] CI – 1.3; – 1.0; p < 0.0001), with 124 (70.5%), 95 (54.0%) and 65 (36.9%) participants achieving HbA1c targets of < 8.0%, < 7.5% and < 7.0%, respectively. Mean reduction in BW was – 7.8 kg [95% CI – 8.7; – 6.8; p < 0.0001], corresponding to relative reduction of – 7.5% [95% CI – 8.4; – 6.6; p < 0.0001]. Improvements in WC (- 8.8 cm [95% CI – 10.4; – 7.2; p < 0.0001]), HRQoL and treatment satisfaction were observed, including across most Short-Form 36 Health Survey domains. One serious adverse drug reaction (cholecystitis) was reported. Eight participants (all receiving concomitant insulin) experienced severe or documented hypoglycaemia.
Conclusion: Individuals with T2D treated with OW semaglutide experienced significant and clinically relevant improvements in glycaemic control and BW from baseline. These results from a diverse real-world population in the Netherlands support the use of OW semaglutide in treating adults with T2D in routine clinical practice.
You can read the full paper for free at https://link.springer.com/article/10.1007/s12325-022-02385-x
door bhrw | apr 15, 2023 | diabetes, gezondheidszorg, wetenschap
The growing public interest in genetic risk scores for various health conditions can be harnessed to inspire preventive health action. However, current commercially available genetic risk scores can be deceiving as they do not consider other, easily attainable risk factors, such as sex, BMI, age, smoking habits, parental disease status and physical activity. Recent scientific literature shows that adding these factors can improve PGS based predictions significantly. However, implementation of existing PGS based models that also consider these factors requires reference data based on a specific genotyping chip, which is not always available. In this paper, we offer a method naïve to the genotyping chip used. We train these models using the UK Biobank data and test these externally in the Lifelines cohort. We show improved performance at identifying the 10% most at-risk individuals for type 2 diabetes (T2D) and coronary artery disease (CAD) by including common risk factors. Incidence in the highest risk group increases from 3.0- and 4.0-fold to 5.8 for T2D, when comparing the genetics-based model, common risk factor-based model and combined model, respectively. Similarly, we observe an increase from 2.4- and 3.0-fold to 4.7-fold risk for CAD. As such, we conclude that it is paramount that these additional variables are considered when reporting risk, unlike current practice with current available genetic tests.
You can read the full paper at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9941118/pdf/41598_2023_Article_27637.pdf
door bhrw | apr 15, 2023 | diabetes, gezondheidszorg
Aims/hypothesis: Optimal diabetes care and risk factor management are important to delay micro- and macrovascular complications in individuals with type 1 diabetes (T1D). Ongoing improvement of management strategies requires the evaluation of target achievement and identification of risk factors in individuals who do (or do not) achieve these targets.
Methods: Cross-sectional data were collected from adults with T1D visiting six diabetes centers in the Netherlands in 2018. Targets were defined as glycated hemoglobin (HbA1c) <53 mmol/mol, low-density lipoprotein-cholesterol (LDL-c) <2.6 mmoL/L (no cardiovascular disease [CVD] present) or <1.8 mmoL/L (CVD present), or blood pressure (BP) <140/90 mm Hg. Target achievement was compared for individuals with and without CVD.
Results: Data from 1737 individuals were included. Mean HbA1c was 63 mmol/mol (7.9%), LDL-c was 2.67 mmoL/L, and BP 131/76 mm Hg. In individuals with CVD, 24%, 33%, and 46% achieved HbA1c, LDL-c, and BP targets respectively. In individuals without CVD these percentages were 29%, 54%, and 77%, respectively. Individuals with CVD did not have any significant risk factors for HbA1c, LDL-c, and BP target achievement. In comparison, individuals without CVD were more likely to achieve glycemic targets if they were men and insulin pump users. Smoking, microvascular complications, and the prescription of lipid-lowering and antihypertensive medication were negatively associated with glycemic target achievement. No characteristics were associated with LDL-c target achievement. Microvascular complications and antihypertensive medication prescription were negatively associated with BP target attainment.
Conclusion: Opportunities for improvement of diabetes management exist for the achievement of glycemic, lipid, and BP targets but may differ between individuals with and without CVD.
You can read the full article at https://onlinelibrary.wiley.com/doi/10.1111/1753-0407.13368
door bhrw | mrt 8, 2023 | diabetes, gezondheidszorg
Fantasie wordt werkelijkheid… introductie van het mylife CamAPS FX systeem in Nederland.
Het totale systeem bestaat -zoals het plaatje aangeeft- uit de myLife YpsoPump insuline pomp, de Dexcom G6 glucose sensor, en het verbindende CamAPS FX software systeem, dat is ontworpen door professor Roman Hovorka, een genie op het gebied van diabetes en closed-loop software.
Kijk hier naar de opnames van dit webinar. De link is: https://www.youtube.com/watch?v=FNzAE-6A1-4
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