Showing papers by "Martin Ridderstråle published in 2017"

Higher health literacy is associated with better glycemic control in adults with type 1 diabetes: a cohort study among 1399 Danes.

Abstract: Aim Self-management of diabetes is influenced by a range of factors including the ability to access, understand, appraise, and use of health information in everyday life, which can collectively be called health literacy. We investigated associations between nine domains of health literacy and HbA1c level in people with type 1 diabetes. Methods A cross-sectional study was conducted with 1399 people with type 1 diabetes attending a Danish specialist diabetes clinic. Health literacy was assessed using the nine-domain Health Literacy Questionnaire. The association between health literacy and HbA1c was analyzed using linear regression with adjustment for age, sex, educational attainment and diabetes duration. Results Of the 1399 participants, 50% were women, mean age was 54 years, and mean HbA1c was 61 mmol/mol (7.8%). Higher health literacy scores were associated with lower HbA1c levels across eight of nine health literacy domains. This association remained significant after adjusting for educational attainment. Among the domains, ‘Actively managing my health’ had the strongest impact on HbA1c. This was in turn predicted by ‘Appraising health information’, ‘Having sufficient information to manage health’, and ‘Social support for health’. Conclusions Higher health literacy levels are associated with lower HbA1c regardless of educational background. This study highlights the importance of healthcare provision to respond to the health literacy levels of people with diabetes and to the possible need to provide program designed to enhance health literacy.

Metabolite profiling of obese individuals before and after a one year weight loss program

Abstract: We and others have previously characterized changes in circulating metabolite levels following diet-induced weight loss Our aim was to investigate whether baseline metabolite levels and weight-loss-induced changes in these are predictive of or associated with changes in body mass index (BMI) and metabolic risk traits Serum metabolites were analyzed with gas and liquid chromatography/mass spectrometry in 91 obese individuals at baseline and after participating in a 1 year non-surgical weight loss program A total of 137 metabolites were identified and semi-quantified at baseline (BMI 427±58, mean±sd) and at follow-up (BMI 363±66) Weight-loss-induced modification was observed for levels of 57 metabolites in individuals with ⩾10% weight loss Lower baseline levels of xylitol was predictive of a greater decrease in BMI (β=006, P 01, P<005) and ⩾10% weight loss (isoleucine: OR=008, CI=001–03, leucine: OR=01, CI=001–06, valine: OR=01, CI=002–05, tyrosine: OR=01, CI=003–06, P<002) Diet-induced weight loss leads to mainly reduced levels of metabolites that are elevated in obese insulin resistant individuals We identified multiple new associations with metabolic risk factors and validated several previous findings related to weight loss-mediated metabolite changes Levels of specific metabolites, such as xylitol, may be predictive of the response to non-surgical weight loss already at baseline

Incidence of Ketoacidosis in the Danish Type 2 Diabetes Population Before and After Introduction of Sodium-Glucose Cotransporter 2 Inhibitors-A Nationwide, Retrospective Cohort Study, 1995-2014.

Abstract: The U.S. Food and Drug Administration warns that sodium–glucose cotransporter 2 (SGLT2) inhibitors may lead to diabetic ketoacidosis (DKA). To establish a baseline occurrence of DKA in type 2 diabetes, we used national registries in Denmark to estimate incidence rates of DKA and linked the data to information on filled prescriptions to determine treatment exposure, with special attention paid to SGLT2 inhibitor use. Patients with filled prescription(s) for antidiabetes medication or a type 2 diabetes diagnosis identified through national registers (1995–2014) (1,2) were included. Patients were followed from the date of diagnosis until an event or censoring due to death or emigration, or by end of study 31 December 2014, whichever occurred first. Events of DKA were defined as a primary or secondary diagnosis in the National Patient Register between 1 January 1995 and 31 December 2014. Patients diagnosed with type 1 diabetes or who had a filled …

Amino Acid Signatures to Evaluate the Beneficial Effects of Weight Loss

Abstract: Aims. We investigated the relationship between circulating amino acid levels and obesity; to what extent weight loss followed by weight maintenance can correct amino acid abnormalities; and whether amino acids are related to weight loss. Methods. Amino acids associated with waist circumference (WC) and BMI were studied in 804 participants from the Malmo Diet and Cancer Cardiovascular Cohort (MDC-CC). Changes in amino acid levels were analyzed after weight loss and weight maintenance in 12 obese subjects and evaluated in a replication cohort (n = 83). Results. Out of the eight identified BMI-associated amino acids from the MDC-CC, alanine, isoleucine, tyrosine, phenylalanine, and glutamate decreased after weight loss, while asparagine increased after weight maintenance. These changes were validated in the replication cohort. Scores that were constructed based on obesity-associated amino acids and known risk factors decreased in the ≥10% weight loss group with an associated change in BMI (R2 = 0.16-0.22, p < 0.002), whereas the scores increased in the <10% weight loss group (p < 0.0004). Conclusions. Weight loss followed by weight maintenance leads to differential changes in amino acid levels associated with obesity. Treatment modifiable scores based on epidemiological and interventional data may be used to evaluate the potential metabolic benefit of weight loss.

High and low vitamin D level is associated with cardiovascular autonomic neuropathy in people with Type 1 and Type 2 diabetes

Abstract: Aim To investigate the possible association between vitamin D deficiency and cardiovascular autonomic neuropathy in people with diabetes. Methods A total of 113 people with Type 1 or Type 2 diabetes [mean (interquartile range) diabetes duration 22.0 (12–31) years, mean (sd) age 56.2 (13.0) years, 58% men] underwent vitamin D (D2 and D3) assessment, and were screened for cardiovascular autonomic neuropathy using three cardiovascular reflex tests [heart rate response to deep breathing (E/I ratio), to standing (30/15 ratio) and to the Valsalva manoeuvre] and assessment of 5-min resting heart rate and heart rate variability indices. Results We found an inverse U-shaped association between serum vitamin D level and E/I ratio, 30/15 ratio and three heart rate variability indices (P<0.05). Vitamin D level was non-linearly associated with cardiovascular autonomic neuropathy diagnosis (P<0.05 adjusted for age and sex). Linear regression models showed that an increase in vitamin D level from 25 to 50 nmol/l was associated with an increase of 3.9% (95% CI 0.1;7.9) in E/I ratio and 4.8% (95% CI 4.7;9.3) in 30/15 ratio. Conversely, an increase from 125 to 150 nmol/l in vitamin D level was associated with a decrease of 2.6% (95% CI -5.8;0.1) and 4.1% (95% CI -5.8;-0.5) in the respective outcome measures. Conclusions High and low vitamin D levels were associated with cardiovascular autonomic neuropathy in people with diabetes. Future studies should explore this association and the efficacy of treating dysvitaminosis D to prevent cardiovascular autonomic neuropathy. This article is protected by copyright. All rights reserved.

Vitamin B12 deficiency is associated with cardiovascular autonomic neuropathy in patients with type 2 diabetes

Abstract: Aims Vitamin B12 deficiency could be associated with cardiovascular autonomic neuropathy (CAN) in diabetes patients. We aim to investigate the association between serum levels of vitamin B12 and CAN in type 2 diabetes patients. Methods 469 ambulatory type 2 diabetes patients (mean diabetes duration 10.0years (IQR 5.0;17.0), mean age 59.0years (SD 11.6), 63% men, mean B12 289.0pmol/l (IQR 217;390)) were screened for CAN using three cardiovascular reflex tests, five minute resting heart rate (5min RHR) and heart rate variability indices. Results Serum levels of vitamin B12 were significantly lower in patients treated with metformin and/or proton pump inhibitors (PPIs) compared with patients not treated ( p A 25pmol/l higher level of vitamin B12 was associated with an odds ratio of the CAN diagnosis of 0.94 (95% CI 0.88; 1.00, p =0.034), an increase in E/I-ratio of 0.21% (95% CI 0.01; 0.43, p =0.038), and a decrease in 5min RHR of 0.25 beats per minute (95% CI −0.47; −0.03, p =0.025). Conclusion Vitamin B12 may be inversely associated with CAN in patients with type 2 diabetes. Confirmatory studies investigating a causal role of vitamin B12 for the development of diabetic CAN are warranted.

Changes in HbA1c and Weight Following Transition to Continuous Subcutaneous Insulin Infusion Therapy in Adults With Type 1 Diabetes.

Abstract: BACKGROUND: Historically, intensive insulin therapy for type 1 diabetes (T1D) has improved glycemic control at the risk of adverse weight gain. The impact of continuous subcutaneous insulin infusion therapy (CSII) on weight in the current era remains unknown. We assessed changes in hemoglobin A1c (HbA1c) and weight in adults with T1D transitioning to CSII at 2 diabetes centers in Denmark and the United States.METHODS: Patients with T1D, aged ≥18 years, managed with multiple daily injections (MDI) who transitioned to CSII between 2002 and 2013 were identified using electronic health record data from the Steno Diabetes Center (n = 600) and Joslin Diabetes Center (n = 658). Changes in HbA1c and weight after 1 year was assessed overall and by baseline HbA1c cut points. Multivariate regression assessed correlates of HbA1c reduction.RESULTS: In adults with T1D transitioning to CSII, clinically significant HbA1c reductions were found in patients with baseline HbA1c 8.0-8.9% (Steno, -0.7%; Joslin, -0.4%) and baseline HbA1c ≥9.0% (Steno, -1.1%; Joslin, -0.9%) (P < .005 for all). Overall, there was no significant change in weight after 1 year at either center. Modest (<2%) weight gain was noted in patients with baseline HbA1c ≥9% at Steno (1.1 ± 0.3 kg, P < .0001) and Joslin (1.7 ± 1.1, P < .005). In multivariate models, HbA1c reduction was associated with higher HbA1c, older age, female sex at Steno (R(2) = .28, P < .005), but only higher baseline HbA1c at Joslin (R(2) = .19, P < .005).CONCLUSION: Adults with T1D with suboptimal glycemic control significantly improved HbA1c without a negative impact on weight 1 year after transitioning from MDI to CSII. (Less)

Effect of Oral Pre-Meal Administration of Betaglucans on Glycaemic Control and Variability in Subjects with Type 1 Diabetes.

Abstract: We conducted a double-blind placebo-controlled crossover pilot study to investigate the effect of oat betaglucans (β-glucan) on glycaemic control and variability in adults with type 1 diabetes (T1D; n = 14). Stomacol® tablets (1.53 g of β-glucan) or placebo (Plac) were administered three times daily before meals for two weeks. Glucose levels were monitored during the second week by continuous glucose monitoring (CGM). There was an increase in basic measures of glycaemic control (maximal glucose value 341 ± 15 vs. 378 ± 13 mg/dL for Plac and β-glucan, p = 0.004), and average daily risk range (62 ± 5 vs. 79 ± 4 mg/dL for Plac and β-glucan, p = 0.003) favouring Plac over β-glucan, but no increase in the M-value (the weighted average of the glucose values) or other more complex measures. Basic measures of glucose variability were also slightly increased during β-glucan treatment, with no difference in more complex measures. However, glycaemic variability increased between the first and last two CGM days on Plac, but remained unchanged on β-glucan. In conclusion, in this pilot study we were unable to demonstrate a general positive effect of β-glucan before meals on glucose control or variability in T1D.

Comparison Between Individually and Group-Based Insulin Pump Initiation by Time-Driven Activity-Based Costing:

Abstract: Background:Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared t...

Longitudinal Assessment of PTH in Community-Dwelling Older Women-Elevations Are Not Associated With Mortality.

Abstract: Context: In older women, the magnitude of elevated parathyroid hormone (PTH) and its consequence is unclear.Objective: To describe normal PTH profiles over time and the association with mortality.Design and Participants: There were 1044 community-dwelling women in the Malmo Osteoporosis Prospective Risk Assessment cohort (OPRA) who attended baseline (age 75 years). Follow-ups were attended by 715 (age 80 years) and 382 (age 85 years).Main Outcome Measures: PTH, estimated glomerular filtration rate (eGFR), 25-hydroxyvitamin D (25OHD) and mortality.Results: At age 75 years, PTH levels for most (n = 877, 88%) were within the normal reference range (NRR) (i.e., 50% was PTH elevated beyond the NRR (mean 7.1 ± 3.3). Here, a pronounced decline in eGFR (56 vs 61 mL/min/1.73 m2, P = 0.002) was found, despite no further changes in 25OHD. Extending the observational period until age 85 years gave similar results. Baseline PTH levels above NRR were associated with mortality (hazard ratio, 1.4; 95% confidence interval (CI), 1.1-1.8; P = 0.007), although not after adjustment for covariates (P = 0.082).Conclusions: Most women remained within normal PTH ranges despite large increases of up to 50%. PTH elevated above normal is not independently associated with mortality; impaired kidney function and low 25OHD status may be more prognostic in the very old. (Less)

Regulation of Nuclear Receptor Interacting Protein 1 (NRIP1) Gene Expression in Response to Weight Loss and Exercise in Humans.

Abstract: Objective Nuclear receptor interacting protein 1 (NRIP1) is an important energy regulator, but few studies have addressed its role in humans. This study investigated adipose tissue and skeletal muscle NRIP1 gene expression and serum levels in response to weight loss and exercise in humans. Methods NRIP1 expression was measured by microarray and serum NRIP1 by ELISA and Western blotting. Skeletal muscle transcriptomes were analyzed from Gene Expression Omnibus databases. Network-based proximity analysis was performed on the proximity of NRIP1 interacting genes in the human interactome. Results In patients with obesity, adipose tissue NRIP1 mRNA expression increased during weight loss and weight maintenance and showed strong associations with metabolic markers and anthropometric parameters. Serum NRIP1 protein levels also increased after weight loss. In skeletal muscle, imposed rest increased NRIP1 expression by 80%, and strength training increased expression by ∼25% compared to baseline. Following rest, NRIP1 expression became sensitive to insulin stimulation. After re-training, NRIP1 expression decreased. Interactome analysis showed significant proximity of NRIP1 interacting partners to the obesity network/module. Conclusions NRIP1 gene expression and serum levels are strongly associated with metabolic states such as obesity, weight loss, different types of exercise, and peripheral tissue insulin resistance, potentially as a mediator of sedentary effects.

Reply to Kurtoglu: Association of heart rate variability with diabetes and vitamin D levels.

Abstract: In their recent article, Hansen et al. [1] evaluated the association between vitamin D deficiency and heart rate variability (HRV) in patients with diabetes mellitus. Methods of quantifying HRV are basically categorized as: time domain and spectral or frequency domain. Traditionally, spectral variables such as low frequency (LF) and high frequency (HF) power have been analysed from standard 5-min ECG segments, while most laboratories require at least 18 h of usable data to calculate time domain variables, such as SDNN and RMSSD, in a 24-h recording. LF and HF powers can also be measured in normalized units, as the Task Force recommends: ‘this representation shows the relative value of each power component in comparison to the total power. The appearance of LF and HF in normalized units highlights controlled and balanced behavior of the two branches of the autonomic nervous system. The normalization also seems to decrease the effects of the changes in total power on the values of LF and HF’ [2]. So, normalized units should be quoted with absolute values of the LF and HF power whenever possible in order to describe thoroughly the distribution of power in spectral components [3]. Lastly, some confounding factors such as myocardial ischaemia, previous myocardial infarction and heart failure, which are common in longstanding diabetes mellitus, should be taken into account while analysing HRV in diabetes [4].