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Antihyperglycaemic treatment of type 2 diabetes: results from a national diabetes register.

https://arctichealth.org/en/permalink/ahliterature163570
Source
Diabetes Metab. 2007 Sep;33(4):269-76
Publication Type
Article
Date
Sep-2007
Author
B. Eliasson
K. Eeg-Olofsson
J. Cederholm
P M Nilsson
S. Gudbjörnsdóttir
Author Affiliation
Department of Medicine, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. bjorn.eliasson@gu.se
Source
Diabetes Metab. 2007 Sep;33(4):269-76
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood Glucose - metabolism
Body mass index
Coronary Disease - prevention & control
Cross-Sectional Studies
Diabetes Mellitus, Type 2 - complications - drug therapy - epidemiology - physiopathology
Diabetic Angiopathies - prevention & control
Female
Hemoglobin A, Glycosylated - analysis
Humans
Hypoglycemic agents - therapeutic use
Lipids - blood
Longitudinal Studies
Male
Middle Aged
Registries
Sweden - epidemiology
Abstract
To describe clinical characteristics and antihyperglycemic treatment patterns in patients with varying duration of diabetes.
We performed a cross-sectional survey of 61890 type 2 diabetic (DM2) patients from the Swedish National Diabetes Register (NDR) in 2004. We also analysed the effect of types of treatment and risk factors on glycaemic control in a longitudinal cohort study from 1996 to 2004. HbA(1c), risk factors and treatments were determined locally in primary care as well as hospital outpatient clinics.
Insulin was frequently used in DM2 patients with long duration of diabetes, although the mean HbA(1c) increased and only a few in this group reached HbA(1c) 1%) from 1996 to 2004 were more often treated with insulin than with oral hypoglycaemic agents (OHA). During this period, the HbA(1c) levels leading to additional treatment decreased. A low BMI, decreasing BMI and not smoking were predictors of good long-term metabolic control. Hypertension and hyperlipidaemia were frequent in both newly diagnosed DM2 patients and in patients with a long duration of diabetes.
Insulin treatment was frequently used, particularly in patients with a long duration of DM2. The glycaemic control, which usually deteriorates over time, did not reach the recommended goal, despite the fact that complementary treatment was added at lower HbA(1c) levels in 2003 than in 1996. High frequencies of hypertension, hyperlipidaemia and high 10-year risks of coronary heart disease necessitate intensified risk factor control in the future.
PubMed ID
17499541 View in PubMed
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Findings in a health survey of middle-aged subjects in Uppsala 1981-82. Risk factors for diabetes mellitus and cardiovascular disease.

https://arctichealth.org/en/permalink/ahliterature48870
Source
Ups J Med Sci. 1985;90(3):201-27
Publication Type
Article
Date
1985
Author
J. Cederholm
Source
Ups J Med Sci. 1985;90(3):201-27
Date
1985
Language
English
Publication Type
Article
Keywords
Angina Pectoris - epidemiology
Blood pressure
Body constitution
Coronary Disease - epidemiology
Diabetes Mellitus - epidemiology
Family Characteristics
Female
Glucose Tolerance Test
Health Surveys
Humans
Hypertension - drug therapy - epidemiology
Male
Middle Aged
Myocardial Infarction - epidemiology
Questionnaires
Research Support, Non-U.S. Gov't
Risk
Smoking
Sweden
Abstract
In a health survey in 1981-82 in the city of Uppsala 819 subjects (443 females and 376 males), 47-54 years old, were examined. A 75 g oral glucose tolerance test OGTT was performed in each subject, and fasting and 2-h venous whole blood glucose values were determined. The 2-h value was somewhat higher in females, 4.7 mmol X l-1, than in males, 4.4 mmol X l-1 (p less than 0.01). Known or probable manifest diabetes was present in 1.9% of all subjects. Glucose values within the limits for WHO criteria of glucose intolerance were found in another 7.1% of all subjects after one OGTT. The rates were similar in both sexes. A history of diabetes in first-degree relatives was noted in 13.2% of all subjects. According to a questionnaire, 1.1% of all subjects had had hospital care for myocardial infarction, 4.7% had angina pectoris and 2.4% had intermittent claudication. The rate of subjects on antihypertensive treatment or with untreated high blood pressure greater than or equal to 170/105 mm Hg was 11.2%; of these only 1.8% had untreated high blood pressure. Of the treated subjects, the treatment was adequate in 82.9%. Obesity, defined as relative body mass index greater than or equal to 120%, was found in 34.0% of all subjects, more frequently in females than in males. The rate of smokers was 28.5%. A comparison was made with the results of a similar health survey of about 2 300 middle-aged men in Uppsala in 1970-73. The prevalence of angina pectoris was higher among the men of the present survey than among those of the 1970-73 survey, which may at least partly be due to differences in methodology. Relative body weight was higher, and fewer men were regularly active during leisure for at least 2-3 h per week in the present study. The rates of hypertension were similar, but fewer men had untreated high blood pressure and more men were on antihypertensive treatment in the present study. There was a lower frequency of smokers in this study.
PubMed ID
4095818 View in PubMed
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The gap between guidelines and reality: Type 2 diabetes in a National Diabetes Register 1996-2003.

https://arctichealth.org/en/permalink/ahliterature46982
Source
Diabet Med. 2005 Oct;22(10):1420-6
Publication Type
Article
Date
Oct-2005
Author
B. Eliasson
J. Cederholm
P. Nilsson
S. Gudbjörnsdóttir
Author Affiliation
Lundberg Laboratory for Diabetes Research, Sahlgrenska University Hospital, Göteborg, Sweden. bjorn.eliasson@medic.gu.se
Source
Diabet Med. 2005 Oct;22(10):1420-6
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Administration, Oral
Aged
Blood Pressure - physiology
Body mass index
Diabetes Mellitus, Type 2 - drug therapy - epidemiology - physiopathology
Diabetic Nephropathies - drug therapy - epidemiology - physiopathology
Female
Hemoglobin A, Glycosylated - analysis
Humans
Hypoglycemic Agents - administration & dosage
Lipids - blood
Longitudinal Studies
Male
Middle Aged
Practice Guidelines
Registries
Research Support, Non-U.S. Gov't
Risk factors
Sweden - epidemiology
Abstract
Guidelines for the treatment of risk factors in diabetes care have been updated recently, due to indisputable results from clinical end-point trials. This study evaluates risk factor control compared with current national and international targets during the period 1996-2003 in Type 2 diabetes (DM2). Patients were registered in primary-care and hospital outpatient clinics using computer software, or via the Internet. The clinical characteristics of the patients, treatment, HbA(1c), and risk factors were reported after screening by local methods. The numbers of cases of DM2 reported were 17547 in 1996 and 57119 in 2003. The mean HbA(1c) decreased from 7.8 to 7.2%, while blood pressure decreased from 150/82 to 143/78 mmHg during the same period. Longitudinal analysis of results was performed in 5356 patients repeatedly reported, showing slightly lower effects. The new European treatment targets of HbA(1c)
PubMed ID
16176206 View in PubMed
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Glucose intolerance in middle-aged subjects--a cause of hypertension?

https://arctichealth.org/en/permalink/ahliterature48872
Source
Acta Med Scand. 1985;217(4):363-71
Publication Type
Article
Date
1985
Author
J. Cederholm
L. Wibell
Source
Acta Med Scand. 1985;217(4):363-71
Date
1985
Language
English
Publication Type
Article
Keywords
Blood Glucose - analysis
Diabetes mellitus
Diabetes Mellitus, Type 2 - complications - epidemiology
Exertion
Fasting
Female
Glucose Tolerance Test
Humans
Hypertension - epidemiology - etiology
Lipids - blood
Male
Middle Aged
Obesity
Research Support, Non-U.S. Gov't
Sweden
Abstract
At a health survey of 819 middle-aged, 47-54-year-old, males and females in a Swedish urban area with a participation rate of 70%, the prevalence of glucose intolerance (GI) was 6.2%, 51 subjects (7.0% of females and 5.3% of males), as the result of two subsequent 75 g oral glucose tolerance tests according to the WHO criteria. In comparison with normoglycemic subjects from the same health survey, with both fasting and 2-hour glucose values less than 5.0 mmol X l-1, the GI group was characterized by higher mean relative body mass index, higher mean blood pressure and rate of hypertension, higher rate of low-degree physical activity during leisure and had more often a family history of diabetes in first-degree relatives. Smoking was less prevalent in GI subjects. Hypertension was more frequent in obese (relative body mass index (BMI) 120-150%) GI subjects than NGT subjects. Finally, comparison of all GI subjects with all normoglycemic subjects of the survey, with use of analysis of covariance, showed that mean systolic and diastolic blood pressures were higher in GI subjects, independently of age, BMI and also smoking.
PubMed ID
4013827 View in PubMed
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Glucose-lowering treatment and clinical results in 163 121 patients with type 2 diabetes: an observational study from the Swedish national diabetes register.

https://arctichealth.org/en/permalink/ahliterature126708
Source
Diabetes Obes Metab. 2012 Aug;14(8):717-26
Publication Type
Article
Date
Aug-2012
Author
N. Ekström
M. Miftaraj
A-M Svensson
K. Andersson Sundell
J. Cederholm
B. Zethelius
S. Gudbjörnsdottir
B. Eliasson
Author Affiliation
Department of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. nils.ekstrom@gu.se
Source
Diabetes Obes Metab. 2012 Aug;14(8):717-26
Date
Aug-2012
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
Blood Glucose - metabolism
Cardiovascular Diseases - blood - drug therapy - epidemiology
Cross-Sectional Studies
Diabetes Mellitus, Type 2 - blood - drug therapy - epidemiology
Diabetic Angiopathies - blood - drug therapy - epidemiology
Female
Hemoglobin A, Glycosylated - metabolism
Humans
Hypoglycemic agents - therapeutic use
Insulin - blood - therapeutic use
Male
Metformin - therapeutic use
Middle Aged
Registries
Risk factors
Sweden - epidemiology
Time Factors
Treatment Outcome
Abstract
To analyse clinical characteristics and treatment results in unselected type 2 diabetes mellitus (T2DM) patients, with non-pharmacological treatment as well as the most commonly used pharmacological glucose-lowering treatment regimens, in everyday clinical practice.
In this population-based cross-sectional study, information was linked from the Swedish National Diabetes Register, Prescribed Drug Register and Patient Register. T2DM patients with non-pharmacological treatment and T2DM patients continuously using the 12 most common pharmacological treatment regimens were included in the study (n = 163121).
There were statistically significant differences in clinical characteristics between the groups. Patients with insulin-based treatment regimens had the longest duration of diabetes and more cardiovascular risk factors than the T2DM-population in general. The proportion of patients reaching HbA1c = 7% varied between 70.1% (metformin) and 25.0% [premixed insulin (PMI) + SU) in patients with pharmacological treatment. 84.8% of the patients with non-pharmacological treatment reached target. Compared to patients on metformin, patients on other pharmacological treatments had a lower likelihood, with hazard ratios ranging from 0.58; 95% confidence interval (CI), 0.54-0.63 to 0.97;0.94-0.99, of having HbA1c = 7% (adjusted for covariates). Patients on insulin-based treatments had the lowest likelihood, while non-pharmacological treatment was associated with an increased likelihood of having HbA1c = 7%.
This nation-wide study shows insufficiently reached treatment goals for haemoglobin A1c (HbA1c) in all treatment groups. Patients on insulin-based treatment regimens had the longest duration of diabetes, more cardiovascular risk factors and the highest proportions of patients not reaching HbA1c target.
PubMed ID
22364580 View in PubMed
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Glucose tolerance and physical activity in a health survey of middle-aged subjects.

https://arctichealth.org/en/permalink/ahliterature68044
Source
Acta Med Scand. 1985;217(4):373-8
Publication Type
Article
Date
1985
Author
J. Cederholm
L. Wibell
Source
Acta Med Scand. 1985;217(4):373-8
Date
1985
Language
English
Publication Type
Article
Keywords
Age Factors
Blood Glucose - analysis
Exertion
Female
Glucose Tolerance Test
Humans
Leisure Activities
Male
Middle Aged
Obesity - blood - epidemiology
Research Support, Non-U.S. Gov't
Sex Factors
Smoking
Sweden
Abstract
Glucose tolerance and reported physical leisure time activity were studied in middle-aged, 47-54 years old, subjects in a health survey. The mean 2-hour blood glucose value after 75 g oral glucose tolerance tests was higher (p less than 0.001) in 682 subjects with a lower degree of leisure time activity than in 125 subjects who were regularly active at least 2-3 hours per week. The mean 2-hour glucose values in the inactive and active groups, respectively, were 4.61 and 4.09 mmol X l-1 after adjustment for the influence of age, body mass index, smoking and physical job activity by analysis of covariance. The difference between adjusted mean 2-hour glucose values was also significant (p less than 0.001) in the subgroups of 280 low leisure time activity males (4.53 mmol X l-1) and 91 active males (3.93 mmol X l-1). Thus, a relation between physical leisure time inactivity and raised post load blood glucose values seems to exist in the general population.
PubMed ID
4013828 View in PubMed
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Hypertension in diabetes: trends in clinical control in repeated large-scale national surveys from Sweden.

https://arctichealth.org/en/permalink/ahliterature47426
Source
J Hum Hypertens. 2003 Jan;17(1):37-44
Publication Type
Article
Date
Jan-2003
Author
P M Nilsson
S. Gudbjörnsdottir
B. Eliasson
J. Cederholm
Author Affiliation
Department of Medicine, University Hospital, Malmö, Sweden. Peter.nilsson@medforsk.mas.lu.se
Source
J Hum Hypertens. 2003 Jan;17(1):37-44
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Antihypertensive Agents - administration & dosage
Blood Pressure Determination
Comorbidity
Comparative Study
Diabetes Mellitus, Type 1 - diagnosis - drug therapy - epidemiology
Diabetes Mellitus, Type 2 - diagnosis - drug therapy - epidemiology
Female
Health Surveys
Humans
Hypertension - diagnosis - drug therapy - epidemiology
Hypoglycemic Agents - administration & dosage
Incidence
Insulin - administration & dosage
Male
Middle Aged
Probability
Registries
Research Support, Non-U.S. Gov't
Risk factors
Severity of Illness Index
Sex Distribution
Sweden - epidemiology
Abstract
Hypertension in diabetes is an important and treatable cardiovascular risk factor. Treatment targets from guidelines cannot always be achieved in everyday clinical practice. It is therefore of great importance to monitor trends in hypertension control in defined populations. Patients with type I diabetes (range 6685-10,100; treated hypertension 21-29%) or with type II diabetes (range 15,935-22,605; treated hypertension 47-56%) were included in four national samples between 1996 and 1999. This screening was part of the procedures for the National Diabetes Register in Sweden, which monitors trends in clinical practice and risk factors for patients with diabetes, recruited both in primary health care and at the hospital level. A favourable trend in mean and median blood pressure levels was noticed during the 4-year study period, based either on data from repeated surveys or on repeated measures in the same individual, both for type I diabetes (mean: -2/-2 mmHg; P
PubMed ID
12571615 View in PubMed
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LDL-cholesterol versus non-HDL-to-HDL-cholesterol ratio and risk for coronary heart disease in type 2 diabetes.

https://arctichealth.org/en/permalink/ahliterature264163
Source
Eur J Prev Cardiol. 2014 Nov;21(11):1420-8
Publication Type
Article
Date
Nov-2014
Author
B. Eliasson
S. Gudbjörnsdottir
B. Zethelius
K. Eeg-Olofsson
J. Cederholm
Source
Eur J Prev Cardiol. 2014 Nov;21(11):1420-8
Date
Nov-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Biological Markers - blood
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Coronary Disease - diagnosis - epidemiology
Diabetes Mellitus, Type 2 - blood - diagnosis - epidemiology
Female
Humans
Linear Models
Male
Middle Aged
Prognosis
Proportional Hazards Models
Registries
Risk assessment
Risk factors
Sweden - epidemiology
Time Factors
Abstract
We assessed the association between different blood lipid measures and risk of fatal/nonfatal coronary heart disease (CHD), which has been less analysed previously in type 2 diabetes.
Observational study of 46,786 patients with type 2 diabetes, aged 30-70 years, from the Swedish National Diabetes Register, followed for a mean of 5.8 years until 2009. Baseline and updated mean low-density lipoprotein (LDL)-, high-density lipoprotein (HDL)-, non-HDL-cholesterol, and non-HDL-to-HDL-cholesterol ratio were measured.
Hazard ratios (HR) for CHD with quartiles 2-4 of baseline lipid measures, with lowest quartile 1 as reference: 1.03-1.29-1.63 for LDL; 1.23-1.41-1.95 for non-HDL; 1.29-1.39-1.57 for HDL; and 1.31-1.67-2.01 for non-HDL:HDL, all p?
PubMed ID
23774274 View in PubMed
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Level of physical activity associated with risk of cardiovascular diseases and mortality in patients with type-2 diabetes: report from the Swedish National Diabetes Register.

https://arctichealth.org/en/permalink/ahliterature256946
Source
Eur J Prev Cardiol. 2014 Feb;21(2):244-51
Publication Type
Article
Date
Feb-2014
Author
B. Zethelius
S. Gudbjörnsdottir
B. Eliasson
K. Eeg-Olofsson
J. Cederholm
Author Affiliation
Uppsala University, Uppsala, Sweden.
Source
Eur J Prev Cardiol. 2014 Feb;21(2):244-51
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - diagnosis - etiology - mortality - physiopathology
Diabetes Mellitus, Type 2 - complications - diagnosis - mortality - physiopathology
Female
Humans
Male
Middle Aged
Motor Activity
Proportional Hazards Models
Questionnaires
Registries
Risk assessment
Risk factors
Sweden - epidemiology
Time Factors
Abstract
To estimate risks of coronary heart disease (CHD), cardiovascular disease (CVD), and total mortality with low or higher levels of physical activity (PA) assessed with questionnaire, in an observational study of patients with type-2 diabetes from the Swedish National Diabetes Register.
A total of 15,462 patients (60 years), were followed for 5 years from baseline in 2004 until 2009, with 760 CVD events and 427 total mortality events based on 54,344 person-years.
Comparing 6963 patients with low baseline PA (never or 1-2 times/week for 30?min) and 8499 patients with higher baseline PA (regular 3 times/week or more), hazard ratios for fatal/nonfatal CHD, fatal/nonfatal CVD, fatal CVD, and total mortality were 1.25 (95% CI 1.05-1.48; p?=?0.01), 1.26 (95% CI 1.09-1.45; p?=?0.002), 1.69 (95% CI 1.18-2.41; p?=?0.004), and 1.48 (95% CI 1.22-1.79; p?
PubMed ID
24227183 View in PubMed
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Microalbuminuria and risk factors in type 1 and type 2 diabetic patients.

https://arctichealth.org/en/permalink/ahliterature47112
Source
Diabetes Res Clin Pract. 2005 Mar;67(3):258-66
Publication Type
Article
Date
Mar-2005
Author
J. Cederholm
B. Eliasson
P M Nilsson
L. Weiss
S. Gudbjörnsdottir
Author Affiliation
Family Medicine and Epidemiology Section, Department of Public Health and Caring Sciences, Dag Hammarskjolds vag 14B, University Hospital, Uppsala SE-75185, Sweden. jan.cederholm@pubcare.uu.se
Source
Diabetes Res Clin Pract. 2005 Mar;67(3):258-66
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Adult
Albuminuria - complications
Blood pressure
Body mass index
Cross-Sectional Studies
Diabetes Mellitus, Type 1 - epidemiology - urine
Diabetes Mellitus, Type 2 - epidemiology - urine
Diabetic Nephropathies - epidemiology
Female
Hemoglobin A, Glycosylated - analysis
Humans
Hypertension - epidemiology
Male
Middle Aged
Registries
Regression Analysis
Research Support, Non-U.S. Gov't
Risk factors
Smoking - epidemiology
Sweden - epidemiology
Abstract
A prospective study of normoalbuminuric diabetic patients was performed between 1997 and 2002 on 4097 type 1 and 6513 type 2 diabetic patients from the Swedish National Diabetes Register (NDR); mean study period, 4.6 years. The strongest independent baseline risk factors for the development of microalbuminuria (20-200 microg/min) were elevated HbA(1c) and diabetes duration in both types 1 and 2 diabetic patients. Other risk factors were high BMI, elevated systolic and diastolic BP in type 2 patients, and antihypertensive therapy in type 1 patients. A subsequent larger cross-sectional study in 2002 showed that established microalbuminuria was independently associated with HbA(1c), diabetes duration, systolic BP, BMI, smoking and triglycerides in types 1 and 2 diabetic patients, and also with HDL-cholesterol in type 2 patients. Relatively few types 1 and 2 patients with microalbuminuria achieved treatment targets of HbA(1c)
PubMed ID
15713359 View in PubMed
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17 records – page 1 of 2.