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Anxiety and Depressive Symptoms as Predictors of All-Cause Mortality among People with Insulin-Naïve Type 2 Diabetes: 17-Year Follow-Up of the Second Nord-Trøndelag Health Survey (HUNT2), Norway.

https://arctichealth.org/en/permalink/ahliterature284783
Source
PLoS One. 2016;11(8):e0160861
Publication Type
Article
Date
2016
Author
Marjolein M Iversen
Giesje Nefs
Grethe S Tell
Birgitte Espehaug
Kristian Midthjell
Marit Graue
Frans Pouwer
Source
PLoS One. 2016;11(8):e0160861
Date
2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anxiety - complications
Depression - complications
Diabetes Mellitus, Type 2 - complications - diagnosis - epidemiology - mortality
Female
Follow-Up Studies
Hemoglobin A, Glycosylated - analysis
Humans
Male
Middle Aged
Norway - epidemiology
Prognosis
Abstract
To examine whether elevated anxiety and/or depressive symptoms are related to all-cause mortality in people with Type 2 diabetes, not using insulin.
948 participants in the community-wide Nord-Trøndelag Health Survey conducted during 1995-97 completed the Hospital Anxiety and Depression Scale with subscales of anxiety (HADS-A) and depression (HADS-D). Elevated symptoms were defined as HADS-A or HADS-D =8. Participants with type 2 diabetes, not using insulin, were followed until November 21, 2012 or death. Cox regression analyses were used to estimate associations between baseline elevated anxiety symptoms, elevated depressive symptoms and mortality, adjusting for sociodemographic factors, HbA1c, cardiovascular disease and microvascular complications.
At baseline, 8% (n = 77/948) reported elevated anxiety symptoms, 9% (n = 87/948) elevated depressive symptoms and 10% (n = 93/948) reported both. After a mean follow-up of 12 years (SD 5.1, range 0-17), 541 participants (57%) had died. Participants with elevated anxiety symptoms only had a decreased mortality risk (unadjusted HR 0.66, 95% CI 0.46-0.96). Adjustment for HbA1c attenuated this relation (HR 0.73, 95% CI 0.50-1.07). Those with elevated depression symptoms alone had an increased mortality risk (fully adjusted model HR 1.39, 95% CI 1.05-1.84). Having both elevated anxiety and depressive symptoms was not associated with increased mortality risk (adjusted HR 1.30, 95% CI 0.96-1.74).
Elevated depressive symptoms were associated with excess mortality risk in people with Type 2 diabetes not using insulin. No significant association with mortality was found among people with elevated anxiety symptoms. Having both elevated anxiety and depressive symptoms was not associated with mortality. The hypothesis that elevated levels of anxiety symptoms leads to behavior that counteracts the adverse health effects of Type 2 diabetes needs further investigation.
Notes
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PubMed ID
27537359 View in PubMed
Less detail

Change in self-rated general health is associated with perceived illness burden: a 1-year follow up of patients newly diagnosed with type 2 diabetes.

https://arctichealth.org/en/permalink/ahliterature267908
Source
BMC Public Health. 2015;15:439
Publication Type
Article
Date
2015
Author
Anni Brit Sternhagen Nielsen
Per Jensen
Dorte Gannik
Susanne Reventlow
Hanne Hollnagel
Niels de Fine Olivarius
Source
BMC Public Health. 2015;15:439
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Cardiovascular Diseases - etiology
Cost of Illness
Denmark
Diabetes Mellitus, Type 2 - complications - diagnosis - psychology - therapy
Diagnostic Self Evaluation
Female
Follow-Up Studies
Health Behavior
Health status
Humans
Life Style
Male
Middle Aged
Self Report
Abstract
Diabetic patients' lifestyle adaptations to improve glycaemic control are not always followed by improvements in self-rated general health (SRH). The perceived impact of diabetes on patients' daily lives may influence changes in their SRH. This paper examines the association of illness severity, treatment, behavioural, and coping-related factors with changes in SRH from diagnosis of type 2 diabetes until one year later, in a population-based sample of 599 patients aged 40 years or over who were treated in general practice.
Change in SRH was estimated by a cumulative probit model with the inclusion of covariates related to SRH (e.g. illness severity at diagnosis, behaviour, treatment, and the perceived impact of diabetes on patients' daily lives one year later).
At diagnosis, 11.6% of patients reported very good, 35.1% good, 44.6% fair and 8.5% poor SRH. Physical inactivity, many diabetes-related symptoms, and cardiovascular disease were related to lower SRH ratings. On average SRH improved by 0.46 (95% CI: 0.37; 0.55) during the first year after diagnosis without inclusion of covariates. Mental and practical illness burden was the only factor associated with change in SRH, independent of patients' diabetes severity and medical treatment (p = 0.03, multivariate analysis). Compared to otherwise similar patients without illness burden, increase in SRH was marginally smaller among patients who expressed minor illness burden, but much smaller among patients with more pronounced illness burden.
Much as one would expect, many patients increased their SRH during the first year after diabetes diagnosis. This increase in SRH was not associated with indicators of illness severity or factors reflecting socio-demographic circumstances, but patients experiencing illness burden had a smaller increase than those who reported no illness burden. We suggest that during the diabetes consultation, general practitioners explore further how patients manage their illness burden. We further suggest that diabetes guidelines extend their current focus on clinical and social aspects of diabetes to include questions on patient's perceived illness burden and SRH.
Notes
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PubMed ID
25924731 View in PubMed
Less detail

A diagnosis of the metabolic syndrome in youth that resolves by adult life is associated with a normalization of high carotid intima-media thickness and type 2 diabetes mellitus risk: the Bogalusa heart and cardiovascular risk in young Finns studies.

https://arctichealth.org/en/permalink/ahliterature120285
Source
J Am Coll Cardiol. 2012 Oct 23;60(17):1631-9
Publication Type
Article
Date
Oct-23-2012
Author
Costan G Magnussen
Juha Koskinen
Markus Juonala
Wei Chen
Sathanur R Srinivasan
Matthew A Sabin
Russell Thomson
Michael D Schmidt
Quoc Manh Nguyen
Ji-Hua Xu
Michael R Skilton
Mika Kähönen
Tomi Laitinen
Leena Taittonen
Terho Lehtimäki
Tapani Rönnemaa
Jorma S A Viikari
Gerald S Berenson
Olli T Raitakari
Author Affiliation
Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland. cmagnuss@utas.edu.au
Source
J Am Coll Cardiol. 2012 Oct 23;60(17):1631-9
Date
Oct-23-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aging
Cardiovascular Diseases - diagnosis - epidemiology - etiology
Carotid Intima-Media Thickness
Child
Diabetes Mellitus, Type 2 - complications - diagnosis - epidemiology
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Metabolic Syndrome X - complications - diagnosis - epidemiology
Prevalence
Prognosis
Remission, Spontaneous
Retrospective Studies
Risk factors
Time Factors
Young Adult
Abstract
The aim of this study was to examine the effect of resolution from metabolic syndrome (MetS) between youth and adulthood on carotid artery intima-media thickness (IMT) and type 2 diabetes mellitus (T2DM).
Published findings demonstrate that youth with MetS are at increased risk of cardio-metabolic outcomes in adulthood. It is not known whether this risk is attenuated in those who resolve their MetS status.
Participants (n = 1,757) from 2 prospective cohort studies were examined as youth (when 9 to 18 years of age) and re-examined 14 to 27 years later. The presence of any 3 components (low high-density lipoprotein cholesterol, high triglycerides, high glucose, high blood pressure, or high body mass index) previously shown to predict adult outcomes defined youth MetS; the harmonized MetS criteria defined adulthood MetS. Participants were classified according to their MetS status at baseline and follow-up and examined for risk of high IMT and T2DM.
Those with MetS in youth and adulthood were at 3.4 times the risk (95% confidence interval: 2.4 to 4.9) of high IMT and 12.2 times the risk (95% confidence interval: 6.3 to 23.9) of T2DM in adulthood compared with those that did not have MetS at either time-point, whereas those that had resolved their youth MetS status by adulthood showed similar risk to those that did not have MetS at either time-point (p > 0.20 for all comparisons).
Although youth with MetS are at increased risk of adult high IMT and T2DM, these data indicate that the resolution of youth MetS by adulthood can go some way to normalize this risk to levels seen in those who have never had MetS.
PubMed ID
23021330 View in PubMed
Less detail

Impact of early detection and treatment of diabetes on the 6-year prevalence of cardiac autonomic neuropathy in people with screen-detected diabetes: ADDITION-Denmark, a cluster-randomised study.

https://arctichealth.org/en/permalink/ahliterature119879
Source
Diabetologia. 2013 Jan;56(1):101-8
Publication Type
Article
Date
Jan-2013
Author
M. Charles
J. Fleischer
D R Witte
N. Ejskjaer
K. Borch-Johnsen
T. Lauritzen
A. Sandbaek
Author Affiliation
Department of Public Health, Section of General Practice, Bartholins Allé 2, bygn. 1260, 8000 Aarhus C, Denmark. mc@alm.au.dk
Source
Diabetologia. 2013 Jan;56(1):101-8
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Autonomic Nervous System Diseases - complications - diagnosis - epidemiology - prevention & control
Cohort Studies
Denmark - epidemiology
Diabetes Mellitus, Type 2 - complications - diagnosis - drug therapy - therapy
Diabetic Cardiomyopathies - diagnosis - epidemiology - physiopathology - prevention & control
Diabetic Neuropathies - diagnosis - epidemiology - physiopathology - prevention & control
Early Diagnosis
Female
Follow-Up Studies
General practice
Heart rate
Humans
Hypoglycemic agents - therapeutic use
Incidence
Male
Mass Screening
Middle Aged
Prevalence
Primary Health Care
Severity of Illness Index
Abstract
There is limited evidence on how multifactorial treatment improves outcomes of diabetes when initiated in the lead time between detection by screening and diagnosis in routine clinical practice. Cardiac autonomic neuropathy (CAN) in people with diabetes indicates widespread damage to the autonomic nervous system, which may severely affect health and quality of life. We examined effects of early detection and subsequent intensive treatment of type 2 diabetes in primary care on the prevalence of CAN at the 6-year follow-up examination in a pragmatic cluster-randomised parallel group trial.
One hundred and ninety general practices were randomised to deliver either intensive multifactorial treatment (IT) or routine care (RC) as recommended by national guidelines to patients with type 2 diabetes, identified through a stepwise screening programme in the primary care setting. 1533 people (IT, n = 910; RC, n = 623) were identified and included. At the 6-year follow-up examination, measures of CAN were applied in an unselected subsample of 777 participants using heart rate variability analysis and standard tests of CAN.
At the 6-year follow-up examination, the prevalence of early CAN was 15.1% in the RC group and 15.5% in the IT group, while manifest CAN was present in 7.1% and 7.3%, respectively. We found no statistically significant effect of intensive treatment on the prevalence of CAN compared with routine care.
In the Danish arm of the ADDITION Study, signs of CAN were highly prevalent 6 years after a screening-based diagnosis of type 2 diabetes. Intensive multifactorial treatment did not significantly affect the prevalence of CAN compared with routine care. However, at follow-up the level of medication was also high in the RC group.
PubMed ID
23064291 View in PubMed
Less detail

Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus.

https://arctichealth.org/en/permalink/ahliterature264066
Source
Diabet Med. 2014 Nov;31(11):1468-76
Publication Type
Article
Date
Nov-2014
Author
C. Bruun
A D Guassora
A B S Nielsen
V. Siersma
P E Holstein
N. de Fine Olivarius
Source
Diabet Med. 2014 Nov;31(11):1468-76
Date
Nov-2014
Language
English
Publication Type
Article
Keywords
Amputation
Combined Modality Therapy
Cross-Sectional Studies
Denmark - epidemiology
Diabetes Mellitus, Type 2 - complications - diagnosis - therapy
Diabetic Foot - epidemiology - prevention & control - surgery
Female
Follow-Up Studies
Humans
Incidence
Life Change Events
Male
Middle Aged
Motivation
Patient compliance
Prevalence
Proportional Hazards Models
Prospective Studies
Registries
Risk factors
Self Care
Sex Factors
Abstract
To investigate the predictive value of both patients' motivation and effort in their management of Type 2 diabetes and their life circumstances for the development of foot ulcers and amputations.
This study was based on the Diabetes Care in General Practice study and Danish population and health registers. The associations between patient motivation, effort and life circumstances and foot ulcer prevalence 6 years after diabetes diagnosis and the incidence of amputation in the following 13 years were analysed using odds ratios from logistic regression and hazard ratios from Cox regression models, respectively.
Foot ulcer prevalence 6 years after diabetes diagnosis was 2.93% (95% CI 1.86-4.00) among 956 patients. General practitioners' indication of 'poor' vs 'very good' patient motivation for diabetes management was associated with higher foot ulcer prevalence (odds ratio 6.11, 95% CI 1.22-30.61). The same trend was seen for 'poor' vs 'good' influence of the patient's own effort in diabetes treatment (odds ratio 7.06, 95% CI 2.65-18.84). Of 1058 patients examined at 6-year follow-up, 45 experienced amputation during the following 13 years. 'Poor' vs 'good' influence of the patients' own effort was associated with amputation (hazard ratio 7.12, 95% CI 3.40-14.92). When general practitioners assessed the influence of patients' life circumstances as 'poor' vs 'good', the amputation incidence increased (hazard ratio 2.97, 95% CI 1.22-7.24). 'Poor' vs 'very good' patient motivation was also associated with a higher amputation incidence (hazard ratio 7.57, 95% CI 2.43-23.57), although not in fully adjusted models.
General practitioners' existing knowledge of patients' life circumstances, motivation and effort in diabetes management should be included in treatment strategies to prevent foot complications.
PubMed ID
25047765 View in PubMed
Less detail

Predicting mortality in people with type 2 diabetes mellitus after major complications: a study using Swedish National Diabetes Register data.

https://arctichealth.org/en/permalink/ahliterature261400
Source
Diabet Med. 2014 Aug;31(8):954-62
Publication Type
Article
Date
Aug-2014
Author
P J Kelly
P M Clarke
A J Hayes
U-G Gerdtham
J. Cederholm
P. Nilsson
B. Eliasson
S. Gudbjornsdottir
Source
Diabet Med. 2014 Aug;31(8):954-62
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Amputation - adverse effects
Diabetes Mellitus, Type 2 - complications - diagnosis - epidemiology - mortality
Diabetic Angiopathies - mortality - surgery
Diabetic Cardiomyopathies - mortality
Diabetic Nephropathies - mortality
Female
Follow-Up Studies
Heart Failure - complications - mortality
Humans
Life expectancy
Male
Models, Biological
Mortality
Myocardial Infarction - complications - mortality
Prognosis
Prospective Studies
Registries
Renal Insufficiency - complications - mortality
Risk factors
Stroke - complications - mortality
Sweden - epidemiology
Abstract
To predict mortality risk and life expectancy for patients with type 2 diabetes after a major diabetes-related complication.
The study sample, taken from the Swedish National Diabetes Register, consisted of 20 836 people with type 2 diabetes who had their first major complication (myocardial infarction, stroke, heart failure, amputation or renal failure) between January 2001 and December 2007. A Gompertz proportional hazards model was derived which determined significant risk factors associated with mortality and was used to estimate life expectancies.
Risk of death changed over time according to type of complication, with myocardial infarction initally having the highest initial risk of death, but after the first month, the risk was higher for heart failure, renal failure and amputation. Other factors that increased the risk of death were male gender (hazard ratio 1.06, 95% CI 1.02-1.12), longer duration of diabetes (hazard ratio 1.07 per 10 years, 95% CI 1.04-1.10), smoking (hazard ratio 1.51, 95% CI 1.40-1.63) and macroalbuminuria (hazard ratio 1.14, 95% CI 1.06-1.22). Low BMI, low systolic blood pressure and low estimated GFR also increased mortality risk. Life expectancy was highest after a stroke, myocardial infarction or heart failure, lower after amputation and lowest after renal failure. Smoking and poor renal function were the risk factors which had the largest impact on reducing life expectancy.
Risk of death and life expectancy differs substantially among the major complications of diabetes, and factors significantly increasing risk included smoking, low estimated GFR and albuminuria.
PubMed ID
24750341 View in PubMed
Less detail

[Randomized controlled trial of structured, individualized treatment of type 2 diabetes mellitus. The project of Diabetes Care in General Practice]

https://arctichealth.org/en/permalink/ahliterature47638
Source
Ugeskr Laeger. 2001 Oct 29;163(44):6134-9
Publication Type
Article
Date
Oct-29-2001
Author
N. de Fine Olivarius
H. Beck-Nielsen
A H Andreasen
M. Hørder
P A Pedersen
Author Affiliation
Københavns Universitet, Central forskningsenhed for almen praksis, samt Afdeling for Almen Medicin, Biostatistisk Afdeling, Institut for Folkesundhedsvidenskab. no@gpract.ku.dk
Source
Ugeskr Laeger. 2001 Oct 29;163(44):6134-9
Date
Oct-29-2001
Language
Danish
Publication Type
Article
Keywords
Comparative Study
Denmark
Diabetes Mellitus, Type 2 - complications - diagnosis - mortality - therapy
English Abstract
Family Practice
Follow-Up Studies
Humans
Intervention Studies
Middle Aged
Multicenter Studies
Patient Education
Physician's Practice Patterns
Practice Guidelines
Research Support, Non-U.S. Gov't
Risk factors
Treatment Outcome
Abstract
INTRODUCTION: We assessed the effect of a multifaceted intervention directed at general practitioners to improve type 2 diabetes care. MATERIALS AND METHODS: Three hundred and eleven Danish practices with 474 general practitioners were randomised to structured personal care (intervention group) or routine care (comparison group). Of 970 surviving patients (aged 40+ years) diagnosed with diabetes in 1989-1991, 874 (90.1%) were assessed after 6 years. Intervention comprised regular follow-up and individualized goal-setting, supported by reminders to doctors, clinical guidelines, feed-back, and continuing medical education. RESULTS: Predefined non-fatal outcomes and mortality were the same in both groups. The following risk factor levels were lower in the intervention patients than in the comparison patients: fasting plasma glucose (7.9 vs 8.7 mmol/l, medians, P = 0.0007), haemoglobin A1c (8.5 vs 9.0%, P
PubMed ID
11715158 View in PubMed
Less detail

[Sporadic registration of obesity as secondary diagnosis]

https://arctichealth.org/en/permalink/ahliterature47525
Source
Ugeskr Laeger. 2002 Jun 10;164(24):3193-5
Publication Type
Article
Date
Jun-10-2002
Author
Ole Lander Svendsen
Bo Sonnich Rasmussen
Author Affiliation
Medicinsk endokrinologisk klinik PE 2131, Abdominalcentret, H:S Rigshospitalet, DK-2100 København. ols@dadlnet.dk
Source
Ugeskr Laeger. 2002 Jun 10;164(24):3193-5
Date
Jun-10-2002
Language
Danish
Publication Type
Article
Keywords
Body mass index
Denmark
Diabetes Complications
Diabetes Mellitus - diagnosis
Diabetes Mellitus, Type 2 - complications - diagnosis
English Abstract
Follow-Up Studies
Humans
Medical Records - standards
Obesity
Outpatient Clinics, Hospital
Physician's Practice Patterns
Registries - standards
Abstract
INTRODUCTION: The aim was to examine the extent to which obese patients, who are followed up for an obesity-related disease in an outpatient clinic, are correctly registered with the secondary diagnosis of obesity. MATERIAL AND METHODS: We investigated the number of patients at the Endocrine Outpatient Clinic, Rigshospitalet, Copenhagen, who were registered in the patient administrative system with the primary diagnosis of type 2 diabetes, and how many of these were registered with the secondary diagnosis of obesity. RESULTS: Of 233 patients with type 2 diabetes, 79 had a BMI between 25.0 and 29.9 kg/m2 (overweight) and 108 a BMI > 30 kg/m2 (obesity). Thus, 80% of these patients were overweight or obese. Of the 108 patients with a BMI > 30 kg/m2. only 13 (12%) were registered with the secondary diagnosis of obesity, and of 17 severely obese patients with a BMI > 40 kg/m2 only four (24%) were registered with the secondary diagnosis of obesity. DISCUSSION: Obese patients with type 2 diabetes are seldom correctly registered with the secondary diagnosis of obesity. The actual practice of registration probably causes a large underestimation of the impact, and thereby of the magnitude of the economic cost of and the contribution of obesity to total health care costs. Improved registration of obesity as secondary diagnosis in obesity-related diseases is needed.
PubMed ID
12082765 View in PubMed
Less detail

Sustained prognostic implications of newly detected glucose abnormalities in patients with acute myocardial infarction: long-term follow-up of the Glucose Tolerance in Patients with Acute Myocardial Infarction cohort.

https://arctichealth.org/en/permalink/ahliterature264644
Source
Diab Vasc Dis Res. 2015 Jan;12(1):23-32
Publication Type
Article
Date
Jan-2015
Author
Viveca Ritsinger
Eleni Tanoglidi
Klas Malmberg
Per Näsman
Lars Rydén
Åke Tenerz
Anna Norhammar
Source
Diab Vasc Dis Res. 2015 Jan;12(1):23-32
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - complications - epidemiology - mortality
Cohort Studies
Diabetes Mellitus, Type 2 - complications - diagnosis
Diabetic Cardiomyopathies - blood - diagnosis - epidemiology - mortality
Female
Follow-Up Studies
Glucose Intolerance - complications - diagnosis
Glucose Tolerance Test
Humans
Male
Middle Aged
Mortality
Myocardial Infarction - complications - diagnosis - epidemiology - mortality
Patient Discharge
Prevalence
Prognosis
Prospective Studies
Recurrence
Risk factors
Survival Analysis
Sweden - epidemiology
Abstract
To investigate long-term prognostic importance of newly discovered glucose disturbances in patients with acute myocardial infarction (AMI).
During 1998-2001, consecutive patients with AMI (n = 167) and healthy controls (n = 184) with no previously known diabetes were investigated with an oral glucose tolerance test (OGTT). Patients and controls were separately followed up for cardiovascular events (first of cardiovascular mortality/AMI/stroke/heart failure) during a decade.
In all, 68% of the patients and 35% of the controls had newly detected abnormal glucose tolerance (AGT). Cardiovascular event (n = 72, p = 0.0019) and cardiovascular mortality (n = 31, p = 0.031) were more frequent in patients with newly detected AGT. Regarding patients, a Cox proportional-hazard regression analysis identified AGT (hazard ratio (HR): 2.30; 95% confidence interval (CI): 1.24-4.25; p = 0.008) and previous AMI (HR: 2.39; CI: 1.31-4.35; p = 0.004) as prognostically important.
An OGTT at discharge after AMI disclosed a high proportion of patients with previously unknown AGT which had a significant and independent association with long-term prognosis.
PubMed ID
25311248 View in PubMed
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