High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort

Objective People with type 2 diabetes on insulin are at risk for hypoglycemia. Recurrent hypoglycemia can cause impaired awareness of hypoglycemia (IAH), and increase the risk for severe hypoglycemia. The aim of this study was to assess the prevalence and determinants of self-reported IAH and severe hypoglycemia in a Dutch nationwide cohort of people with insulin-treated type 2 diabetes. Research design and methods Observational study of The Dutch Diabetes Pearl, a cohort of people with type 2 diabetes treated in primary, secondary and tertiary diabetes care centers. The presence of IAH and the occurrence of severe hypoglycemia in the past year, defined as an event requiring external help to re

Entering a new era of body indices: the feasibility of a body shape index and body roundness index to identify cardiovascular health status.

BACKGROUND: The Body Mass Index (BMI) and Waist Circumference (WC) are well-used anthropometric predictors for cardiovascular diseases (CVD), but their validity is regularly questioned. Recently, A Body Shape Index (ABSI) and Body Roundness Index (BRI) were introduced as alternative anthropometric indices that may better reflect health status. OBJECTIVE: This study assessed the capacity of ABSI and BRI in identifying cardiovascular diseases and cardiovascular disease risk factors and determined whether they are superior to BMI and WC. DESIGN AND METHODS: 4627 Participants (54±12 years) of the Nijmegen Exercise Study completed an online questionnaire concerning CVD health status (defined as history of CVD or CVD risk factors) and anthropometric characteristics. Quintiles of ABSI, BRI, BMI, and WC were used regarding CVD prevalence. Odds ratios (OR), adjusted for age, sex, and smoking, were calculated per anthropometric index. RESULTS: 1332 participants (27.7%) reported presence of CVD or CVD risk factors. The prevalence of CVD increased across quintiles for BMI, ABSI, BRI, and WC. Comparing the lowest with the highest quintile, adjusted OR (95% CI) for CVD were significantly different for BRI 3.2 (1.4-7.2), BMI 2.4 (1.9-3.1), and WC 3.0 (1.6-5.6). The adjusted OR (95% CI) for CVD risk factors was for BRI 2.5 (2.0-3.3), BMI 3.3 (1.6-6.8), and WC 2.0 (1.6-2.5). No association was observed for ABSI in both groups. CONCLUSIONS: BRI, BMI, and WC are able to determine CVD presence, while ABSI is not capable. Nevertheless, the capacity of BRI as a novel body index to identify CVD was not superior compared to established anthropometric indices like BMI and WC

Association of Variants at UMOD with Chronic Kidney Disease and Kidney Stones—Role of Age and Comorbid Diseases

Chronic kidney disease (CKD) is a worldwide public health problem that is associated with substantial morbidity and mortality. To search for sequence variants that associate with CKD, we conducted a genome-wide association study (GWAS) that included a total of 3,203 Icelandic cases and 38,782 controls. We observed an association between CKD and a variant with 80% population frequency, rs4293393-T, positioned next to the UMOD gene (GeneID: 7369) on chromosome 16p12 (OR = 1.25, P = 4.1×10−10). This gene encodes uromodulin (Tamm-Horsfall protein), the most abundant protein in mammalian urine. The variant also associates significantly with serum creatinine concentration (SCr) in Icelandic subjects (N = 24,635, P = 1.3×10−23) but not in a smaller set of healthy Dutch controls (N = 1,819, P = 0.39). Our findings validate the association between the UMOD variant and both CKD and SCr recently discovered in a large GWAS. In the Icelandic dataset, we demonstrate that the effect on SCr increases substantially with both age (P = 3.0×10−17) and number of comorbid diseases (P = 0.008). The association with CKD is also stronger in the older age groups. These results suggest that the UMOD variant may influence the adaptation of the kidney to age-related risk factors of kidney disease such as hypertension and diabetes. The variant also associates with serum urea (P = 1.0×10−6), uric acid (P = 0.0064), and suggestively with gout. In contrast to CKD, the UMOD variant confers protection against kidney stones when studied in 3,617 Icelandic and Dutch kidney stone cases and 43,201 controls (OR = 0.88, P = 5.7×10−5)

Relatie tussen leefstijl en kanker; onderwerp van gesprek in de spreekkamer?

Doel: Dit onderzoek verkent in hoeverre er draagvlak is onder zorgprofessionals voor het ondersteunen van kankerpatiënten bij leefstijlveranderingen, aan de hand van 3 vragen: (a) Wat is de invloed van leefstijl op kanker volgens zorgprofessionals? (b) Beschouwen zorgprofessionals het als hun taak om kankerpatiënten te ondersteunen bij leefstijlveranderingen? (c) Beïnvloedt de eigen leefstijl van zorgprofessionals de gesprekken die zij met kankerpatiënten voeren over leefstijl? Opzet: Vragenlijstonderzoek. Methode: 1550 zorgprofessionals uit Nijmegen en omgeving ontvingen in januari 2015 een digitale vragenlijst over de relatie tussen leefstijl en kanker. De vragenlijst werd ingevuld door 562 zorgprofessionals (respons: 36%), van wie er 404 (72%) met kankerpatiënten werkten. Deze groep bestond uit 170 medisch specialisten, 62 huisartsen en 172 verpleegkundigen en praktijkondersteuners. Resultaten: Zorgprofessionals onderkenden de invloed van leefstijl op het ontstaan van kanker. Vrijwel alle professionals (98%) waren het erover eens dat een gezonde leefstijl het welbevinden van kankerpatiënten in zekere mate beïnvloedt. Circa twee derde van alle zorgprofessionals vond dat leefstijl ‘meestal’ of ‘altijd’ moet worden besproken met kankerpatiënten en iets meer dan de helft van alle zorgprofessionals gaf aan dit ook te doen. Zorgprofessionals hebben behoefte aan evidencebased kennis over de relatie tussen leefstijl en kanker, voorlichtingsmateriaal en extra consulttijd om kankerpatiënten te ondersteunen bij leefstijlveranderingen. De leefstijl van zorgprofessionals lijkt ook van invloed: bij zorgprofessionals die niet aan leefstijlnormen voldoen, kwam leefstijl minder vaak aan bod in de spreekkamer. Conclusie: Er lijkt draagvlak te zijn onder zorgprofessionals om leefstijl te bespreken met kankerpatiënten en om hen te ondersteunen bij leefstijlveranderingen

Cardiovascular events in type 2 diabetes: Comparison with nondiabetic individuals without and with prior cardiovascular disease: 10-Year follow-up of the Hoorn study

Aims: We questioned whether prior cardiovascular disease has the same impact on risk of cardiovascular events as type 2 diabetes, and whether this differed between men and women. Methods and results: To address these issues we compared the 10-year risk of cardiovascular events among 208 Caucasian individuals with diabetes to that of 2253 Caucasian individuals without diabetes, in a population-based cohort study. Gender significantly modified the association between type 2 diabetes and cardiovascular events (p=0.01). The hazard ratio of cardiovascular events associated with the presence of diabetes was higher in women (adjusted hazard ratio, 1.8; 95% CI, 1.2 to 2.7) than in men (adjusted hazard ratio, 1.3; 0.9 to 2). As compared to men without diabetes but with prior cardiovascular disease, risk of cardiovascular events was significantly lower in men with diabetes but without prior cardiovascular disease (adjusted hazard ratio, 0.5; 0.3 to 0.9). In contrast, this risk was equal in women with diabetes but without prior cardiovascular disease and women without diabetes but with prior cardiovascular disease (adjusted hazard ratio, 1.0; 0.6 to 1.7; P for interaction between gender and diabetes=0.05). Conclusions: Women with diabetes but without prior cardiovascular disease have a risk of cardiovascular events that is similar to that of women without diabetes but with prior cardiovascular disease, whereas in men the presence of prior cardiovascular disease conferred a higher risk. These data emphasise the necessity of aggressive treatment of cardiovascular risk factors in women with type 2 diabetes

Correlations between body size and shape.

<p>ABSI: A Body Shape Index; BRI: Body Roundness Index; BMI: Body Mass Index; WC; Waist Circumference.</p><p>Correlation coefficients between height, weight, ABSI, BMI, BRI, and WC among the NES study population (n = 4627). **Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed).</p><p>Correlations between body size and shape.</p

The unadjusted odds of CVD and CVD risk factor prevalence for ABSI, BRI, BMI, and WC.

<p>ABSI: A Body Shape Index; BRI: Body Roundness Index; BMI: Body Mass Index; WC; Waist Circumference.</p><p>Ranges in parentheses are 95% confidence intervals. The between cut points are 0.077, 0.080, 0.083, and 0.086 for ABSI; 2.8, 3.5, 3.9, 4.7 for BRI; 22.1, 23.7, 25.2, and 27.1 for BMI; 0.89, 0.94, 0.98, 1.04 for WC (males); 0.78, 0.82, 0.87, 0.94 for WC (females). *Significant at P<0.05; ^<i>Φ</i>Significant at P<0.01.</p><p>The unadjusted odds of CVD and CVD risk factor prevalence for ABSI, BRI, BMI, and WC.</p

The odds of CVD and CVD risk factor prevalence for quintiles of ABSI, BRI, BMI, and WC adjusted for sex, age, and smoking.

<p>ABSI: A Body Shape Index; BRI: Body Roundness Index; BMI: Body Mass Index; WC; Waist Circumference.</p><p>Ranges in parentheses are 95% confidence intervals. The between cut points are 0.077, 0.080, 0.083, and 0.086 for ABSI; 2.8, 3.5, 3.9, 4.7 for BRI; 22.1, 23.7, 25.2, and 27.1 for BMI; 0.89, 0.94, 0.98, 1.04 for WC (males); 0.78, 0.82, 0.87, 0.94 for WC (females). *Significant at P<0.05; ^<i>Φ</i>Significant at P<0.01.</p><p>The odds of CVD and CVD risk factor prevalence for quintiles of ABSI, BRI, BMI, and WC adjusted for sex, age, and smoking.</p

Prevalence of CVD and CVD risk factors in quintiles of ABSI, BRI, BMI, and WC.

<p>ABSI: A Body Shape Index; BRI: Body Roundness Index; BMI: Body Mass Index; WC; Waist Circumference.</p><p>Data presented as mean (SD) or proportion (number).</p><p>Prevalence of CVD and CVD risk factors in quintiles of ABSI, BRI, BMI, and WC.</p

Characteristics of the total study population and according to cardiovascular disease status.

<p>Abbreviations: ABSI, A Body Shape Index; BRI, Body Roundness Index; BMI, Body Mass Index; MI, Myocardial Infarction; norm PA, norm physical activity;</p><p>Data presented as mean (SD) or proportion (number).</p><p>*significantly different from ‘<i>Controls’</i>;</p><p>** significantly different from ‘ <i>CVD risk factors</i>’.</p><p>Characteristics of the total study population and according to cardiovascular disease status.</p