Assessing the relationship between markers of glycemic control through flexible copula regression models

Glycated haemoglobin (HbA1c) is a sensitive marker of blood glucose in patientswith diabetes. However, levels can vary considerably, even among individualswith similar mean blood glucose concentrations. Other glycated proteins, such asfructosamine, can also act as blood sugar markers, but estimating HbA1c and fruc-tosamine via independent models may lead to errors of interpretation regardingdisease severity. From a clinical standpoint, it would be of great interest to knowthe factors that affect the mean concentration of both HbA1c and fructosamine,that influence the variability in the concentrations of these glycated markers, andthat cause HbA1c/fructosamine discordance. Flexible models are required that illus-trate the behaviour of these variables as well as the association between them. Thepresent work reviews existing models that might serve in this regard. Flexible cop-ula regression models using P-splines, were used to provide a better understandingof the behaviour of both glycated proteins, and the relationship between them underthe possible influence of different covariates. This work shows the usefulness ofthis type of models in practice, and provides a basis for its clinical interpretation bymeans of an understandable case study. Ultimately, to better understand the effectsof each continuous covariate, they were represented at the true scale of the response variables

Assessing the relationship between markers of glycemic control through flexible copula regression models

Glycated haemoglobin (HbA1c) is a sensitive marker of blood glucose in patients with diabetes. However, levels can vary considerably, even amongst individuals with similar mean blood glucose concentrations. Other glycated proteins, such as fructosamine, can also act as blood sugar markers, but estimating HbA1c and fructosamine via independent models may lead to errors of interpretation regarding disease severity. From a clinical standpoint, it would be of great interest to know the factors that affect the mean concentration of both HbA1c and fructosamine, which influence the variability in the concentrations of these glycated markers and cause HbA1c/fructosamine discordance. Flexible models are required to illustrate the behaviour of these variables as well as the association between them. This work reviews existing models that might serve in this regard. Flexible copula regression models using splines were used to provide a better understanding of the behaviour of both glycated proteins and the relationship between them under the possible influence of different covariates. This work shows the usefulness of this type of models in practise and provides a basis for their clinical interpretation by means of an understandable case study. Ultimately, to better understand the effects of each continuous covariate, they are represented at the true scale of the response variables

Offering, participation and adherence to cardiac rehabilitation programmes in the elderly: a European comparison based on the EU-CaRE multicentre observational study

AIMS : Cardiac rehabilitation (CR) is strongly recommended but participation of elderly patients has not been well characterized. This study aims to analyse current rates and determinants of CR referral, participation, adherence, and compliance in a contemporary European cohort of elderly patients. METHODS AND RESULTS : The EU-CaRE observational study included data from consecutive patients aged ≥ 65 with acute coronary syndrome, revascularization, stable coronary artery disease, or heart valve replacement, recruited in eight European centres. Rates and factors determining offering, participation, and adherence to CR programmes and compliance with training sessions were studied across centres, under consideration of extensive-outpatient vs. intensive-inpatient programmes. Three thousand, four hundred, and seventy-one patients were included in the offering and participation analysis. Cardiac rehabilitation was offered to 80.8% of eligible patients, formal contraindications being the main reason for not offering CR. Mean participation was 68.0%, with perceived lack of usefulness and transport issues being principal barriers. Mean adherence to CR programmes of participants in the EU-CaRE study (n = 1663) was 90.3%, with hospitalization/physical impairment as principal causes of dropout. Mean compliance with training sessions was 86.1%. Older age was related to lower offering and participation, and comorbidity was associated with lower offering, participation, adherence, and compliance. Intensive-inpatient programmes displayed higher adherence (97.1% vs. 85.9%, P < 0.001) and compliance (full compliance: 66.0% vs. 38.8%, P < 0.001) than extensive-outpatient programmes. CONCLUSION : In this European cohort of elderly patients, older age and comorbidity tackled patients' referral and uptake of CR programmes. Intensive-inpatient CR programmes showed higher completion than extensive-outpatient CR programmes, suggesting this formula could suit some elderly patients