Regression of albuminuria and its association with incident cardiovascular outcomes and mortality in type 1 diabetes: the FinnDiane Study

Aims/hypothesis Our aim was to assess regression of albuminuria and its clinical consequences in type 1 diabetes. Methods The analysis included 3642 participants from the Finnish Diabetic Nephropathy (FinnDiane) Study with a 24 h urine sample and a history of albuminuria available at baseline. A total of 2729 individuals had normal AER, 438 a history of microalbuminuria and 475 a history of macroalbuminuria. Regression was defined as a change from a higher category of albuminuria pre-baseline to a lower category in two out of the three most recent urine samples at baseline. The impact of regression on cardiovascular events (myocardial infarction, stroke, coronary procedure) and mortality was analysed over a follow-up of 14.0 years (interquartile range 11.9-15.9). Results In total, 102 (23.3%) individuals with prior microalbuminuria and 111 (23.4%) with prior macroalbuminuria had regressed at baseline. For individuals with normal AER as a reference, the age-adjusted HRs (95% CI) for cardiovascular events were 1.42 (0.75, 2.68) in individuals with regression from microalbuminuria, 2.62 (1.95, 3.54) in individuals with sustained microalbuminuria, 3.15 (2.02, 4.92) in individuals with regression from macroalbuminuria and 5.49 (4.31, 7.00) in individuals with sustained macroalbuminuria. Furthermore, for all-cause and cardiovascular mortality rates, HRs in regressed individuals were comparable with those with sustained renal status at the achieved level (i.e. those who did not regress but remained at the most advanced level of albuminuria noted pre-baseline). Conclusions/interpretation Progression of diabetic nephropathy confers an increased risk for cardiovascular disease and premature death. Notably, regression reduces the risk to the same level as for those who did not progress.Peer reviewe

Frequent physical activity is associated with reduced risk of severe diabetic retinopathy in type 1 diabetes

The aim of this study was to investigate whether leisure-time physical activity (LTPA) is associated with the development of severe diabetic retinopathy in individuals with type 1 diabetes.Peer reviewe

Soluble receptor for AGE in diabetic nephropathy and its progression in Finnish individuals with type 1 diabetes

Aims/hypothesisActivation of the receptor for AGE (RAGE) has been shown to be associated with diabetic nephropathy. The soluble isoform of RAGE (sRAGE) is considered to function as a decoy receptor for RAGE ligands and thereby protects against diabetic complications. A possible association between sRAGE and diabetic nephropathy is still, however, controversial and a more comprehensive analysis of sRAGE with respect to diabetic nephropathy in type 1 diabetes is therefore warranted.MethodssRAGE was measured in baseline serum samples from 3647 participants with type 1 diabetes from the nationwide multicentre Finnish Diabetic Nephropathy (FinnDiane) Study. Associations between sRAGE and diabetic nephropathy, as well as sRAGE and diabetic nephropathy progression, were evaluated by regression, competing risks and receiver operating characteristic curve analyses. The non-synonymous SNP rs2070600 (G82S) was used to test causality in the Mendelian randomisation analysis.ResultsBaseline sRAGE concentrations were highest in participants with diabetic nephropathy, compared with participants with a normal AER or those with microalbuminuria. Baseline sRAGE was associated with progression from macroalbuminuria to end-stage renal disease (ESRD) in the competing risks analyses, but this association disappeared when eGFR was entered into the model. The SNP rs2070600 was strongly associated with sRAGE concentrations and with progression from macroalbuminuria to ESRD. However, Mendelian randomisation analysis did not support a causal role for sRAGE in progression to ESRD.Conclusions/interpretationsRAGE is associated with progression from macroalbuminuria to ESRD, but does not add predictive value on top of conventional risk factors. Although sRAGE is a biomarker of diabetic nephropathy, in light of the Mendelian randomisation analysis it does not seem to be causally related to progression from macroalbuminuria to ESRD.</p

Soluble receptor for AGE in diabetic nephropathy and its progression in Finnish individuals with type 1 diabetes

Aims/hypothesis Activation of the receptor for AGE (RAGE) has been shown to be associated with diabetic nephropathy. The soluble isoform of RAGE (sRAGE) is considered to function as a decoy receptor for RAGE ligands and thereby protects against diabetic complications. A possible association between sRAGE and diabetic nephropathy is still, however, controversial and a more comprehensive analysis of sRAGE with respect to diabetic nephropathy in type 1 diabetes is therefore warranted. Methods sRAGE was measured in baseline serum samples from 3647 participants with type 1 diabetes from the nationwide multicentre Finnish Diabetic Nephropathy (FinnDiane) Study. Associations between sRAGE and diabetic nephropathy, as well as sRAGE and diabetic nephropathy progression, were evaluated by regression, competing risks and receiver operating characteristic curve analyses. The non-synonymous SNP rs2070600 (G82S) was used to test causality in the Mendelian randomisation analysis. Results Baseline sRAGE concentrations were highest in participants with diabetic nephropathy, compared with participants with a normal AER or those with microalbuminuria. Baseline sRAGE was associated with progression from macroalbuminuria to end-stage renal disease (ESRD) in the competing risks analyses, but this association disappeared when eGFR was entered into the model. The SNP rs2070600 was strongly associated with sRAGE concentrations and with progression from macroalbuminuria to ESRD. However, Mendelian randomisation analysis did not support a causal role for sRAGE in progression to ESRD. Conclusions/interpretations RAGE is associated with progression from macroalbuminuria to ESRD, but does not add predictive value on top of conventional risk factors. Although sRAGE is a biomarker of diabetic nephropathy, in light of the Mendelian randomisation analysis it does not seem to be causally related to progression from macroalbuminuria to ESRD.Peer reviewe

Frequent and intensive physical activity reduces risk of cardiovascular events in type 1 diabetes

Aims/hypothesis Cardiovascular disease (CVD) is the most common cause of premature death and disability among patients with type 1 diabetes. Diabetic nephropathy accounts for the increased cardiovascular morbidity and mortality of these patients. We recently showed that the intensity of exercise predicts the incidence and progression of diabetic nephropathy in patients with type 1 diabetes. Little is known about the relationship between physical activity and CVD. Therefore, we studied how physical activity affects the risk of CVD events in patients with type 1 diabetes. Methods A 10 year follow-up study including 2180 type 1 diabetes patients from the nationwide multicentre Finnish Diabetic Nephropathy Study (FinnDiane). Leisure time physical activity (LTPA) was assessed by a previously validated self-report questionnaire. A CVD event was defined as a verified myocardial infarction, coronary procedure or stroke. Patients were analysed separately for the risk of developing a first ever CVD event and for the risk of a recurrent CVD event following a baseline event. Results A total of 206 patients had an incident CVD event during follow-up. A higher total LTPA and higher intensity, frequency and duration of activity were associated with a lower risk of incident CVD events. The observed association between exercise frequency and incident CVD remained significant when adjusted for classic risk factors. Exercise intensity also had a borderline effect on the recurrence-free time in patients with a major CVD event at baseline. Conclusion/interprelation This study suggests that exercise, particularly high frequency and high intensity exercise, may reduce the risk of CVD events in patients with type 1 diabetes.Peer reviewe

Frequent physical activity is associated with reduced risk of severe diabetic retinopathy in type 1 diabetes

AimsThe aim of this study was to investigate whether leisure-time physical activity (LTPA) is associated with the development of severe diabetic retinopathy in individuals with type 1 diabetes.MethodsProspective observational analysis as part of the Finnish diabetic nephropathy (FinnDiane) Study with a mean follow-up time of 10.7 years was performed. A total of 1612 individuals with type 1 diabetes were recruited, and LTPA was assessed at baseline using a validated self-report questionnaire. Severe diabetic retinopathy was defined as the initiation of laser treatment due to severe nonproliferative, proliferative retinopathy or diabetic maculopathy (identified from the Care Register for Health Care).ResultsA total of 261 patients received laser treatment during the follow-up. Higher frequency of LTPA was associated with a lower incidence of severe diabetic retinopathy (p = 0.024), a finding that remained significant after adjustment for gender, duration, age at onset of diabetes, kidney function, BMI, triglycerides and systolic blood pressure. However, when HbA1c and smoking were added to the Cox regression model the association was no more significant.ConclusionsFrequent LTPA is associated with a lower incidence of severe diabetic retinopathy during the follow-up. The total amount or the other components of LTPA (intensity or duration of a single session) were not associated with severe diabetic retinopathy.</p

"LEIKITÄÄN ET NÄÄ OLIS KEIJUJA!" : havaintoja 3-5-vuotiaiden päiväkotilasten vapaan leikin tilanteista

TIIVISTELMÄ Elonen, Nina ja Karvonen, Maija. ”Leikitään, et nää olis keijuja!” Havaintoja 3–5-vuotiaiden päiväkotilasten vapaan leikin tilanteista. Helsinki, syksy 2010, 55 s., 1 liite. Diakonia-ammattikorkeakoulu, Diak Etelä Helsinki. Sosiaalialan koulutusohjelma, sosionomi (AMK) + lastentarhanopettajan kelpoisuus. Opinnäytetyö on osa VKK-Metro-hanketta eli pääkaupunkiseudun varhaiskasvatuksen kehittämisyksikköä. Hankkeen yhtenä tavoitteena on kehittää varhaiskasvatuksen havainnointia, dokumentointia ja arviointia. Tässä opinnäytetyössä osallistuttiin hankkeeseen havainnoimalla videokuvausta käyttäen lasten leikkiä yhteistyöpäiväkodissa, joka on helsinkiläinen päiväkoti Havukka. Päiväkoti asetti yleiseksi tavoitteekseen arvioinnin kehittämisen havainnoinnin ja dokumentoinnin avulla. Opinnäytetyö oli osana tätä työtä. Tavoitteena oli havainnoida 3–5-vuotiaiden lasten vapaata leikkiä ja käsitellä aineistolähtöisesti havainnoista nousevia aiheita. Tutkimuksen teemoiksi valikoituivat aineiston perusteella kuvitteluleikki, sukupuoliroolien näkyminen leikeissä, lasten vallankäyttö sekä lasten kuolemakäsitys. Kyseiset teemat valikoituivat aineistosta käsiteltäviksi, koska ne nousivat esille leikeistä. Keväällä 2009 kuvattuja leikkejä kertyi lähes neljä tuntia. Kuvattuja tilanteita nauhoilla oli useampia, mutta niistä seitsemän valikoitui opinnäytetyön aineistoksi. Opinnäytetyö oli aineistolähtöinen, joten havaintoja peilattiin aiemmin leikistä kirjoitettuun teoriaan, eikä teoreettista pohjaa ollut ennakkoon. Tuloksia olivat seuraavat asiat. Kuvitteluleikki on 3–5-vuotiaiden pääasiallinen leikin muoto ja sille tulisi luoda hyvät edellytykset päivähoidossa. Se myös kertoo paljon lapsista, joten sen havainnointi on erittäin tärkeää ja hyödyllistä. Sukupuoliroolit näkyvät yhä tänä päivänä leikeissä selvästi. Tytöt leikkivät ihmissuhdeleikkejä ja pojat toiminnallisia leikkejä. Leikeissä esiintyvää vallankäyttöä voi olla vaikea huomata, ellei seuraa leikkiä tarkasti. Kuolema on yksi elämän peruskysymyksistä, joka mietityttää lapsia kovasti ja joka näkyy myös leikeissä. Asiasanat: lapset, varhaiskasvatus, päivähoito, projektit, leikki, sukupuoliroolit, vallankäyttö, havainnointi, kvalitatiivinen tutkimusABSTRACT Elonen, Nina and Karvonen, Maija “Let’s play fairies!” Observations of free play situations between 3–5 year-olds in day care. 55p., 1 appendix. Language: Finnish. Helsinki, Autumn 2010. Diaconia University of Applied Sciences. Degree Programme in Social Services, Degree: Bachelor of Social Services. The thesis was a part of a project named VKK-Metro-hanke which aimed at developing early childhood education in day care centers. The thesis was created in cooperation with day care centre Havukka. The aim of the study was to investigate children’s behavior in free play settings, for instance, what kind of features there were in children’s group play situations. The study focused on imaginary plays and the differences between boys and girls in play situations. The gender roles the children adopted were one focus. In addition, the use of power between the children and the concept of death were also discussed. A permission to observe the children was asked from the parents. The qualitative research method was used in the study. The audio-visual material was collected in 2009. Play situations were observed and videotaped in a day care centre and later analyzed on the basis of literature. There were nearly four hours of material. Seven play situations were selected to be studied further. The results of the study were that the imaginary play has a very important role among 3–5 year-olds and it would be useful to observe it more in day care centers. Girls’ and boys’ different ways to play were visible in the play situations. For example, girls’ plays and games included relationship roles whereas boys preferred action. The children’s use of power was easier when the adults were not present. Death was a subject of interest to children and it was seen in the play situations also. Keywords: children, early childhood education, day care, free play situations, observation, qualitative research metho