Prosomatostatine en de relatie met totale en cardiovasculaire mortaliteit bij patienten met type 2 diabetes mellitus

Prosomatostatin, the prohormone of somastatin, is suggested to be involved in the glucose metabolism by inhibition of the secretion of both glucagon and insulin. However, the endogenous action of somatostatin in diabetes in not fully understood. Prosomatostatin also influences the growth-hormone-insulin-like growth factor-1 axis (GH-IGF-1 axis) by inhibiting the secretion of GH and therefore it leads to low concentrations of IGF-1, which are associated with an increased risk of glucose-intolerance and increased cardiovascular risk. Aim of the current study is to investigate whether the serum concentration prosomatostatin is related to all-cause and cardiovascular mortality in patients with T2DM. Data for this study were collected from a patient population of general practitioners in the Zwolle (The Netherlands) region, which were originally collected for the ZODIAC study. It covers a total of 1687 patients with T2DM. In these patients, a number of variables is measured. For the current study the following variables were used: serumconcentration prosomatostatin, age, gender, duration of diabetes in years, smoking (yes/no), macrovascular complications (yes/no), BMI, systolic blood pressure, HbA1c, serum creatinine, cholesterol-HDL ratio and albuminuria (yes/no). With the aid of these variables three different models were composed to investigate the relationship between the serumconcentration prosomatostatin and mortality. This was done using Cox regression analysis. In the first model only prosomatostatin was used a variable. In the second model, age and gender were added as potential confounders. For the third model all above-mentioned variables were used. With the use of Harrells’s C statistic, the model which is the most capable of predicting mortality with prosomatostatin was examined. In 1326 patients, 78.6% of the total ZODIAC population, prosomatostatin concentrations were determined. The median concentration at baseline was 591.5 [449.8 - 783.3] pmol/L. Patients were followed for a median period of 6.0 [3.2 -10.0] years. During this period 413 (31.1%) patients died, of which 176 (42.6%) patients to a cardiovascular cause. The Cox regression analyzes showed for both the first and the second model significantly increased hazard ratios. This applied to both models for both total and for cardiovascular mortality. In the first model every increase of 1 pmol/L log prosomatostatin led to an increase in the hazard of mortality by 180% respectively 286%. In the second model it concerns 48% respectively 121%. However, in the third model the significant relation between log prosomatostatin and mortality disappeared. To predict mortality, the third model was the best model. With the results of this study it can be concluded that in patients with T2DM, also when correcting for age and gender, a higher total and cardiovascular mortality occurs at higher values prosomatostatin. However, when all the tested variables were added the significant relationship disappeared.

Quality assessment of point-of-care ultrasound reports for patients at the emergency department treated by internists

Background: POCUS (point-of-care ultrasound) is an important diagnostic tool for several medical specialties. To provide safe patient care, the quality of this exam should be as high as possible. This includes solid documentation with a written report and the availability of images for review. However, international guidelines or publications about this quality assessment and its application in clinical practice are scarce. Methods: We designed a criteria-checklist to evaluate the quality of POCUS examinations. This checklist was made based on international guidelines and protocols and was validated by a Dutch expert group using the nominal group technique (NGT). All POCUS exams in general internal medicine patients documented between August 2019 and November 2020 in our ED were evaluated using this checklist. Results: A total of 169 exams were included. In general, the compliance for most important criteria was high, but not optimal. A clinical question or indication for the POCUS exam was stated in 75.7% of cases. The completeness of all standard views differed per indication, but was lower when more than one standard view was required. Labels were provided in 83.5% of the saved images, while 90.8% of all examinations showed a written conclusion. Conclusions: Our research showed that the overall quality of documentation varies with regard to several important criteria. Suboptimal compliance of documentation may have adverse effects on patient safety. We have developed a checklist which can be used to improve POCUS documentation

The relationship between N-terminal prosomatostatin, all-cause and cardiovascular mortality in patients with type 2 diabetes mellitus (ZODIAC-35)

Background: The hormone somatostatin inhibits growth hormone release from the pituitary gland and is theoretically linked to diabetes and diabetes related complications. This study aimed to investigate the relationship between levels of the stable somatostatin precursor, N-terminal prosomatostatin (NT-proSST), with mortality in type 2 diabetes (T2DM) patients. Methods: In 1,326 T2DM outpatients, participating in this ZODIAC prospective cohort study, Cox proportional hazards models were used to investigate the independent relationship between plasma NT-proSST concentrations with all-cause and cardiovascular mortality. Results: Median concentration of NT-proSST was 592 [IQR 450-783] pmol/L. During follow-up for 6 [3-10] years, 413 (31%) patients died, of which 176 deaths (43%) were attributable to cardiovascular causes. The age and sex adjusted hazard ratios (HRs) for all-cause and cardiovascular mortality were 1.48 (95% CI 1.14 - 1.93) and 2.21 (95% CI 1.49 - 3.28). However, after further adjustment for cardiovascular risk factors there was no independent association of log NT-proSST with mortality, which was almost entirely attributable to adjustment for serum creatinine. There were no significant differences in Harrell's C statistics to predict mortality for the models with and without NT-proSST: both 0.79 (95% CI 0.77 - 0.82) and 0.81 (95% CI 0.77 - 0.84). Conclusions: NT-proSST is unsuitable as a biomarker for cardiovascular and all-cause mortality in stable outpatients with T2DM