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Additional file 7: Supplementary file 7. CONSORT checklist for pragmatic trials

Additional file 3: Supplementary file 3. The “Diabetes Overview” containing aggregated patient data used in general practice

Additional file 4: Supplementary file 4. Overview of the questionnaire to general practitioners and practice staff

Introduction. Diabetes distress is often seen in adolescents with Type 1 diabetes (T1D). Problem Areas in Diabetes (PAID) is the most frequently used scale to assess diabetes distress in clinical settings, but the version for teenagers has not been translated into Danish and validated before now. Objective. This study describes the translation into Danish of the PAID-T scale, which was developed to measure emotional distress in teenagers with diabetes. Materials and Methods. The study was conducted in two phases. First, the PAID-T was translated into Danish based on the guidelines from the International Society for Pharmacoeconomics and Outcome Research and a forwardbackward translation procedure. Second, cognitive interviews were conducted, and the Danish version of the PAID-T was modified to ensure linguistic equivalence with the original scale in English. Results. The Danish version of the PAID-T questionnaire was found to be understandable and relevant for adolescents with T1D. No questions were found to be irrelevant. However, the cognitive interviews showed that the issue of balancing alcohol intake and blood sugar levels was not covered by PAID-T, although this was found relevant in the Danish target group. Conclusion. This study described the translation and linguistic validation of the PAID-T scale into Danish. After modifications based on the feedback from the cognitive interviews, the Danish version was found to be linguistically equivalent to the original English version.

Additional file 6: Supplementary file 6. Model consent form

Additional file 1: Supplementary file 1. SPIRIT guidelines

Additional file 2: Supplementary file 2. Model for the development of the intervention

Additional file 5: Supplementary file 5. Key parameters in the power calculations and an example of the STATA command used

This review focuses on communication about weight-related issues with patients with obesity in general practice. Primary care providers still lack knowledge and tools to address and communicate about the topic of weight and weight-related issues - with focus on minimizing stigmatization and a person centered approach. A few communication tools on the topic have been developed but it seems that the use of those is limited, suggesting an urgent need for making a fast, easy and simple tool for the use in general practice.

Preregistration of epidemiologic study of type 2 diabetes burden and care quality in Denmark and the role of immigrant origin.

This scoping review protocol covers the steps and methods for conducting a scoping review with the following aim: to provide a "map" of the available peer-reviewed studies, explore, map and summarize the evidence and identify knowledge gaps to future research regarding the topic of communication about weight-related issues in general practice with adult patients with obesity in a scoping review. The methodology is based on knowledge from Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews (PRISMA).

Many initiatives in clinical research have a difficult time getting funds for building and maintaining needed software that make sure health science is the highest quality it can be. We submitted a grant proposal to build software tools that streamline and automate aspects of collecting, managing, and sharing data. Details found on the website: https://steno-aarhus.github.io/dif-project/

Key Points Question Is a female community health volunteer (FCHV)–delivered intervention associated with reduced blood glucose levels among adults with type 2 diabetes? Findings In this cluster randomized clinical trial involving 244 adults with type 2 diabetes, the FCHV-delivered intervention was associated with a significant reduction in fasting blood glucose level (−27.90 mg/dL) compared with the control group over 12 months. Meaning These findings suggest that interventions delivered by FCHVs could improve diabetes control among adults with type 2 diabetes in a low-resource setting., This cluster randomized clinical trial examines whether an intervention delivered by female community health volunteers was more effective than usual care in reducing blood glucose among adults with type 2 diabetes in Nepal., Importance Female community health volunteers (FCHVs) are frontline community health workers who have been a valuable resource in improving public health outcomes in Nepal, but their value is understudied in diabetes care. Objective To assess whether an FCHV-delivered intervention is associated with reduced blood glucose levels among adults with type 2 diabetes. Design, Setting, and Participants This community-based, open-label, 2-group, cluster randomized clinical trial with a 12-month delayed control group design was conducted in 14 clusters of a semiurban setting in Western Nepal. A total of 244 adults with type 2 diabetes were recruited between November 2016 and April 2017. The follow-up assessment was conducted at 12 months after enrollment. Data analysis was performed from January to February 2019. Interventions Seven clusters were randomized to the FCHV-delivered intervention in which 20 FCHVs provided home visits 3 times a year (once every 4 months) for health promotion counseling and blood glucose monitoring. If participants had blood glucose levels of 126 mg/dL or higher, the FCHVs referred them to the nearest health facility, and if participants were taking antihyperglycemic medication, they were followed up by the FCHVs for adherence to their medication. Seven clusters were randomized to usual care (control group). Main Outcomes and Measures The primary outcome was the change in mean fasting blood glucose from baseline to 12-month follow-up. Secondary outcomes included changes in mean systolic blood pressure, mean diastolic blood pressure, mean body mass index, percentage change in the proportion of low physical activity, harmful alcohol consumption, current smoking, low fruit and vegetable intake, and antihyperglycemic medication status. Results Of 244 participants, 120 women (56.6%) and 92 men (43.4%) completed the trial. At baseline, the mean (SD) age was 51.71 (8.77) years; 127 participants were in the intervention group, and 117 participants were in the control group (usual care). At baseline, the mean (SD) fasting blood glucose level was 156.06 (44.48) mg/dL (158.48 [45.50] mg/dL in the intervention group and 153.43 [43.39] mg/dL in the control group). At 12-month follow-up, the mean fasting blood glucose decreased by 22.86 mg/dL in the intervention group, whereas it increased by 7.38 mg/dL in the control group. The mean reduction was 27.90 mg/dL greater with the intervention (95% CI, −37.62 to −18.18 mg/dL; P

This document describes the statistical analyses of health outcomes planned as part of the scientific project entitled “Pesticide Exposure, Asthma and Diabetes in Uganda” (PEXADU).

AIMS/HYPOTHESIS: Trials have not demonstrated benefits to the population of screening for type 2 diabetes. However, there may be cost savings for those found to have diabetes. We therefore aimed to compare healthcare costs among individuals with incident type 2 diabetes in a screened group with those in an unscreened group. METHODS: In this register-based, non-randomised controlled trial, eligible individuals were men and women aged 40-69 years without known diabetes who were registered with a general practice in Denmark (n = 1,912,392). Between 2001 and 2006, 153,107 individuals registered with 181 practices participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care (ADDITION)-Denmark study were sent a diabetes risk-score questionnaire. Individuals with a moderate-to-high risk were invited to visit their family doctor for assessment of diabetes status and cardiovascular risk (screening group). The 1,759,285 individuals registered with all other practices in Denmark constituted the retrospectively constructed no-screening (control) group. In this post hoc analysis, we identified individuals from the screening and no-screening groups who were diagnosed with diabetes between 2001 and 2009 (n = 139,075). Using national registry data, we quantified the cost of healthcare services in these two groups between 2001 and 2012. From a healthcare sector perspective, we estimated the potential healthcare cost savings for individuals with diabetes that were attributable to the screening programme. RESULTS: In the screening group, 27,177 of 153,107 individuals (18% of those sent a risk-score questionnaire) attended for screening, 1533 of whom were diagnosed with diabetes. Between 2001 and 2009, 13,992 people were newly diagnosed with diabetes in the screening group (including those diagnosed by screening) and 125,083 in the no-screening group. Healthcare costs were significantly lower in the screening group compared with the no-screening group (difference in mean total annual healthcare costs -€889 per individual with incident diabetes; 95% CI -€1196, -€581). The screening programme was associated with a cost saving per person with incident diabetes over a 5-year period of €2688 (95% CI €1421, €3995). CONCLUSIONS/INTERPRETATION: Healthcare costs were lower among individuals with incident type 2 diabetes in the screened group compared with the unscreened group. The relatively modest cost of screening per person discovered to have developed diabetes was offset within 2 years by savings in the healthcare system.

Background: Poor uptake among socio-economically disadvantaged and susceptible populations is a well-known challenge of general health check interventions, and is widely cited as one of the reasons for the lack of population level effects seen in many studies. We report on patient characteristics among attendees and non-attendees of health checks made available to residents in the social housing sector of the municipality of Aarhus. We focus on this general population, as well as a particular sub-group living in an exceptionally deprived social housing area, and discuss the properties of intervention uptake that we need to be aware of to qualify and compare the effects of general versus targeted health checks in socially deprived areas. Methods: Cross-sectionally in a sample of 6650 residents of the Aarhus social housing sector who were invited for a health check in the first year of the 'Your Life - Your Health' program. The analyses consisted of 1) descriptive analysis of the characteristics of attenders/non-attenders, 2) unadjusted and adjusted Poisson regression to examine associations of patient characteristics and uptake of health checks, and 3) decision tree analyses (CHAID) to examine interaction and homogeneity in patient characteristics among attenders. Results: Of the overall population 30% attended. In a nested cohort of people residing in a particularly deprived social housing settlement, 25% attended. Further, in the overall population, we found an association between the likelihood of taking up a health check and age, sex, country of origin, educational attainment, cohabitation, occupational status, and past medical treatment. In the nested cohort the association between uptake and medical treatment was non-significant, while the association between uptake and occupation was limited to people who were employed. These results resonate with past evidence on health check attendance. Conclusions: Attendance in the 'Your Life - Your Health' program is higher among people of a higher socio-economic status. This should be taken into consideration when analysing and interpreting the overall study effects. Moreover, the results suggest that a targeted approach in the social housing sector could be more effective than a mass screening approach. However, more information is required to make such assertion definitive.

The authors have discovered a coding error in the statistical analysis syntax file used for the mixed-effect model analyses in this paper. The error has led to differences (first decimal) in the estimates for the main results. Although the conclusions stand unaltered the actual change over time for many parameters is smaller than previously reported and the direction of change reversed for fasting insulin, HOMA-IR and HOMA-β.

Background: It has been stressed that early detection of impaired lung function can be useful in prevention of lung diseases. It is unknown whether spirometry as an integrated part of preventive health checks including a questionnaire regarding risk factors and exposure, can be used for early detection of lung diseases.The aim of the study is to describe exposure characteristics and spirometry parameters 15 years ahead of a diagnosis of Chronic Obstructive Pulmonary Disease (COPD*)*Defined by FEV1/FVC < 70 and FEV1< 80% of predicted.Method: In a cohort study of citizens of Ebeltoft municipality (n=573), aged 30-49 years at baseline, attended in 1991 and 2006 a health check and a follow-up consultation at their own general practitioner. The characteristics of the citizens are described according to sex, age, smoking history, exposure, lung symptoms and spirometry values. Register information on sociodemographic, diagnosis, redeemed medication and mortality will be obtained from the Danish National Registers. Results: 44(7.6%) out of 573 citizens had COPD at the final examination. The characteristics of this group show a significant difference on baseline spirometry values. 44.7% of the COPD group reported respiratory symptoms at baseline compared to 24% in the no-COPD group. We also found an overweight of current smokers and a higher proportion using inhalation medication. Finally we found that only 4.5% of the COPD patients knew they had COPD and no more than 27.3% of the COPD patients received inhalation medication at the final examination. Conclusion: Persons with COPD had a significant lower lung function at baseline than persons without COPD. Self-reported symptoms and smoking history were also more frequent in the COPD group. Further analysis on socioeconomic characteristics will be done.

OBJECTIVE: To determine the benefit of multifactorial treatment on microvascular complications among people with type 2 diabetes detected by screening.RESEARCH DESIGN AND METHODS: This study was a multicenter cluster randomized controlled trial in primary care with randomization at the practice level. In four centers in Denmark; Cambridge, U.K.; the Netherlands; and Leicester, U.K., 343 general practices participated in the trial. Eligible for follow-up were 2,861 of the 3,057 people with diabetes detected by screening included in the original trial. Biomedical data on nephropathy were collected in 2,710 (94.7%) participants, retinal photos in 2,190 (76.6%), and questionnaire data on peripheral neuropathy in 2,312 (80.9%). The prespecified microvascular end points were analyzed by intention to treat. Results from the four centers were pooled using fixed-effects meta-analysis.RESULTS: Five years after diagnosis, any kind of albuminuria was present in 22.7% of participants in the intensive treatment (IT) group and in 24.4% in the routine care (RC) group (odds ratio 0.87 [95% CI 0.72-1.07]). Retinopathy was present in 10.2% of the IT group and 12.1% of the RC group (0.84 [0.64-1.10]), and severe retinopathy was present in one patient in the IT group and seven in the RC group. Neuropathy was present in 4.9% and 5.9% (0.95 [0.68-1.34]), respectively. Estimated glomerular filtration rate increased between baseline and follow-up in both groups (4.31 and 6.44 mL/min, respectively).CONCLUSIONS: Compared with RC, an intervention to promote target-driven, intensive management of patients with type 2 diabetes detected by screening was not associated with significant reductions in the frequency of microvascular events at 5 years.

A Cochrane review has recently challenged the benefit of health checks. Included studies, screening procedures and treatments were however very heterogeneous and did not fulfil present days standards and most studies were done outside primary care. This review concentrates on research from health checks in Danish general practices focusing on early detection and treatment of risk factors for cardiovascular disease and diabetes. The authors recommend Danish general practitioners to offer opportunistic screening and treatment of people with diabetes and people at risk for cardiovascular disease. Future research questions are highlighted.

BACKGROUND: There is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory.AIM: To describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status.DESIGN AND SETTING: Cohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands.METHOD: A total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years.RESULTS: The largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable.CONCLUSION: Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.

Artiklen opsummerer de nuværende resultater fra ADDITION studiet. Forfatterne konkluderer at ADDITION studiet har skabt yderligere evidens til støtte for tidlig opsporing og behandling af patienter med uerkendt diabetes. Frem for at fokusere på populationsbaseret screening opfordre forfatterne praktiserende læger til at fokusere på tidlig opsporing fx ved opportunistisk screening. For hver diabetiker, som findes ved screening, vil man finde ca. 6 med høj risiko for hjertekarsygdom (SCORE≥5) uden at vedkomne har diabetes. Lægerne opfordres til at behandle såvel de fundne diabetikere som de personer, som findes med høj risiko for diabetes eller høj risiko for hjertekarsygdom uden diabetes i henhold til gældende vejledninger, det vil sige livsstilsrådgivning og rådgivning om forebyggende farmakologisk behandling med blodtrykssænkende, kolesterolsænkende og blodsukkersænkende medicin. Resultaterne understøtter således DSAM’s nuværende screenings- og behandlingsalgoritmer.

OBJECTIVEDiabetes is associated with increased brachial and central blood pressure and aortic stiffness. We examined the effect of intensive multifactorial treatment in general practice on indices of peripheral and central hemodynamics among patients with screen-detected diabetes.RESEARCH DESIGN AND METHODSAs part of a population-based screening and intervention study in general practice, 1,533 Danes aged 40-69 years were clinically diagnosed with screen-detected diabetes. General practitioners were randomized to provide intensive multifactorial treatment or routine care. After a mean follow-up of 6.2 years, an unselected subsample of 456 patients underwent central hemodynamic assessments by applanation tonometry. Central pressure was derived from the radial pulse wave. Aortic stiffness was assessed as carotid-femoral pulse wave velocity (aPWV). The intervention effect on each index of central hemodynamics was analyzed by mixed-effects models adjusted for heart rate, cluster randomization, age, and sex.RESULTSAt screening, median age was 59.2 years (interquartile range 55.2-64.6); 289 patients (63%) were in the intensive treatment group, and 278 patients (61%) were men. Patients in the intensive treatment group had a 0.51 m/s (95% CI -0.96 to -0.05, P = 0.03) lower aPWV compared with routine care. Respective differences for central augmentation index (-0.84% [-2.54 to 0.86]), pulse pressure (0.28 mmHg [-1.75 to 2.32]), and systolic (-1.42 mmHg [-4.47 to 1.64]) and diastolic (-1.79 mmHg [-3.72 to 0.14]) blood pressure were not statistically significant.CONCLUSIONSIntensive multifactorial treatment of screen-detected diabetes during 6 years in general practice has a significant impact on aortic stiffness, whereas the effects on other hemodynamic measures are smaller and not statistically significant.

African Americans are disproportionately affected by type 2 diabetes (T2DM) yet few studies have examined T2DM using genome-wide association approaches in this ethnicity. The aim of this study was to identify genes associated with T2DM in the African American population. We performed a Genome Wide Association Study (GWAS) using the Affymetrix 6.0 array in 965 African-American cases with T2DM and end-stage renal disease (T2DM-ESRD) and 1029 population-based controls. The most significant SNPs (n = 550 independent loci) were genotyped in a replication cohort and 122 SNPs (n = 98 independent loci) were further tested through genotyping three additional validation cohorts followed by meta-analysis in all five cohorts totaling 3,132 cases and 3,317 controls. Twelve SNPs had evidence of association in the GWAS (P

Det er velkendt at der er social gradient i prognosen for diabetes, men det er uklart on denne ulighed også gælder brug af almen praksis blandt personer med diabetes. En nationalt, populationsbaseret kohortestudie blev udført med 137.492 personer med incident diabetes i alderen 40-79 år og 687.460 reference personser uden diabetes, matchet på køn og alder. Oplysninger om diabetes blev hentet for det Nationale Diabetes Register, socioøkonomisk position (SEP) fra Danmarks Statistik og antal konsultationer i almen praksis fra Sygesikringsregistret. Konsultationsrate fordelt på SEP-grupper for første år efter diagnose blev sammenlignet. Personer med diabetes havde 4,8 (95%CI:4,7-4,8) flere konsultationer i almen praksis første år efter diagnose. Denne ekstra konsultationsrate steg med faldende SEP; f.eks. 5,8 (95%CI: 5.6-6.0) for kvinder i aldersgruppen 40-54 år med laveste uddannelsesniveau og 4,9 (95%CI: 4,7-5,1) for kvinder med det højeste uddannelsesniveau. Personer med diabetes havde næsten 5 ekstra konsultationer i almen praksis første år efter diagnoses og antallet var højest for de med lavest SEP. INTRODUCTION: The social inequality gradient in the prognosis of diabetes is well-established but it is unclear whether this inequality gradient extends to the use of general practice among persons with diabetes. METHODS: A nationwide, population-based cohort study was conducted including 137,492 persons with incident diabetes aged 40-79 years and 687,460 reference persons with no history of diabetes matched on gender and age. Information on diabetes was obtained from the National Diabetes Register, socioeconomic position (SEP) from Statistics Denmark and number of general practice consultations from the National Health Insurance Service Registry. Consultation rates for different SEP-groups during the first year after index day were compared. RESULTS: Overall, persons with diabetes had 4.8 (95%CI: 4.7-4.8) more consultations in general practice during the first year after their diagnosis than reference persons with no history of diabetes. This additional consultation rate increased with decreasing SEP, e.g. 5.8 (95%CI: 5.6-6.0) for women aged 40-54 years with the lowest educational level and 4.9 (95%CI: 4.7-5.1) for women with the highest educational level. CONCLUSION: Persons with diabetes had nearly five additional consultations with their general practitioner during the first year after their diagnosis and the number was higher for those with the lowest SEP.

Aims: To describe and compare attendance rates and the proportions of people identified with Type 2 diabetes mellitus in people with previously unknown diabetes who participated in screening programmes undertaken in general practice in the UK, Denmark and the Netherlands as part of the ADDITION‐Europe study.Methods: In Cambridge, routine computer data searches were conducted to identify individuals aged 40–69 years at high risk of Type 2 diabetes using the Cambridge Diabetes Risk Score. In Denmark, the Danish Diabetes Risk Score was mailed to individuals aged 40–69 years, or completed by patients visiting their general practitice. In the Netherlands, the Hoorn Symptom Risk Questionnaire was mailed to individuals aged 50–69 years. In these three centres, high‐risk individuals were invited to attend subsequent steps in the screening programme, including random blood glucose, HbA1c, fasting blood glucose and/or oral glucose tolerance test. In Leicester, eligible people aged 40–69 years were invited directly for an oral glucose tolerance test. In all centres, Type 2 diabetes was defined according to World Health Organization 1999 diagnostic criteria.Results: Attendance rates ranged from 20.2% (oral glucose tolerance test in Leicester without pre‐stratification) to 95.1% (random blood glucose in opportunistic screening in Denmark in high‐risk people). The percentage of people with newly detected Type 2 diabetes from the target population ranged from 0.33% (Leicester) to 1.09% (the Netherlands).Conclusions: Screening for Type 2 diabetes was acceptable and feasible, but relatively few participants were diagnosed in all participating centres. Different strategies may be required to increase initial attendance and ensure completion of screening programmes.

Background: The evidence gained from effective self-management interventions is often criticised for the ambiguity of its active components, and consequently the obstruction of their implementation into daily practice. Our aim is to report how an intervention development model aids the careful selection of active components in an intervention for people with dysglycaemia. Methods: The first three phases of the UK Medical Research Council's model for developing complex interventions in primary care were used to develop a self-management intervention targeting people with screen-detected dysglycaemia. In the preclinical phase, the expected needs of the target group were assessed by review of empirical literature and theories. In phase I, a preliminary intervention was modelled and in phase II, the preliminary intervention was pilot tested. Results: In the preclinical phase the achievement of health-related action competence was defined as the overall intervention goal and four learning objectives were identified: motivation, informed decision-making, action experience and social involvement. In Phase I, the educational activities were defined and the pedagogical tools tested. In phase II, the intervention was tested in two different primary healthcare settings and adjusted accordingly. The 18- hour intervention "Ready to Act" ran for 3 months and consisted of two motivational one-to-one sessions conducted by nurses and eight group meetings conducted by multidisciplinary teams. Conclusions: An intervention aimed at health-related action competence was successfully developed for people with screen-detected dysglycaemia. The systematic and transparent developmental process is expected to facilitate future clinical research. The MRC model provides the necessary steps to inform intervention development but should be prioritised according to existing evidence in order to save time

Objective. In people with screen-detected type 2 diabetes in primary care, (1) to assess adherence to guidelines, recommending consultation with the GP every three months and treatment initiation with an ACE inhibitor or an angiotensin-II receptor antagonist when systolic BP was > 120 mmHg and/or diastolic BP was > 80 mmHg, and (2) to identify predictors for adherence. Design. Prospective follow-up of a fixed cohort of patients. Setting. Fifty-four Danish general practices. Subjects and main outcome measures. A total of 361 people with screen-detected type 2 diabetes were followed up for 410 days to assess planned consultations with their GP and recording of BP. Some 226 people, with BP recorded above guideline threshold(s) and where treatment was not already initiated, were followed for up to 410 days to monitor prescription redemption. Results. At 3, 6, 9 and 12 months 80%, 77%, 74%, and 73% of the cohort attended a consultation. A total of 89% of the cohort attended two of the four planned consultations. The probability of redeemed prescriptions for an ACE inhibitor or an angiotensin-II receptor antagonist according to the guideline during the first year following diagnosis was 51%. High initial BP was associated with prescription redemption. No other analysed individual or organisational characteristics were found to be associated with treatment initiation. Conclusion. The consultation attendance was reasonably high, and treatment initiation with an ACE inhibitor or an angiotensin-II receptor antagonist according to the guideline was found in half of the cases. High initial BP increased the probability of treatment initiation.

Objective: We evaluated association of variants in the sterol regulatory element-binding factor 1 gene (SREBF1) with type 2 diabetes. Due to the previous inconclusive quantitative trait associations, we also did studies of intermediate quantitative phenotypes. Research design and methods: We genotyped four variants in SREBF1 in the population-based Inter99 cohort (n=6,070), the Danish ADDITION study (n=8,662) and in additional type 2 diabetic patients (n=1,002). The case-control studies involved 2,980 type 2 diabetic patients and 4,522 glucose-tolerant subjects. Results: The minor alleles of the rs2297508, rs11868035 and rs1889018 (linkage disequilibrium R(2)=0.6-0.8) associated with a modestly increased risk of type 2 diabetes (rs2297508: OR 1.17 [95% CI 1.05-1.30], P=0.003) which was confirmed in meta-analyses of all published studies (rs2297508 G-allele: OR 1.08 [1.03-1.14] per allele, P=0.001). The diabetes-associated alleles also associated strongly with a higher plasma-glucose at 30 and 120 minutes and serum-insulin at 120 minutes during an OGTT (all P Udgivelsesdato: 2008-Feb-25

The benefits and drawbacks of exenatide as an alternative to insulin in the treatment of poorly regulated type 2 diabetes are reviewed. Exenatide and insulin have equal effects on HbA1c but exenatide causes weight-loss and improved postprandial glucose control. Nausea is reported by nearly half of patients treated with exenatide. Exenatide can be considered in the overweight patient without extremely elevated HbA1c but nausea could pose a substantial hurdle for successful treatment. Udgivelsesdato: 2008-Sep-22

We evaluated variations in glucose measurements and the reproducibility of glucose tolerance classification in a high-risk screening setting in general practice. Screening for diabetes was performed in persons aged 40-69 years. Based on capillary fasting (FBG) and 2-h blood glucose (2hBG) individuals with impaired fasting glycaemia (IFG), impaired glucose tolerance (IGT) and diabetes had a second test done after 14 days. Intra-individual coefficients of variation (CV) were estimated in each glucose tolerance class using the approximation CV(2)(x)=var(ln(x)). Bland-Altman plots with limits of agreement were made. In the total population, the CV(intra) was 7.9% and 13.8% for FBG and 2hBG, respectively. Limits of agreement ranged from -1.15 to 1.67mmol/l for FBG and from - 2.62 to 3.27mmol/l for 2hBG. One individual with IFG and 22.5% with IGT had diabetes at the second test, 76.1% with diabetes had this diagnosis confirmed, and about 30% with IFG and IGT had normal glucose tolerance at the second test. The expected values of repeated capillary blood glucose measurements were about+/-1 and+/-3mmol/l for FBG and 2hBG, respectively. Yet, 70% of high-risk prediabetic individuals were persistently classified with abnormal glucose regulation; diabetes was confirmed in 76% of the cases. Udgivelsesdato: 2007-Dec-12

Udgivelsesdato: 2007-Dec