Search

Objective Some brachial cuffs for oscillometric blood pressure (BP) measurement are claimed to cover a wide range of upper-arm circumferences; however, their validation is rarely conducted. Our aim was to compare oscillometric BP measurements obtained with a universal cuff with those obtained with an appropriately sized cuff.Methods We utilised the Microlife B6 Connect monitor, conducting oscillometric BP measurements in a random sequence with both a universal cuff (recommended for arm circumferences from 22 to 42 cm) and an appropriately sized cuff (medium for circumference 22–32 cm and large for 32–42 cm). We included 91 individuals with an arm circumference of 22–32 cm and 64 individuals with an arm circumference of 32–42 cm.Results For arm circumferences > 32 cm, systolic and diastolic BP measured with the universal cuff was higher than that measured with the large cuff (systolic 6.4 mmHg, 95% confidence interval [CI]). 3.9–8.8, diastolic 2.4 mmHg, 95%CI, 1.2–3.7, p

Abstract Introduction The aim of the study was to assess the variation of glucose time in range (TIR) for persons with type 1 diabetes who perform intermittently scanned continuous glucose monitoring (isCGM). Methods Glucose data for 8 weeks were analysed for 166 persons. TIR was calculated over four consecutive 2 weeks periods. Sixty‐one of the persons had two downloads with an interval of >3 months. Results A total of 140 individuals (84%) used multiple daily injection, and 26 (16%) used continuous insulin infusion. The within‐individual standard deviation (SD) for TIR was 6.3% corresponding to 95% limits of agreement for the difference between two TIR values of ±17.6%. Mean TIR calculated from the first and last 2 weeks was 52.2 ± 17.1% and 53.7 ± 16.4%, respectively (difference 1.5%, SD of the difference 10.4%, p = .07). For persons with two downloads separated by months, the SD of the difference in TIR was 12.6%. Conclusions The 95% limit of agreement for TIR is vast for persons using isCGM. It is difficult to draw firm conclusions regarding systematic differences when individual TIR from 2 weeks are compared. This may not be valid for users of insulin pumps with closed‐loop insulin delivery.

Abstract Aim Obstructive sleep apnoea (OSA) is frequent in type 2 diabetes (T2D). The aim was to investigate the effect of a 12‐week treatment with continuous positive airway pressure (CPAP) on glycaemic control assessed by continuous glucose monitoring (CGM), HbA1c and fasting blood glucose in patients with T2D and newly detected OSA. Methods In a randomized controlled multicentre study, 72 participants with T2D and moderate to severe OSA (78% male, age 62 ± 7, AHI 35 ± 15) were recruited from outpatient clinics in three Danish hospitals and were randomized to CPAP intervention or control. The main outcome was glycaemic control assessed by 6 days CGM at baseline and after 12‐week therapy, as well as by HbA1c and fasting blood glucose. Results No significant changes were found in average glucose levels, time in glucose range, time with hypoglycaemia, time with hyperglycaemia or coefficient of variability. HbA1c decreased 0.7 mmol/mol (0.07%; P = .8) in the CPAP group and increased 0.8 mmol/mol (0.08%; P = .6) in the control group (intergroup difference, P = .6). Fasting blood glucose increased by 0.2 mmol/L (P = .02) in the CPAP group and by 0.4 mmol/L (P = .01) in the control group (intergroup difference, P = .7). In a prespecified subgroup analysis comparing participants with high adherence (minimum usage of four hours/night for 70% of all nights) to CPAP to the control group, no significant changes were observed either, although these participants had a tendency towards better glycaemic indices. Conclusions CPAP treatment for 12 weeks does not significantly change glycaemic control in patients with type 2 diabetes and OSA.

Abstract Aims We assessed adherence and long‐term effects on HbA1c of unrestricted access to flash glucose monitoring (FGM) in a single diabetes centre. Methods In this observational study, we reviewed data files for all 411 patients with type 1 diabetes attending our clinic during a 2‐year period. Adherence was reported in those who initiated FGM in our clinic (n = 321). Baseline and final HbA1c were noted for patients who continued FGM for more than 6 months without clinical conditions or interventions at baseline that could interfere with the effect of FGM on glycaemic control (n = 270). Results After 2 years, the fraction of patients using FGM increased from 3% to 72%. Adherence to FGM was 88%. Baseline and final HbA1c was median (interquartile range) 63 mmol/mol (56, 74) (7.9% (7.3, 8.9)) and 59 mmol/mol (53, 68) (7.6% (7.0, 8.4)), respectively. The estimated difference final‐baseline HbA1c was −4 mmol/mol (95% CI −5, −3) (−0.4% (−0.5, −0.3)) (P

Objectives: To investigate, whether renal denervation (RDN) improves arterial stiffness, central blood pressure (C-BP) and heart rate variability (HRV) in patients with treatment resistant hypertension. Methods: ReSET was a randomized, sham-controlled, double-blinded trial (NCT01459900). RDN was performed by a single experienced operator using the Medtronic unipolar Symplicity FlexTM catheter. C-BP, carotid-femoral pulse wave velocity (PWV), and HRV were obtained at baseline and after six months with the SphygmoCor®-device. Results: Fifty-three patients (77% of the ReSET-cohort) were included in this substudy. The groups were similar at baseline (SHAM/RDN): n = 27/n = 26; 78/65% males; age 59 ± 9/54 ± 8 years (mean ± SD); systolic brachial BP 158 ± 18/154 ± 17 mmHg; systolic 24-hour ambulatory BP 153 ± 14/151 ± 13 mmHg. Changes in PWV (0.1 ± 1.9 (SHAM) vs. −0.6 ± 1.3 (RDN) m/s), systolic C-BP (−2 ± 17 (SHAM) vs. −8 ± 16 (RDN) mmHg), diastolic C-BP (−2 ± 9 (SHAM) vs. −5 ± 9 (RDN) mmHg), and augmentation index (0.7 ± 7.0 (SHAM) vs. 1.0 ± 7.4 (RDN) %) were not significantly different after six months. Changes in HRV-parameters were also not significantly different. Baseline HRV or PWV did not predict BP-response after RDN. Conclusions: In a sham-controlled setting, there were no significant effects of RDN on arterial stiffness, C-BP and HRV. Thus, the idea of BP-independent effects of RDN on large arteries and cardiac autonomic activity is not supported.

Introduction: Obstructive sleep apnea (OSA) is associated with increased cardiovascular (CV) risk. OSA is highly prevalent among patients with type-2 diabetes (T2D). Patients with T2D have increased risk of cardiovascular events, and have an increased aortic stiffness. Continuous Positive Airway Pressure (CPAP) treatment reduces severity of OSA, but whether it reduces CV risk remains unclear. One randomized trial with CPAP intervention and pulse wave velocity (PWV) as endpoint has shown a significant reduction in PWV after four months, in non-diabetic patients. The effect on patients with diabetes remains unknown. Aim: Investigate the effects of CPAP treatment on PWV in patients with T2D and newly diagnosed OSA. Furthermore, investigate the relationship between PWV and severity of OSA. Method: A randomized, controlled, multicenter study. 70 patients with T2D and newly diagnosed OSA randomized to: CPAP treatment or a control group. Data will be collected at baseline, 4 and 12 weeks. PWV was measured using SphygmoCor (AtCor Medical, Sydney, Australia) and AHI measured using ApneaLink (ResMed, Poway, CA, USA). Relationship between PWV and AHI was evaluated at baseline. Results: Baseline data from the first 21 patients showed mean age 63 years (±8.1), mean systolic blood pressure (BP) was 134 (±12.5) mmHg, mean AHI was 30.2 (±12.4) and mean PWV was 11.6 (±1.9) m/s. AHI was associated with PWV in multivariate analysis with adjustment for age and systolic BP, beta-coefficient 0.08, p = 0.029. Conclusion: At baseline PWV and AHI were correlated. Progression of the study will reveal if CPAP treatment can lower PWV in this cohort.

Continuous positive airway pressure (CPAP) therapy is an efficacious treatment for patients diagnosed with obstructive sleep apnea (OSA). However, there are only few data on long-term adherence. The aim of this study is to quantify the extent of non-adherence and describe the clinical characteristics.A retrospective study including 695 patients with newly diagnosed OSA and prescribed CPAP therapy within an inclusion period of 14 months. All patients were offered free of charge individually adjusted CPAP therapy. Data on comorbidity, medication, BMI and Epworth Sleepiness Score (ESS) were obtained by questionnaires and consultation with an otorhinolaryngeal specialist.The median follow-up time after initiating CPAP therapy was 3.0 (range 2.4-3.6) years. An adherence rate of 89% was found for severe OSA, 71% for moderate OSA and 55% for mild OSA. 18% initiated humidification. Patients adherent to CPAP had a significantly higher Body Mass Index (BMI), Apnea Hypopnea Index (AHI), Oxygen Desaturation Index (ODI) and ESS compared to non-adherent patients. Furthermore, adherence was associated with a higher frequency of observed interrupted breathing, a less frequent use of hypnotic drugs, fewer smokers, and they were more often offered humidification. Age, gender and comorbidity were not significantly associated with adherence. In a Cox model only AHI (Hazard Ratio (HR) 0.963, p < 0.001), ESS (HR 0.939, p = 0.001) and smoking (HR 1.576, p = 0.022) were independently associated with CPAP non-adherence.The severity of OSA, subjective daytime sleepiness and smoking status are independently related to adherence to CPAP therapy.

Several studies in different populations have suggested that nighttime blood pressure (BP) is a stronger predictor of cardiovascular events than daytime BP. Consequently, treatment strategies to target nighttime BP have come into focus. The aim of the present study was to investigate the effect of change of administration time of antihypertensive drugs. We included 41 patients with type 2 diabetes mellitus and nocturnal hypertension (nighttime systolic BP >120 mmHg) in an open-label, crossover study. Patients were randomized to 8 weeks of either morning or bedtime administration of all of the individual's once-daily antihypertensive drugs, followed by 8 weeks of switched dosing regimen. Bedtime administration of antihypertensive drugs resulted in a significant reduction in nighttime (7.5 mmHg; P<0.001) and 24-hour (3.1 mmHg; P=0.014) systolic BP, with a nonsignificant reduction in daytime (1.3 mmHg; P=0.336) systolic BP. We did not find morning BP surge to be different between dosing regimens. Levels of C-reactive protein were significantly lower with bedtime administration, which may indicate an effect on low-grade inflammation. We found no difference in urinary albumin excretion, regardless of albuminuria status. Urinary sodium/creatinine was significantly increased and urinary osmolality significantly reduced with bedtime administration, which can be interpreted as increased nocturnal natriuresis. In patients with type 2 diabetes mellitus and nocturnal hypertension, administration of once-daily antihypertensive drugs at bedtime may be favorable. The increased nocturnal natriuresis may reflect increased effect of bedtime-administered thiazides and renin-angiotensin system inhibitors, suggesting a potential mechanism of the observed effects on BP with chronotherapeutic intervention. [ABSTRACT FROM AUTHOR]