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OBJECTIVE--Regular physical activity (PA) reduces the risk of developing type 2 diabetes, and different subtypes of dysglycemia have shown different associations with PA. To better understand the associations of PA [...]

OBJECTIVE--Diabetes is associated with increased brachial and central blood pressure and aortic stiffness. We examined the effect of intensive multi factorial treatment in general practice on indices of peripheral and [...]

OBJECTIVE--There is limited evidence on how intensive multifactorial treatment (IT) improves outcomes of diabetes when initiated in the lead time between detection by screening and diagnosis in routine clinical practice. [...]

OBJECTIVE--Common variants in the melatonin receptor type 1B (MTNR1B) locus have been shown to increase fasting plasma glucose (FPG) and the risk of type 2 diabetes. The aims of this study were to evaluate whether nonsynonymous variants in MTNR1B associate with monogenic forms of hyperglycemia, type 2 diabetes, or related metabolic traits. RESEARCH DESIGN AND METHODS--MTNR1B was sequenced in 47 probands with clinical maturity-onset diabetes of the young (MODY), in 51 probands with early-onset familial type 2 diabetes, and in 94 control individuals. Six nonsynonymous variants (G24E, L60R, V124I, R138C, R231H, and K243R) were genotyped in up to 22,142 Europeans. Constitutive and melatonin-induced signaling was characterized for the wild-type melatonin receptor type 1B (MT2) and the 24E, 60R, and 124I MT2 mutants in transfected COS-7 cells. RESULTS--No mutations in MTNR1B were MODY specific, and none of the investigated MTNR1B variants associated with type 2 diabetes. The common 24E variant associated with increased prevalence of obesity (odds ratio 1.20 [1.08-1.34]; P = 8.3 x [10.sup.-4]) and increased BMI (β = 0.5 kg/[m.sup.2]; P = 1.2 x [10.sup.-5]) and waist circumference (β = 1.2 cm; P = 9 x [10.sup.-6]) in combined Danish and French study samples. 24E also associated with decreased FPG (β = -0.08 mmol/l; P = 9.2 x [10.sup.-4]) in the Danish Inter99 population. Slightly decreased constitutive activity was observed for the MT2 24E mutant, while the 124I and 60R mutants displayed considerably decreased or completely disrupted signaling, respectively. CONCLUSIONS--Nonsynonymous mutations in MTNR1B are not a common cause of MODY or type 2 diabetes among Danes. MTNR1B 24E associates with increased body mass and de creased FPG. Decreased MT2 signaling does apparently not directly associate with FPG or type 2 diabetes. Diabetes 59: 1539-1548, 2010, Genome-wide association (GWA) studies have shown that common variation in the melatonin receptor type 1B (MTNR1B) locus increases the level of fasting plasma glucose (FPG) and the risk of type [...]

OBJECTIVE--Phosphoinositide 3-kinase (PI3K) is a major effector in insulin signaling, rs361072, located in the promoter of the gene (PIK3CB) for the p110[beta] subunit, has previously been found to be associated [...]

OBJECTIVE--Variants downstream of the melanocortin-4 receptor gene (MC4R) have been reported to associate with obesity. We examined rs17782313, rs17700633, rs12970134, rs477181, rs502933, and rs4450508 near MC4R for association with obesity-related quantitative traits, obesity, and type 2 diabetes in Danish individuals. RESEARCH DESIGN AND METHODS--The variants were investigated for association with obesity-related quantitative traits in 5,807 population-based sampled individuals, obesity in 14,940 individuals, and type 2 diabetes in 8,821 individuals. RESULTS--The minor risk alleles of rs17782313, rs17700633, and rs12970134 were associated with BMI (effect per allele 0.25 kg/[m.sup.2], P = 0.01; 0.23, P = 0.01; and 0.31, P = 7 x [10.sup.-4], respectively), waist circumference (0.67 cm, P = 0.006; 0.53, P = 0.02; and 0.85, P = 3 x [10.sup.-4]), and body weight (1.04 kg, P = 6 x [10.sup.-4]; 0.71, P = 0.01; and 1.16, P = 8 x [10.sup.-5]). In case-control studies of obesity defined by BMI, the minor C-allele of rs17782313 was associated with overweight/obesity and obesity (odds ratio [OR] 1.09, P = 0.006 and OR 1.12, P = 0.003, respectively). Similarly, the minor A-allele of rs17700633 was associated with overweight/obesity and obesity (1.12, P = 8 x [10.sup.-5] and 1.16, P = 2 x [10.sup.-5]), and the minor A-allele of rs12970134 was also associated with overweight/obesity and obesity (1.13, P = 2 x [10.sup.-5] and 1.15, P = 6 x [10.sup.-5]). rs477181, rs502933, and rs4450508 were not significantly associated with obesity in the Danish population. The frequency of the minor risk alleles of rs17782313 and rs12970134 was higher among patients with type 2 diabetes than among glucose-tolerant individuals (OR 1.08, P = 0.08 and 1.08, P = 0.06, respectively); however, these borderline associations were abolished after adjustment for BMI. CONCLUSIONS--rs17782313, rs17700633, and rs12970134 near MC4R associate with measures of obesity in Danish individuals., Obesity and the accompanying risk of common diseases such as type 2 diabetes and premature cardiovascular morbidity and mortality are increasing global health burdens. Multiple variations in genes are likely [...]

OBJECTIVE--We evaluated the 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 rs2297508, rs11868035, and rs1889018 (linkage disequilibrium [R.sup.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: 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 rain and serum insulin at 120 min during an oral glucose tolerance test (all P < 0.006) and the minor allele of rs1889018 with a surrogate measure of insulin sensitivity (P = 0.03). Furthermore, the diabetes-associated alleles associated with a modestly increased A1C level in the population-based Inter99 of middle-aged subjects and in the ADDITION study of high-risk individuals (P = 0.006 and P = 0.008, respectively). CONCLUSIONS--We associate sequence variation in SREBF1 with a modestly increased predisposition to type 2 diabetes. In the general population, the diabetes-associated alleles are discreetly associated with hyperglycemia presumably due to decreased insulin sensitivity. Because sterol regulatory element-binding protein-1c is a mediator of insulin action, the findings are consistent with the presence of a yet undefined subtle loss-of-function SREBF1 variant., The sterol regulatory element-binding factor (SREBF1) gene encodes the transcription factors sterol regulatory element-binding protein (SREBP)-1a and -1c by differential transcription start sites (1). SREBP-1a and -1c, and the third [...]

OBJECTIVE--Three independent studies have shown that variation in the fat mass and obesity-associated (FTO) gene associates with BMI and obesity. In the present study, the effect of FTO variation on [...]

OBJECTIVE--In the present study, we aimed to validate the type 2 diabetes susceptibility alleles identified in six recent genome-wide association studies in the HHEX/KIF11/IDE (rs1111875), CDKN2A/B (rs10811661), and IGF2BP2 (rs4402960) [...]

OBJECTIVE--To examine the correlates of patient and provider attitudes toward insulin therapy. RESEARCH DESIGN AND METHODS--Data are from surveys of patients with type 2 diabetes not taking insulin (n = [...]

OBJECTIVE--To develop a simple self-administered questionnaire identifying individuals with undiagnosed diabetes with a sensitivity of 75% and minimizing the high-risk group needing subsequent testing. RESEARCH DESIGN AND METHODS--A population-based sample [...]

KEY POINTS FOR CLINICIANS * Health screening decreased cardiovascular risk in the general population. * The mean cardiovascular risk score was modestly reduced, and the proportion of persons at elevated [...]

Fasting duration has been associated with lower fasting blood glucose levels, but higher 2-h post-load levels, and research has indicated an adverse effect of ‘weekend behavior’ on human metabolism. We investigated associations of fasting duration and weekday of examination with glucose, insulin, glucagon and incretin responses to an oral glucose tolerance test (OGTT). This cross-sectional study is based on data from the ADDITION-PRO study, where 2082 individuals attended a health examination including an OGTT. Linear regression analysis was applied to study the associations of overnight fasting duration and day of the week with glucose, insulin, glucagon, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) responses to an OGTT. We found that a 1 h longer fasting duration was associated with 1.7% (95% CI: 0.8,2.5) higher 2-h glucose levels, as well as a 3.0% (95% CI: 1.3,4.7) higher GIP and 2.3% (95% CI: 0.3,4.4) higher GLP-1 response. Fasting insulin levels were 20.6% (95% CI: 11.2,30.7) higher on Mondays compared to the other weekdays, with similar fasting glucose levels (1.7%, 95% CI: 0.0,3.4). In this study, longer overnight fasting duration was associated with a worsening of glucose tolerance and increased incretin response to oral glucose. We found higher fasting insulin levels on Mondays compared to the other days of the week, potentially indicating a worsened glucose regulation after the weekend.

The hormone glucagon-like peptide-1 (GLP-1) decreases blood glucose and appetite. Greater physical activity (PA) is associated with lower incidence of type 2 diabetes. While acute exercise may increase glucose-induced response of GLP-1, it is unknown how habitual PA affects GLP-1 secretion. We hypothesised that habitual PA associates with greater glucose-induced GLP-1 responses in overweight individuals.Cross-sectional analysis of habitual PA levels and GLP-1 concentrations in 1326 individuals (mean (s.d.) age 66 (7) years, BMI 27.1 (4.5) kg/m2) from the ADDITION-PRO cohort. Fasting and oral glucose-stimulated GLP-1 responses were measured using validated radioimmunoassay. PA was measured using 7-day combined accelerometry and heart rate monitoring. From this, energy expenditure (PAEE; kJ/kg/day) and fractions of time spent in activity intensities (h/day) were calculated. Cardiorespiratory fitness (CRF; mL O2/kg/min) was calculated using step tests. Age-, BMI- and insulin sensitivity-adjusted associations between PA and GLP-1, stratified by sex, were evaluated by linear regression analysis.In 703 men, fasting GLP-1 concentrations were 20% lower (95% CI: −33; −3%, P= 0.02) for every hour of moderate-intensity PA performed. Higher CRF and PAEE were associated with 1–2% lower fasting GLP-1 (P= 0.01). For every hour of moderate-intensity PA, the glucose-stimulated GLP-1 response was 16% greater at peak 30 min (1; 33%, PrAUC0-30= 0.04) and 20% greater at full response (3; 40%, PrAUC0-120= 0.02). No associations were found in women who performed PA 22 min/day vs 32 min/day for men.Moderate-intensity PA is associated with lower fasting and greater glucose-induced GLP-1 responses in overweight men, possibly contributing to improved glucose and appetite regulation with increased habitual PA.

We screened variants on an exome-focused genotyping array in >300,000 participants (replication in >280,000 participants) and identified 444 independent variants in 250 loci significantly associated with total cholesterol (TC), high-density-lipoprotein cholesterol (HDL-C), low-density-lipoprotein cholesterol (LDL-C), and/or triglycerides (TG). At two loci (JAK2 and A1CF), experimental analysis in mice showed lipid changes consistent with the human data. We also found that: (i) beta-thalassemia trait carriers displayed lower TC and were protected from coronary artery disease (CAD); (ii) excluding the CETP locus, there was not a predictable relationship between plasma HDL-C and risk for age-related macular degeneration; (iii) only some mechanisms of lowering LDL-C appeared to increase risk for type 2 diabetes (T2D); and (iv) TG-lowering alleles involved in hepatic production of TG-rich lipoproteins (TM6SF2 and PNPLA3) tracked with higher liver fat, higher risk for T2D, and lower risk for CAD, whereas TG-lowering alleles involved in peripheral lipolysis (LPL and ANGPTL4) had no effect on liver fat but decreased risks for both T2D and CAD.

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BackgroundEthnic variation in abdominal fat distribution may explain differences in cardiometabolic risk between populations. However, the ability of anthropometric measures to quantify abdominal fat is not clearly understood across ethnic groups. The aim of this study was to investigate the associations between anthropometric measures and visceral (VAT) and subcutaneous abdominal adipose tissue (SAT) in Inuit, Africans and Europeans.MethodsWe combined cross-sectional data from 3 studies conducted in Greenland, Kenya and Denmark using similar methodology. A total of 5275 individuals (3083 Inuit, 1397 Africans and 795 Europeans) aged 17–95 years with measures of anthropometry and ultrasonography of abdominal fat were included in the study. Multiple regression models with fractional polynomials were used to analyse VAT and SAT as functions of body mass index (BMI), waist circumference, waist-to-hip ratio, waist-to-height ratio and body fat percentage.ResultsThe associations between conventional anthropometric measures and abdominal fat distribution varied by ethnicity in almost all models. Europeans had the highest levels of VAT in adjusted analyses and Africans the lowest with ethnic differences most apparent at higher levels of the anthropometric measures. Similar ethnic differences were seen in the associations with SAT for a given anthropometric measure.ConclusionsConventional anthropometric measures like BMI and waist circumference do not reflect the same amount of VAT and SAT across ethnic groups. Thus, the obesity level at which Inuit and Africans are at increased cardiometabolic risk is likely to differ from that of Europeans.

The genetic architecture of common traits, including the number, frequency, and effect sizes of inherited variants that contribute to individual risk, has been long debated. Genome-wide association studies have identified scores of common variants associated with type 2 diabetes, but in aggregate, these explain only a fraction of the heritability of this disease. Here, to test the hypothesis that lower-frequency variants explain much of the remainder, the GoT2D and T2D-GENES consortia performed whole-genome sequencing in 2,657 European individuals with and without diabetes, and exome sequencing in 12,940 individuals from five ancestry groups. To increase statistical power, we expanded the sample size via genotyping and imputation in a further 111,548 subjects. Variants associated with type 2 diabetes after sequencing were overwhelmingly common and most fell within regions previously identified by genome-wide association studies. Comprehensive enumeration of sequence variation is necessary to identify functional alleles that provide important clues to disease pathophysiology, but large-scale sequencing does not support the idea that lower-frequency variants have a major role in predisposition to type 2 diabetes.

Context:Glucose-dependent insulinotropic polypeptide (GIP) may increase lipid clearance by stimulating lipid uptake. However, given that GIP promotes release of insulin by the pancreas and insulin is anti-lipolytic, the effect may be indirect.Objective:In this study we examined the association between GIP and lipid metabolism in individuals with low to high risk of type 2 diabetes and assessed whether the associations were modified by or mediated through insulin.Design, Setting, and Participants:Analyses were based on the Danish cross-sectional ADDITION-PRO study (n = 1405). Lipid metabolism was measured by fasting plasma lipids and obesity including abdominal fat distribution assessed by ultrasonography. GIP and insulin were measured during an oral glucose tolerance test (0, 30 and 120 min). Linear regression analysis was used to study the associations between GIP, plasma lipids, and obesity measures.Results:A doubling in fasting GIP levels was associated with lower low-density lipoprotein in both men (mean [95% CI] −0.10 mmol/l [−0.18–−0.03]) and women (−0.14 mmol/l [−0.23–−0.04]) and with higher high-density lipoprotein in women (0.06 mmol/l [−0.02–0.10]). In men, a doubling in stimulated GIP was associated with 0.13 cm less 0.01–0.25 sc fat but with more visceral abdominal fat (0.45 cm [0.12–0.78]) and higher waist-hip ratio (0.011 [0.004–0.019]).Conclusions:Contrary to what was previously thought, GIP may be associated with improved low-density lipoprotein clearance but with an unhealthy fat distribution independent of insulin. The effect of GIP on obesity measures was substantially different between men and women. The potential effect of GIP on visceral and sc adipose tissue physiology warrants further examination.

Context:Regional fat distribution rather than overall obesity has been recognized as important to understanding the link between obesity and cardiovascular disease.Objective:We examined the associations of abdominal visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) with cardiovascular risk factors in a Caucasian population of men and women with normal glucose tolerance, prediabetes, or screen-detected diabetes.Design, Setting, and Participants:The study was based on cross-sectional analysis of data from 1412 adults age 45–80 years. VAT and SAT were assessed by ultrasound. The associations of VAT and SAT with blood pressure and lipids were examined by linear regression analysis adjusted for age, sex, smoking, alcohol, physical activity, glucose tolerance status (GTS), medication use, and body mass index. Effect modification by GTS and sex was examined, and stratified analyses performed.Results:Independent of SAT and overall obesity, VAT was associated with higher triglyceride and lower high-density lipoprotein (HDL) cholesterol levels in both men and women and additionally associated with higher total cholesterol in men. SAT was independently associated with higher total cholesterol and low-density lipoprotein cholesterol levels in both sexes, and SAT was additionally associated with higher triglyceride and lower HDL cholesterol levels in women and with higher blood pressure in participants with diabetes.Conclusion:Both abdominal VAT and SAT are independent of overall obesity associated with cardiovascular risk in a population of men and women at low to high risk of diabetes or with screen-detected diabetes.

SUMMARY The main ADDITION study was planned as a screening study followed by a randomized, intervention study comparing routine treatment with more intensive treatment in people with screen-detected diabetes. The stepwise screening programs had low yield, but for each person with diabetes identified, another two at high risk of diabetes and six at high risk of cardiovascular disease were identified. Screening for diabetes had limited short- and long-term adverse psychological impacts on participants. The intervention study showed substantial improvements in cardiovascular risk factors following detection of diabetes, even among those receiving routine general practice care. The randomized trial did not deliver conclusive evidence to justify implementation of a systematic screening program. Uncertainties remain concerning the overall cost–effectiveness. However, the overall results of the ADDITION study, including cohort analyses, suggest that earlier detection and treatment of diabetes is associated with net benefits. Thus, primary care teams are encouraged to develop systems to enable earlier detection. This might include opportunistic screening. Individuals identified should be offered lifestyle interventions and preventive drug treatments appropriate to their level of risk.

Intensive treatment of multiple cardiovascular risk factors can halve mortality among people with established type 2 diabetes. We investigated the effect of early multifactorial treatment after diagnosis by screening.

Previous studies have shown that the progression of diabetic retinopathy to vision-threatening lesions may be related to the development of retinopathy lesions in specific retinal areas. The purpose of the present study was to examine whether the occurrence of retinopathy in these retinal areas is related to known risk factors for progression of retinopathy in type 2 diabetes.

To determine the prevalence of diabetic retinopathy and the causes of visual impairment in an unselected population of type 2 diabetes patients, and to describe the risk factors for developing diabetic retinopathy in this population.A total of 10 851 type 2 diabetes patients were identified in the county of Århus. A representative sample of 378 patients underwent a routine ocular examination, including fundus photography. Blood pressure and serum haemoglobin A1c, total cholesterol, high density lipoprotein cholesterol, triglyceride and apolipoprotein a were measured.The prevalence of diabetic retinopathy in the type 2 diabetes population was 31.5%. In all, 2.9% had proliferative diabetic retinopathy and 5.3% had clinically significant macular oedema. Of the latter, 8/20 (40%) were newly identified and had not yet been laser-treated. There was a positive correlation between severity of retinopathy and duration of diabetes, HbA1c, systolic blood pressure and treatment with insulin. None of the patients had social blindness (visual acuity < 0.1), but 15/378 (4.0%) had developed visual impairment (VA < 0.3).The prevalence of diabetic retinopathy and visual impairment in this unselected type 2 diabetes population was lower than anticipated from the existing literature, and causes other than diabetic retinopathy contributed significantly to the occurrence of visual loss. A substantial number of the patients with vision-threatening diabetic maculopathy had not been referred for timely photocoagulation treatment.

Background Randomised, controlled trials focusing on long-term psychological reactions to information about increased risk of coronary heart disease are scarce.Design A population-based randomised, controlled, 5-year follow-up trial was conducted in general practice.Methods In 1991, invitations were sent to 2,000 middle-aged people registered in the general practices in the district of Ebeltoft, Denmark. A total of 1,507 (75.4%) agreed to participate and were randomised into a control group and two intervention groups: one included health screening, a written feedback and an optional follow-up visit with the general practitioner; the other included health screening, written feedback and a planned 45-min follow-up visit with the general practitioner. The participants were informed at screening about their risk of developing coronary heart disease. Psychological distress was measured by the GHQ-12 before screening and at the 1 and the 5-year follow-up.Results Before the screening (0 year), 1 and 5 years after there were no significant differences in the GHQ-12 score between the control group and the two intervention groups. Nor were there any differences related to information about increased risk of coronary heart disease between scores obtained at the 1 and the 5-year follow-up.Conclusion Middle-aged persons had no long-term psychological reaction after information about increased risk of developing coronary heart disease following a health screening in general practice evaluated by the GHQ-12,1 year and 5 years after the examinations.

The aim of the present study was to compare patient and GP priorities for general practice care.

Aim/Objectives: Evaluation of how the substitution system has been implemented, how it was assessed by the general practitioners (GPs), pharmacists (PHs) and patients, and clarification of benefits and problems related to the system.Methods: The study was based on specific question-naires to GPs, PHs and patients. The questionnaires were based on qualitative interviews with all three groups and afterwards validated and pilot tested.Results: 80% of 300 GPs, 72% of PHs and 82% of 105 patients responded. The study showed that 84% of the patients were satisfied with the system. Of the patients, 83% had tried a substituted drug previously. Of these, 4% had experienced various side effects, and 7% had experienced a weaker effect from the substi tuted drug. One case of adverse medical treatment as a consequence of substitution was reported. The study showed that 61% of GPs were dissatisfied with the system and assessed that it should be abolished.Conclusions: The GPs' reasons for suggesting that the system be abolished were that the system was incomprehensible, badly introduced and created an extra workload. Half of the PHs were dissatisfied with the system, primarily due to the excessive workload imposed. In spite of this, about half of the PHs wanted the system to be continued, because the overall intention was good, in terms of getting the prescribed drug as cheaply as possible for the patient. Nearly all statements from the patients showed that overall the patients thought the benefits greater than the disadvantages in the system. All GPs and nearly all PHs were of the opinion that analogue substitution (substitution between drugs with the same effect obtained by different means) was medically unjustifiable, did not have potentially desirable effects, and should therefore not be introduced.

A population-based cross-sectional and 5-year prospective questionnaire study.

Cross-sectional data were collected in a postal questionnaire within the framework of a 5-year randomized, controlled, prospective, population-based study.

Data were obtained in a Danish crosssectional postal survey and compared with information from four methodologically similar studies conducted in some of the Nordic countries between 19771985.

Abstract. A double-blind cross-over study of the sc absorption of radiolabelled semi-synthetic human (SHI) and purified porcine (PPI) insulin was made. Absorption of both isophane (n = 10) and soluble insulin (n = 8) was studied. There was no significant difference between the disappearance from the injection site, the plasma free insulin concentrations, or blood glucose levels after sc injection of the isophane preparations.A faster disappearance of the soluble SHI (as judged from T/50 and AUC) was found (both P-values < 0.01). However, no difference was observed between the plasma insulin concentrations at any time point (P< 0.05). Blood glucose levels showed no statistical differences between the two soluble preparations. The data indicate minor differences between the pharmaco-kinetics of SHI and PPI, but these seem of no clinical importance.

Objective-We carried out two studies (a and b) to assess general practitioners' attitudes towards a) regionally developed guidelines and b) guidelines developed by the Danish College of General Practitioners.Design-a) A randomized study among all GPs in Aarhus county comparing their attitudes towards guidelines in general and towards regional multidisciplinary developed guidelines on Pap-testing for cervical cancer, and b) a survey among all Danish GPs on attitudes towards earlier submitted guidelines for diabetes Type 2.Setting-GPs in Aarhus county and in all Denmark.Subjects-a) Questionnaires sent to 370 doctors in Aarhus county, and b) to 3471 GPs in all Denmark. Main outcome measures-a) Attitudes to the known Pap guidelines compared with general attitudes. Themes in question were acceptance of guidelines, acceptance of multidisciplinary involvement, especially from the administrative staff, perceived effect on the consultation and the quality of care. In study b) remembrance of receiving, having read and used previous guidelines. Wishes with respect to future updates.Results-a) GPs were very positive towards the Pap guidelines they knew, and only few resisted. The number of positive answers was significantly fewer when doctors were asked about guidelines in general, b) There was an overwhelmingly positive attitude towards guidelines from the College on diabetes care and other topics relevant to GP work.Conclusion-Danish GPs reported a very positive attitude towards the presented well-known guidelines on Pap testing and diabetes Type 2, and a fairly positive attitude towards hypothetical questions on guidelines in general.

Objective - C-reactive protein (CRP) is a well-known diagnostic tool in general practice. The scope of this study was to assess how frequently CRP is used by general practitioners and to evaluate the reasons for using it.Design - A retrospective part based on data from a laboratory database system, and a prospective part with a questionnaire-based registration.Setting - 30 general practice clinics in the catchment area of Vejle County Central Hospital.Subjects - Retrospectively, all patients from general practice serviced by the laboratory for one year. Prospectively, 1190 patients from whom a blood sample was taken for CRP-measurement during a 2 month study period.Main outcome measures - The frequency of using CRP and the reason requesting it; A) diagnosing a new disease, B) monitoring a well-known disease, or C) "screening". Furthermore; 1) infections, 2) chronic inflammatory disease, 3) malignant disease, or 4) others.Results - CRP-measurements were ordered in 3.7% of all consultations in general practice and for 34.1% of all patients whose blood sample was analysed at the central laboratory. The use of CRP was as follows: A-1: 28.6%, A-2: 6.7%, A-3,4: 9.3%, B-1: 8.2%, B-2: 12.4%, B-3,4: 6.5%, C-1: 5.7%, C-2: 3.2%, C-3: 3.5% and C-4: 15.2%. Diagnosing a new (infectious) disease was the most frequent single reason for CRP-measurement There was major interpractice variation.Conclusions - CRP is frequently used in general practice, mostly (65.4%) in the field of infections and chronic inflammatory diseases. Because of major interpractice variation, the most correct way of using CRP should be evaluated and guidelines should be provided.

In 1959 the problems connected to insulin therapy was described by Somogyi. He said »The blood glucose and glucosuria of diabetic patients often show wide fluctuations even when both carbohydrate content of diet and insulin dose are unchanged« (1). When analysing this problem Somogyi defined the »R« ratio as grams of glucose available in the diet/units of insulin injected and the »G/I« ratio as grams of glucose utilized per unit of insulin injected. The observation which caused confusion was »that blood sugar and glucosuria of diabetic patients often show wide fluctuations even when both the carbohydrate content of the diet and the insulin dose are unchanged«; that is to say, the G/I ratio is subject to fluctuations even when R is constant. This paradox of Somogyi and its long-term consequences will be analysed in the following.Somogyi thought of insulin in terms of the dose injected per day and

BackgroundDiabetes is becoming more common in the Greenlandic population. Patients with diabetes are more prone to periodontal disease. Periodontal status may have an effect on metabolic control.ObjectiveThe aim of this study was to estimate the prevalence of periodontitis amongst patients with diabetes in Nuuk, Greenland, and secondly, to observe if dental care was associated with improved periodontal status and metabolic control.Study designObservational cross-sectional study and a pilot study of a dental care intervention.MethodsSixty-two Greenlandic patients with diabetes were included in the study. Data were collected from the Electronic Medical Records (EMR), in addition to a telephone interview. Patients were offered 3 dental examinations with a 3-month interval. The dental examinations consisted of a full-mouth assessment of number of remaining teeth and assessment of periodontal status. Patients received scaling and root planing, together with information and instructions on oral hygiene. Information on glycated haemoglobin (HbA1C) values was collected from the EMR at each dental examination.ResultsIn this study, 21.0% (13/62) of patients with diabetes had periodontitis. About 42% had less than 20 teeth. The association between diabetes and periodontitis was known by 20 out of the 62 patients. Over half of the patients had been to a dental examination within the last year. The prevalence of periodontitis decreased significantly from 21.0 to 0% (p<0.001) after 3 dental examinations. No change in HbA1Clevels was observed (p=0.440).ConclusionPeriodontitis was common among patients with diabetes in Nuuk. Dental health status based on Periodontal Screening Index (PSI) and bleeding on probing (BOP) seemed to improve after dental health care, indicating a need for increased awareness among patients and health care professionals. HbA1Clevels were not improved among the patients.

Background. The 12-lead electrocardiogram (ECG) is a common diagnostic test available to the GP in the evaluation of patients with cardiac complaints. In daily clinical practice it is important for GPs to know the sensitivity and specificity of their ECG interpretation skills. Objectives. The purpose of the present study was to evaluate the ECG interpretation skills of GPs and the value of automatic ECG recorder interpretations in general practice. Methods. A total of 902 ECGs were recorded in a random sample of the population aged 31–51 years in the district of Ebeltoft, Denmark, from December 1991 to June 1992. They were interpreted automatically by an interpretive ECG recorder and by the GPs in the clinic in Ebeltoft, with a cardiologists interpretation as a gold standard. Sensitivity, specificity and predictive values of diagnoses were calculated. Results. Overall, the sensitivity of abnormal diagnoses made by the GPs (69.8%) was significantly lower (P < 0.001) than that of diagnoses made by the interpretive ECG recorder (84.4%). The overall specificity of abnormal diagnoses made by the GP (85.7%) was significantly higher (P < 0.001) than that achieved by the interpretive ECG recorder (75.6%). Conclusions. GPs in this study were good at correcting false-positive diagnoses made by the interpretive ECG recorder. In order to avoid unfortunate reclassifications of true-positive to false-negative diagnoses, GPs are recommended to pay special attention to the diagnoses of ST-segment deviation, T-wave inversion or the presence of Q-waves made by interpretive ECG recorders, when ECGs are used in individual risk assessment.

Objective. The aim of this study was to explore beliefs and attitudes about refusing health screening in general practice. Methods. In 1991, in Ebeltoft, Denmark people aged between 30 and 50 years were invited to participate in a 5-year randomized, controlled, population-based project testing the value of health screenings and health discussions in general practice. In 1994, non-participants who declined the offered health screening but expressed willingness to be contacted in the future were asked to participate in a qualitative interview. They were drawn by stratified purposeful sampling which reflected variation in perceived health, body mass index, age and sex. The sample comprised six men and 12 women Results. Some had not participated because they were busy, felt healthy or had recently been examined. The non-participants emphasized the limitations of health screening and did not want possible risk factors to be revealed, or their feeling of good health to be disturbed. They stressed the individuals own responsibility for maintaining good health and believed that a positive attitude promoted health. They would contact their GP if they had symptoms. Conclusion. Non-participants have rational views on risk factor testing and on their own responsibility for maintaining health. Non-attendance was due to a conscious choice which included consulting their own GP.