682 results on '"De Galan, BE"'
Search Results
2. Cross-sectional associations between patterns and composition of upright and stepping events with physical function: insights from The Maastricht Study
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Culverhouse, Joshua, Hillsdon, Melvyn, Koster, Annemarie, Bosma, Hans, de Galan, Bastiaan E., Savelberg, Hans H.C.M., and Pulsford, Richard
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- 2024
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3. The impact of prior exposure to hypoglycaemia on the inflammatory response to a subsequent hypoglycaemic episode
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Verhulst, Clementine E. M., van Heck, Julia I. P., Fabricius, Therese W., Stienstra, Rinke, Teerenstra, Steven, McCrimmon, Rory J., Tack, Cees J., Pedersen-Bjergaard, Ulrik, and de Galan, Bastiaan E.
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- 2024
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4. Socioeconomic inequalities in health-related functioning among people with type 2 Diabetes: longitudinal analyses in the Maastricht Study
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Meisters, Rachelle, Albers, Jeroen, Sezer, Bengisu, de Galan, Bastiaan E., Eussen, Simone J. P. M., Stehouwer, Coen D. A., Schram, Miranda T., van Greevenbroek, Marleen M. J., Wesselius, Anke, Koster, Annemarie, and Bosma, Hans
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- 2024
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5. Cross-sectional associations between patterns and composition of upright and stepping events with physical function: insights from The Maastricht Study
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Joshua Culverhouse, Melvyn Hillsdon, Annemarie Koster, Hans Bosma, Bastiaan E. de Galan, Hans H.C.M. Savelberg, and Richard Pulsford
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Physical activity ,Accelerometer ,Patterns ,Fragmentation ,Posture ,Physical function ,Geriatrics ,RC952-954.6 - Abstract
Abstract Introduction Age-related declines in physical functioning have significant implications for health in later life. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between accelerometer-determined daily PA patterns, including composition and temporal distribution (burstiness) of upright and stepping events, with physical function. Methods Data was from participants who wore an activPAL3 accelerometer as part of The Maastricht Study. Exposures included a suite of metrics describing the composition and the temporal distribution (burstiness) of upright and sedentary behaviour. Physical function outcomes included the six-minute walk test (6MWT), timed chair-stand test (TCST), grip strength (GS), and SF-36 physical functioning sub-scale (SF-36pf). Multivariable linear regression models were used to assess associations, adjusting for covariates including overall PA volume (daily step count). Results Participants(n = 6085) had 6 or 7 days of valid data. Upright and stepping event metrics were associated with physical function outcomes, even after adjusting PA volume. Higher sedentary burstiness was associated with better function (6MWT, TCST, and SF-36pf), as was duration and step volume of stepping events (6MWT, TCST, GS, and SF-36pf), step-weighted cadence (6MWT, TCST, and SF-36pf). Number of stepping events was associated with poorer function (6MWT, GS, and SF-36pf), as was upright event burstiness (SF-36pf). Associations varied according to sex. Conclusion Our study reveals that diverse patterns of physical activity accumulation exhibit distinct associations with various measures of physical function, irrespective of the overall volume. Subsequent investigations should employ longitudinal and experimental studies to examine how changing patterns of physical activity may affect physical function, and other health outcomes.
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- 2024
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6. The impact of prior exposure to hypoglycaemia on the inflammatory response to a subsequent hypoglycaemic episode
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Clementine E. M. Verhulst, Julia I. P. van Heck, Therese W. Fabricius, Rinke Stienstra, Steven Teerenstra, Rory J. McCrimmon, Cees J. Tack, Ulrik Pedersen-Bjergaard, Bastiaan E. de Galan, and the Hypo-RESOLVE consortium
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Antecedent hypoglycaemia ,Clamp ,Diabetes ,Inflammatory responses ,Humans ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Hypoglycaemia has been shown to induce a systemic pro-inflammatory response, which may be driven, in part, by the adrenaline response. Prior exposure to hypoglycaemia attenuates counterregulatory hormone responses to subsequent hypoglycaemia, but whether this effect can be extrapolated to the pro-inflammatory response is unclear. Therefore, we investigated the effect of antecedent hypoglycaemia on inflammatory responses to subsequent hypoglycaemia in humans. Methods Healthy participants (n = 32) were recruited and randomised to two 2-h episodes of either hypoglycaemia or normoglycaemia on day 1, followed by a hyperinsulinaemic hypoglycaemic (2.8 ± 0.1 mmol/L) glucose clamp on day 2. During normoglycaemia and hypoglycaemia, and after 24 h, 72 h and 1 week, blood was drawn to determine circulating immune cell composition, phenotype and function, and 93 circulating inflammatory proteins including hs-CRP. Results In the group undergoing antecedent hypoglycaemia, the adrenaline response to next-day hypoglycaemia was lower compared to the control group (1.45 ± 1.24 vs 2.68 ± 1.41 nmol/l). In both groups, day 2 hypoglycaemia increased absolute numbers of circulating immune cells, of which lymphocytes and monocytes remained elevated for the whole week. Also, the proportion of pro-inflammatory CD16+-monocytes increased during hypoglycaemia. After ex vivo stimulation, monocytes released more TNF-α and IL-1β, and less IL-10 in response to hypoglycaemia, whereas levels of 19 circulating inflammatory proteins, including hs-CRP, increased for up to 1 week after the hypoglycaemic event. Most of the inflammatory responses were similar in the two groups, except the persistent pro-inflammatory protein changes were partly blunted in the group exposed to antecedent hypoglycaemia. We did not find a correlation between the adrenaline response and the inflammatory responses during hypoglycaemia. Conclusion Hypoglycaemia induces an acute and persistent pro-inflammatory response at multiple levels that occurs largely, but not completely, independent of prior exposure to hypoglycaemia. Clinical Trial information Clinicaltrials.gov no. NCT03976271 (registered 5 June 2019).
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- 2024
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7. Socioeconomic inequalities in health-related functioning among people with type 2 Diabetes: longitudinal analyses in the Maastricht Study
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Rachelle Meisters, Jeroen Albers, Bengisu Sezer, Bastiaan E. de Galan, Simone J. P. M. Eussen, Coen D. A. Stehouwer, Miranda T. Schram, Marleen M. J. van Greevenbroek, Anke Wesselius, Annemarie Koster, and Hans Bosma
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Health-related functioning ,Patient-reported outcome measures ,Socioeconomic inequalities ,Type 2 Diabetes mellitus ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Type 2 diabetes mellitus (T2DM) is a common chronic disease that disproportionally affects disadvantaged groups. People with a low socioeconomic position (SEP) have increased risk of T2DM and people with a low SEP and T2DM have higher HbA1c-levels compared to people with T2DM and high SEP. The aim of this study is to analyze longitudinal socioeconomic differences in health-related functioning in people with T2DM. Methods Longitudinal data from 1,537 participants of The Maastricht Study with T2DM were used (32.6% female, mean (SD) age 62.9 (7.7) years). SEP was determined by baseline measures of education, occupation and income. Health-related functioning (physical, mental and social) was measured with the Short-Form Health Survey and the Impact on Participation and Autonomy survey (all scored from 0 to 100). Associations of SEP and health-related functioning were studied annually over a 10-year period (median (IQR) 7.0 (5.0) years, baseline 2010–2018) using linear mixed methods adjusting for demographics, HbA1c-levels and lifestyle factors. Results Participants with a low SEP had significantly worse health-related functioning compared to those with a high SEP. For example, participants with low income had lower scores for physical (-4.49[CI -5.77;-3.21]), mental (-2.61[-3.78,-1.44]) and social functioning (-9.76[-12.30;-7.23]) compared to participants with high income on a scale from 0 to 100. In addition, participants with a low education significantly declined more over time in mental (score for interaction education with time − 0.23[-0.37;-0.09]) and social functioning (-0.44[-0.77;-0.11]) compared to participants with high education. Participants with low and intermediate incomes significantly declined more over time in physical functioning (-0.17 [-0.34, -0.01 and − 0.18 [-0.36, 0.00]) compared to participants with high income. Conclusions Among people with T2DM, those with a lower SEP had worse health-related functioning in general than people with a higher SEP. Additionally, people with T2DM and low education developed poorer mental and social functioning over time compared to people with T2DM and high education. People with T2DM and low or intermediate income declined more in physical functioning over time than those with high incomes. In addition to HbA1c-levels and lifestyle patterns, more attention is needed for socioeconomic differences in health-related functioning for people living with T2DM.
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- 2024
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8. Hyperglycemia and glucose variability are associated with worse survival in mechanically ventilated COVID-19 patients: the prospective Maastricht Intensive Care Covid Cohort
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Thijs T.W. van Herpt, Frank van Rosmalen, Hendrica P.M.G. Hulsewé, Anouk N.A. van der Horst-Schrivers, Mariëlle Driessen, Robin Jetten, Noortje Zelis, Bastiaan E. de Galan, Sander M.J. van Kuijk, Iwan C.C. van der Horst, and Bas C.T. van Bussel
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Prognosis ,Glycemic variability ,Hyperglycemia ,COVID-19 ,Mortality ,Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Background Data on hyperglycemia and glucose variability in relation to diabetes mellitus, either known or unknown in ICU-setting in COVID-19, are scarce. We prospectively studied daily glucose variables and mortality in strata of diabetes mellitus and glycosylated hemoglobin among mechanically ventilated COVID-19 patients. Methods We used linear-mixed effect models in mechanically ventilated COVID-19 patients to investigate mean and maximum difference in glucose concentration per day over time. We compared ICU survivors and non-survivors and tested for effect-modification by pandemic wave 1 and 2, diabetes mellitus, and admission HbA1c. Results Among 232 mechanically ventilated COVID-19 patients, 21.1% had known diabetes mellitus, whereas 16.9% in wave 2 had unknown diabetes mellitus. Non-survivors had higher mean glucose concentrations (ß 0.62 mmol/l; 95%CI 0.20–1.06; ß 11.2 mg/dl; 95% CI 3.6–19.1; P = 0.004) and higher maximum differences in glucose concentrations per day (ß 0.85 mmol/l; 95%CI 0.37–1.33; ß 15.3; 95%CI 6.7–23.9; P = 0.001). Effect modification by wave, history of diabetes mellitus and admission HbA1c in associations between glucose and survival was not present. Effect of higher mean glucose concentrations was modified by pandemic wave (wave 1 (ß 0.74; 95% CI 0.24–1.23 mmol/l) ; (ß 13.3; 95%CI 4.3–22.1 mg/dl)) vs. (wave 2 (ß 0.37 (95%CI 0.25–0.98) mmol/l) (ß 6.7 (95% ci 4.5–17.6) mg/dl)). Conclusions Hyperglycemia and glucose variability are associated with mortality in mechanically ventilated COVID-19 patients irrespective of the presence of diabetes mellitus.
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- 2023
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9. Hyperglycemia and glucose variability are associated with worse survival in mechanically ventilated COVID-19 patients: the prospective Maastricht Intensive Care Covid Cohort
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van Herpt, Thijs T.W., van Rosmalen, Frank, Hulsewé, Hendrica P.M.G., van der Horst-Schrivers, Anouk N.A., Driessen, Mariëlle, Jetten, Robin, Zelis, Noortje, de Galan, Bastiaan E., van Kuijk, Sander M.J., van der Horst, Iwan C.C., and van Bussel, Bas C.T.
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- 2023
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10. Chronic hyperglycaemia increases the vulnerability of the hippocampus to oxidative damage induced during post-hypoglycaemic hyperglycaemia in a mouse model of chemically induced type 1 diabetes
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McNeilly, Alison D., Gallagher, Jennifer R., Evans, Mark L., de Galan, Bastiaan E., Pedersen-Bjergaard, Ulrik, Thorens, Bernard, Dinkova-Kostova, Albena T., Huang, Jeffrey-T., Ashford, Michael L. J., and McCrimmon, Rory J.
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- 2023
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11. No insulin degludec dose adjustment required after aerobic exercise for people with type 1 diabetes: the ADREM study
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Drenthen, Linda C. A., Ajie, Mandala, Abbink, Evertine J., Rodwell, Laura, Thijssen, Dick H. J., Tack, Cees J., and de Galan, Bastiaan E.
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- 2023
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12. Importance of beta cell mass for glycaemic control in people with type 1 diabetes
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Jansen, Theodorus J. P., Brom, Maarten, Boss, Marti, Buitinga, Mijke, Tack, Cees J., van Meijel, Lian A., de Galan, Bastiaan E., and Gotthardt, Martin
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- 2023
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13. Assessing the Content Validity, Acceptability, and Feasibility of the Hypo-METRICS App: Survey and Interview Study
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Uffe Søholm, Natalie Zaremba, Melanie Broadley, Johanne Lundager Axelsen, Patrick Divilly, Gilberte Martine-Edith, Stephanie A Amiel, Julia K Mader, Ulrik Pedersen-Bjergaard, Rory J McCrimmon, Eric Renard, Mark Evans, Bastiaan de Galan, Simon Heller, Christel Hendrieckx, Pratik Choudhary, Jane Speight, and Frans Pouwer
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
BackgroundThe Hypoglycaemia – MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizing ecological validity. It was used in the Hypo-METRICS study, a European multicenter observational study wherein participants wore a blinded continuous glucose monitoring device and completed the app assessments 3 times daily for 70 days. ObjectiveThe 3 aims of the study were to explore the content validity of the app, the acceptability and feasibility of using the app for the duration of the Hypo-METRICS study, and suggestions for future versions of the app. MethodsParticipants who had completed the 70-day Hypo-METRICS study in the United Kingdom were invited to participate in a brief web-based survey and an interview (approximately 1h) to explore their experiences with the app during the Hypo-METRICS study. Thematic analysis of the qualitative data was conducted using both deductive and inductive methods. ResultsA total of 18 adults with diabetes (type 1 diabetes: n=10, 56%; 5/10, 50% female; mean age 47, SD 16 years; type 2 diabetes: n=8, 44%; 2/8, 25% female; mean age 61, SD 9 years) filled out the survey and were interviewed. In exploring content validity, participants overall described the Hypo-METRICS app as relevant, understandable, and comprehensive. In total, 3 themes were derived: hypoglycemia symptoms and experiences are idiosyncratic; it was easy to select ratings on the app, but day-to-day changes were perceived as minimal; and instructions could be improved. Participants offered suggestions for changes or additional questions and functions that could increase engagement and improve content (such as providing more examples with the questions). In exploring acceptability and feasibility, 5 themes were derived: helping science and people with diabetes; easy to fit in, but more flexibility wanted; hypoglycemia delaying responses and increasing completion time; design, functionality, and customizability of the app; and limited change in awareness of symptoms and impact. Participants described using the app as a positive experience overall and as having a possible, although limited, intervention effect in terms of both hypoglycemia awareness and personal impact. ConclusionsThe Hypo-METRICS app shows promise as a new research tool to assess the impact of hypoglycemia on an individual’s daily functioning. Despite suggested improvements, participants’ responses indicated that the app has satisfactory content validity, overall fits in with everyday life, and is suitable for a 10-week research study. Although developed for research purposes, real-time assessments may have clinical value for monitoring and reviewing hypoglycemia symptom awareness and personal impact.
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- 2023
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14. Glycaemic thresholds for counterregulatory hormone and symptom responses to hypoglycaemia in people with and without type 1 diabetes: a systematic review
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Verhulst, Clementine E. M., Fabricius, Therese W., Teerenstra, Steven, Kristensen, Peter L., Tack, Cees J., McCrimmon, Rory J., Heller, Simon, Evans, Mark L., Amiel, Stephanie A., Pedersen-Bjergaard, Ulrik, and de Galan, Bastiaan E.
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- 2022
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15. Circulating N-Acetylaspartate does not track brain NAA concentrations, cognitive function or features of small vessel disease in humans
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Eleni Rebelos, Giuseppe Daniele, Beatrice Campi, Alessandro Saba, Kalle Koskensalo, Jukka Ihalainen, Ekaterina Saukko, Pirjo Nuutila, Walter H. Backes, Jacobus F. A. Jansen, Pieter C. Dagnelie, Sebastian Köhler, Bastiaan E. de Galan, Thomas T. van Sloten, Coen D. A. Stehouwer, and Ele Ferrannini
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Medicine ,Science - Abstract
Abstract N-acetylaspartate (NAA) is the second most abundant metabolite in the human brain; although it is assumed to be a proxy for a neuronal marker, its function is not fully elucidated. NAA is also detectable in plasma, but its relation to cerebral NAA levels, cognitive performance, or features of cerebral disease has not been investigated. To study whether circulating NAA tracks cerebral NAA levels, and whether circulating NAA correlates with cognitive function and features of cerebral small vessel disease (SVD). Two datasets were analyzed. In dataset 1, structural MRI was acquired in 533 subjects to assess four features of cerebral SVD. Cognitive function was evaluated with standardized test scores (N = 824). In dataset 2, brain 1H-MRS from the occipital region was acquired (N = 49). In all subjects, fasting circulating NAA was measured with mass spectrometry. Dataset 1: in univariate and adjusted for confounders models, we found no correlation between circulating NAA and the examined features of cerebral SVD. In univariate analysis, circulating NAA levels were associated inversely with the speed in information processing and the executive function score, however these associations were lost after accounting for confounders. In line with the negative findings of dataset 1, in dataset 2 there was no correlation between circulating and central NAA or total NAA levels. This study indicates that circulating NAA levels do not reflect central (occipital) NAA levels, cognitive function, or cerebral small vessel disease in man.
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- 2022
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16. The 12-Item Hypoglycemia Impact Profile (HIP12): psychometric validation of a brief measure of the impact of hypoglycemia on quality of life among adults with type 1 or type 2 diabetes
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Jill Carlton, Frans Pouwer, Alan Brennan, Stephanie A Amiel, Pratik Choudhary, Simon Heller, Bastiaan E de Galan, Jane Speight, Ulrik Pedersen-Bjergaard, Giovanni Sparacino, Helen Colhoun, Christel Hendrieckx, Rory McCrimmon, Stephanie Amiel, Mark Evans, Eric Renard, Mark Ibberson, Rory J McCrimmon, Sean Sullivan, Stephen Gough, Hannah Chatwin, Melanie Broadley, Uffe Søholm, Ohad Cohen, Søren E Skovlund, Cees Tack, Bastiaan de Galan, Thomas Pieber, Julia Mader, Bernard Thorens, Jakob Haardt, Zvonko Milicevic, Mahmood Kazemi, Sanjoy Dutta, Dominique Robert, and Wendy Wolf
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Introduction The aim of this study was to determine the psychometric properties of the 12-Item Hypoglycemia Impact Profile (HIP12), a brief measure of the impact of hypoglycemia on quality of life (QoL) among adults with type 1 (T1D) or type 2 diabetes (T2D).Research design and methods Adults with T1D (n=1071) or T2D (n=194) participating in the multicountry, online study, ‘Your SAY: Hypoglycemia’, completed the HIP12. Psychometric analyses were undertaken to determine acceptability, structural validity, internal consistency, convergent/divergent validity, and known-groups validity.Results Most (98%) participants completed all items on the HIP12. The expected one-factor solution was supported for T1D, T2D, native English speaker, and non-native English speaker groups. Internal consistency was high across all groups (ω=0.91–0.93). Convergent and divergent validity were satisfactory. Known-groups validity was demonstrated for both diabetes types, by frequency of severe hypoglycemia (0 vs ≥1 episode in the past 12 months) and self-treated episodes (
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- 2022
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17. Circulating N-Acetylaspartate does not track brain NAA concentrations, cognitive function or features of small vessel disease in humans
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Rebelos, Eleni, Daniele, Giuseppe, Campi, Beatrice, Saba, Alessandro, Koskensalo, Kalle, Ihalainen, Jukka, Saukko, Ekaterina, Nuutila, Pirjo, Backes, Walter H., Jansen, Jacobus F. A., Dagnelie, Pieter C., Köhler, Sebastian, de Galan, Bastiaan E., van Sloten, Thomas T., Stehouwer, Coen D. A., and Ferrannini, Ele
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- 2022
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18. Bone microarchitecture and strength assessed by HRpQCT in individuals with type 2 diabetes and prediabetes: the Maastricht study.
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Van Hulten, Veerle, Sarodnik, Cindy, Driessen, Johanna H M, Viggers, Rikke, Rasmussen, Nicklas H, Geusens, Piet P M M, Schaper, Nicolaas, Schram, Miranda T, De Galan, Bastiaan E, Koster, Annemarie, Bours, Sandrine P G, Vestergaard, Peter, Stehouwer, Coen D A, and van den Bergh, Joop P
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TYPE 2 diabetes ,GLYCEMIC control ,GLUCOSE tolerance tests ,GLUCOSE metabolism ,PREDIABETIC state ,CANCELLOUS bone ,BONE density - Abstract
Type 2 diabetes (T2D) is a prevalent disease and has been associated with an increased fracture risk despite normal or even higher areal BMD. The aim of this study was to estimate the association between glucose metabolism status (GMS) and measurements of glycemic control with HRpQCT parameters of bone microarchitecture and strength. Participants of the Maastricht study who underwent an HRpQCT scan at the distal radius and tibia were included. GMS was determined by use of an oral glucose tolerance test and grouped into a normal glucose metabolism (NGM), prediabetes, or T2D. Linear regression models were used, stratified by sex with multiple adjustments. This study incorporated cross-sectional data from 1400 (796 [56.9%] NGM, 228 [16.3%] prediabetes, and 376 [26.9%] T2D) men and 1415 (1014 [71.7%] NGM, 211 [14.9%] prediabetes, and 190 [13.4%] T2D) women. The mean age was 59.8 ± 8.6 and 57.6 ± 9.0 yr for men and women, respectively. After adjustment, T2D was associated with a higher total BMD measured by HRpQCT and cortical thickness, and a smaller total and trabecular area in men and women compared with NGM. In women, T2D was additionally associated with a higher stiffness and failure load at the radius. Results were more pronounced at the distal radius than at the distal tibia. To conclude, these findings suggest that in this cohort of Maastricht study participants, total and trabecular bone area are smaller, but bone microarchitecture, density, and bone strength assessed by HRpQCT are not impaired in individuals with T2D. [ABSTRACT FROM AUTHOR]
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- 2024
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19. Device-measured sitting time and musculoskeletal pain in adults with normal glucose metabolism, prediabetes and type 2 diabetes-The Maastricht Study.
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Francis Q S Dzakpasu, Annemarie Koster, Neville Owen, Bastiaan E de Galan, Alison Carver, Christian J Brakenridge, Annelies Boonen, Hans Bosma, Pieter C Dagnelie, Simone J P M Eussen, Parneet Sethi, Coen D A Stehouwer, Nicolaas C Schaper, and David W Dunstan
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Medicine ,Science - Abstract
BackgroundDetrimental associations of sedentary behaviour (time spent sitting) with musculoskeletal pain (MSP) conditions have been observed. However, findings on those with, or at risk of, type 2 diabetes (T2D) have not been reported. We examined the linear and non-linear associations of device-measured daily sitting time with MSP outcomes according to glucose metabolism status (GMS).MethodsCross-sectional data from 2827 participants aged 40-75 years in the Maastricht Study (1728 with normal glucose metabolism (NGM); 441 with prediabetes; 658 with T2D), for whom valid data were available on activPAL-derived daily sitting time, MSP [neck, shoulder, low back, and knee pain], and GMS. Associations were examined by logistic regression analyses, adjusted serially for relevant confounders, including moderate-to-vigorous intensity physical activity (MVPA) and body mass index (BMI). Restricted cubic splines were used to further examine non-linear relationships.ResultsThe fully adjusted model (including BMI, MVPA, and history of cardiovascular disease) showed daily sitting time to be significantly associated with knee pain in the overall sample (OR = 1.07, 95%CI: 1.01-1.12) and in those with T2D (OR = 1.11, 95%CI: 1.00-1.22); this was not statistically significant in those with prediabetes (OR = 1.04, 95%CI: 0.91-1.18) or NGM (OR = 1.05, 95%CI: 0.98-1.13). There were no statistically significant associations between daily sitting time and neck, shoulder, or low back pain in any of the models. Furthermore, the non-linear relationships were statistically non-significant.ConclusionAmong middle-aged and older adults with T2D, daily sitting time was significantly associated with higher odds of knee pain, but not with neck, shoulder, or low back pain. No significant association was observed in those without T2D for neck, shoulder, low back, or knee pain. Future studies, preferably those utilising prospective designs, could examine additional attributes of daily sitting (e.g., sitting bouts and domain-specific sitting time) and the potential relationships of knee pain with mobility limitations.
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- 2023
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20. Psychometric properties of an innovative smartphone application to investigate the daily impact of hypoglycemia in people with type 1 or type 2 diabetes: The Hypo-METRICS app.
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Uffe Søholm, Melanie Broadley, Natalie Zaremba, Patrick Divilly, Giesje Nefs, Jill Carlton, Julia K Mader, Petra Martina Baumann, Mikel Gomes, Gilberte Martine-Edith, Daniel J Pollard, Dajana Rath, Simon Heller, Ulrik Pedersen-Bjergaard, Rory J McCrimmon, Eric Renard, Mark Evans, Bastiaan de Galan, Thomas Forkmann, Stephanie A Amiel, Christel Hendrieckx, Jane Speight, Pratik Choudhary, Frans Pouwer, and Hypo-RESOLVE consortium
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Medicine ,Science - Abstract
IntroductionThe aim of this study was to determine the acceptability and psychometric properties of the Hypo-METRICS (Hypoglycemia MEasurement, ThResholds and ImpaCtS) application (app): a novel tool designed to assess the direct impact of symptomatic and asymptomatic hypoglycemia on daily functioning in people with insulin-treated diabetes.Materials and methods100 adults with type 1 diabetes mellitus (T1DM, n = 64) or insulin-treated type 2 diabetes mellitus (T2DM, n = 36) completed three daily 'check-ins' (morning, afternoon and evening) via the Hypo-METRICs app across 10 weeks, to respond to 29 unique questions about their subjective daily functioning. Questions addressed sleep quality, energy level, mood, affect, cognitive functioning, fear of hypoglycemia and hyperglycemia, social functioning, and work/productivity. Completion rates, structural validity, internal consistency, and test-retest reliability were explored. App responses were correlated with validated person-reported outcome measures to investigate convergent (rs>±0.3) and divergent (rsResultsParticipants' mean±SD age was 54±16 years, diabetes duration was 23±13 years, and most recent HbA1c was 56.6±9.8 mmol/mol. Participants submitted mean±SD 191±16 out of 210 possible 'check-ins' (91%). Structural validity was confirmed with multi-level confirmatory factor analysis showing good model fit on the adjusted model (Comparative Fit Index >0.95, Root-Mean-Square Error of Approximation ConclusionHigh completion rates and satisfactory psychometric properties demonstrated that the Hypo-METRICS app is acceptable to adults with T1DM and T2DM, and a reliable and valid tool to explore the daily impact of hypoglycemia.
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- 2023
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21. Cold-induced dishabituation in rodents exposed to recurrent hypoglycaemia
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Vickneson, Keeran, Blackburn, Jessica, Gallagher, Jennifer R., Evans, Mark L., de Galan, Bastiaan E., Pedersen-Bjergaard, Ulrik, Thorens, Bernard, McNeilly, Alison D., and McCrimmon, Rory J.
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- 2021
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22. 4. Painful diabetic polyneuropathy
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Zuidema, Xander, de Galan, Bastiaan, Brouwer, Brigitte, Cohen, Steven, Eldabe, Sam, Argoff, Charles, Huygen, Frank, Van Zundert, Jan, Zuidema, Xander, de Galan, Bastiaan, Brouwer, Brigitte, Cohen, Steven, Eldabe, Sam, Argoff, Charles, Huygen, Frank, and Van Zundert, Jan
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Introduction: Pain as a symptom of diabetic polyneuropathy (DPN) significantly lowers quality of life, increases mortality and is the main reason for patients with diabetes to seek medical attention. The number of people suffering from painful diabetic polyneuropathy (PDPN) has increased significantly over the past decades. Methods: The literature on the diagnosis and treatment of diabetic polyneuropathy was retrieved and summarized. Results: The etiology of PDPN is complex, with primary damage to peripheral nociceptors and altered spinal and supra-spinal modulation. To achieve better patient outcomes, the mode of diagnosis and treatment of PDPN evolves toward more precise pain-phenotyping and genotyping based on patient-specific characteristics, new diagnostic tools, and prior response to pharmacological treatments. According to the Toronto Diabetic Neuropathy Expert Group, a presumptive diagnosis of “probable PDPN” is sufficient to initiate treatment. Proper control of plasma glucose levels, and prevention of risk factors are essential in the treatment of PDPN. Mechanism-based pharmacological treatment should be initiated as early as possible. If symptomatic pharmacologic treatment fails, spinal cord stimulation (SCS) should be considered. In isolated cases, where symptomatic pharmacologic treatment and SCS are unsuccessful or cannot be used, sympathetic lumbar chain neurolysis and/or radiofrequency ablation (SLCN/SLCRF), dorsal root ganglion stimulation (DRGs) or posterior tibial nerve stimulation (PTNS) may be considered. However, it is recommended that these treatments be applied only in a study setting in a center of expertise. Conclusions: The diagnosis of PDPN evolves toward pheno-and genotyping and treatment should be mechanism-based.
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- 2024
23. The effect of bolus advisors on glycaemic parameters in adults with diabetes on intensive insulin therapy:A systematic review with meta-analysis
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den Brok, Elisabeth J., Svensson, Cecilie H., Panagiotou, Maria, van Greevenbroek, Marleen M.J., Mertens, Peter R., Vazeou, Andriani, Mitrakou, Asimina, Makrilakis, Konstantinos, Franssen, Gregor H.L.M., van Kuijk, Sander, Proennecke, Stephan, Mougiakakou, Stavroula, Pedersen-Bjergaard, Ulrik, de Galan, Bastiaan E., den Brok, Elisabeth J., Svensson, Cecilie H., Panagiotou, Maria, van Greevenbroek, Marleen M.J., Mertens, Peter R., Vazeou, Andriani, Mitrakou, Asimina, Makrilakis, Konstantinos, Franssen, Gregor H.L.M., van Kuijk, Sander, Proennecke, Stephan, Mougiakakou, Stavroula, Pedersen-Bjergaard, Ulrik, and de Galan, Bastiaan E.
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Aim To conduct a systematic review with meta-analysis to provide a comprehensive synthesis of randomized controlled trials (RCTs) and prospective cohort studies investigating the effects of currently available bolus advisors on glycaemic parameters in adults with diabetes. Materials and Methods An electronic search of PubMed, Embase, CINAHL, Cochrane Library and ClinicalTrials.gov was conducted in December 2022. The risk of bias was assessed using the revised Cochrane Risk of Bias tool. (Standardized) mean difference (MD) was selected to determine the difference in continuous outcomes between the groups. A random-effects model meta-analysis and meta-regression were performed. This systematic review was registered on PROSPERO (CRD42022374588). Results A total of 18 RCTs involving 1645 adults (50% females) with a median glycated haemoglobin (HbA1c) concentration of 8.45% (7.95%–9.30%) were included. The majority of participants had type 1 diabetes (N = 1510, 92%) and were on multiple daily injections (N = 1173, 71%). Twelve of the 18 trials had low risk of bias. The meta-analysis of 10 studies with available data on HbA1c showed that the use of a bolus advisor modestly reduced HbA1c compared to standard treatment (MD −011%, 95% confidence interval −0.22 to −0.01; I2 = 0%). This effect was accompanied by small improvements in low blood glucose index and treatment satisfaction, but not with reductions in hypoglycaemic events or changes in other secondary outcomes. Conclusion Use of a bolus advisor is associated with slightly better glucose control and treatment satisfaction in people with diabetes on intensive insulin treatment. Future studies should investigate whether personalizing bolus advisors using artificial intelligence technology can enhance these effects., Aim: To conduct a systematic review with meta-analysis to provide a comprehensive synthesis of randomized controlled trials (RCTs) and prospective cohort studies investigating the effects of currently available bolus advisors on glycaemic parameters in adults with diabetes. Materials and Methods: An electronic search of PubMed, Embase, CINAHL, Cochrane Library and ClinicalTrials.gov was conducted in December 2022. The risk of bias was assessed using the revised Cochrane Risk of Bias tool. (Standardized) mean difference (MD) was selected to determine the difference in continuous outcomes between the groups. A random-effects model meta-analysis and meta-regression were performed. This systematic review was registered on PROSPERO (CRD42022374588). Results: A total of 18 RCTs involving 1645 adults (50% females) with a median glycated haemoglobin (HbA1c) concentration of 8.45% (7.95%–9.30%) were included. The majority of participants had type 1 diabetes (N = 1510, 92%) and were on multiple daily injections (N = 1173, 71%). Twelve of the 18 trials had low risk of bias. The meta-analysis of 10 studies with available data on HbA1c showed that the use of a bolus advisor modestly reduced HbA1c compared to standard treatment (MD −011%, 95% confidence interval −0.22 to −0.01; I2 = 0%). This effect was accompanied by small improvements in low blood glucose index and treatment satisfaction, but not with reductions in hypoglycaemic events or changes in other secondary outcomes. Conclusion: Use of a bolus advisor is associated with slightly better glucose control and treatment satisfaction in people with diabetes on intensive insulin treatment. Future studies should investigate whether personalizing bolus advisors using artificial intelligence technology can enhance these effects.
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- 2024
24. Counterregulatory hormone and symptom responses to hypoglycaemia in people with type 1 diabetes, insulin-treated type 2 diabetes or without diabetes:the Hypo-RESOLVE hypoglycaemic clamp study
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Fabricius, Therese W., Verhulst, Clementine E. M., Kristensen, Peter L., Holst, Jens J., Tack, Cees J., McCrimmon, Rory J., Heller, Simon R., Evans, Mark L., de Galan, Bastiaan E., Pedersen-Bjergaard, Ulrik, Fabricius, Therese W., Verhulst, Clementine E. M., Kristensen, Peter L., Holst, Jens J., Tack, Cees J., McCrimmon, Rory J., Heller, Simon R., Evans, Mark L., de Galan, Bastiaan E., and Pedersen-Bjergaard, Ulrik
- Abstract
Aim: The sympathetic nervous and hormonal counterregulatory responses to hypoglycaemia differ between people with type 1 and type 2 diabetes and may change along the course of diabetes, but have not been directly compared. We aimed to compare counterregulatory hormone and symptom responses to hypoglycaemia between people with type 1 diabetes, insulin-treated type 2 diabetes and controls without diabetes, using a standardised hyperinsulinaemic-hypoglycaemic clamp. Materials: We included 47 people with type 1 diabetes, 15 with insulin-treated type 2 diabetes, and 32 controls without diabetes. Controls were matched according to age and sex to the people with type 1 diabetes or with type 2 diabetes. All participants underwent a hyperinsulinaemic–euglycaemic-(5.2 ± 0.4 mmol/L)-hypoglycaemic-(2.8 ± 0.13 mmol/L)-clamp. Results: The glucagon response was lower in people with type 1 diabetes (9.4 ± 0.8 pmol/L, 8.0 [7.0–10.0]) compared to type 2 diabetes (23.7 ± 3.7 pmol/L, 18.0 [12.0–28.0], p < 0.001) and controls (30.6 ± 4.7, 25.5 [17.8–35.8] pmol/L, p < 0.001). The adrenaline response was lower in type 1 diabetes (1.7 ± 0.2, 1.6 [1.3–5.2] nmol/L) compared to type 2 diabetes (3.4 ± 0.7, 2.6 [1.3–5.2] nmol/L, p = 0.001) and controls (2.7 ± 0.4, 2.8 [1.4–3.9] nmol/L, p = 0.012). Growth hormone was lower in people with type 2 diabetes than in type 1 diabetes, at baseline (3.4 ± 1.6 vs 7.7 ± 1.3 mU/L, p = 0.042) and during hypoglycaemia (24.7 ± 7.1 vs 62.4 ± 5.8 mU/L, p = 0.001). People with 1 diabetes had lower overall symptom responses than people with type 2 diabetes (45.3 ± 2.7 vs 58.7 ± 6.4, p = 0.018), driven by a lower neuroglycopenic score (27.4 ± 1.8 vs 36.7 ± 4.2, p = 0.012). Conclusion: Acute counterregulatory hormone and symptom responses to experimental hypoglycaemia are lower in people with type 1 diabetes than in those with long-standing insulin-treated type 2 diabetes and controls.
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- 2024
25. Improved glucometrics in people with type 1 diabetes 1 year into the COVID-19 pandemic
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Giesje Nefs, Bastiaan E de Galan, Cornelis J Tack, Namam Ali, and Soumia El Hamdaoui
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2022
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26. Role of integrin expression in the prediction of response to vedolizumab: A prospective real‐life multicentre cohort study
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Cara De Galan, Gerard Bryan Gonzales, Sophie Van Welden, Simon Jan Tavernier, Triana Lobaton, Wouter Van Moerkercke, Beatrijs Strubbe, Harald Peeters, Elisabeth Macken, Martine De Vos, Debby Laukens, and Pieter Hindryckx
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Medicine (General) ,R5-920 - Published
- 2022
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27. Effect of lactate administration on cerebral blood flow during hypoglycemia in people with type 1 diabetes
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Bastiaan E de Galan, Lian A van Meijel, Cornelis J Tack, Jack J A van Asten, Joanes Grandjean, Arend Heerschap, Marinette van der Graaf, and Evita C Wiegers
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2022
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28. Investigating the day-to-day impact of hypoglycaemia in adults with type 1 or type 2 diabetes: design and validation protocol of the Hypo-METRICS application
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Giesje Nefs, Frans Pouwer, Alan Brennan, Pratik Choudhary, Jane Speight, Ulrik Pedersen-Bjergaard, Christel Hendrieckx, Daniel John Pollard, Rory J McCrimmon, Melanie Broadley, Bastiaan de Galan, Uffe Søholm, Natalie Zaremba, Patrick Divilly, Zeinab Mahmoudi, and Stephanie A. Amiel
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Medicine - Published
- 2022
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29. Safety and Effectiveness of Vedolizumab and Ustekinumab in Elderly Patients with Inflammatory Bowel Disease: A Real-Life Multicentric Cohort Study
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Holvoet, Tom, primary, Truyens, Marie, additional, De Galan, Cara, additional, Peeters, Harald, additional, Gismero, Francisco Mesonero, additional, Elorza, Ainara, additional, Torres, Paola, additional, Vandermeulen, Liv, additional, Jauregui-Amezaga, Aranzazu, additional, Ferreiro-Iglesias, Rocio, additional, Zabana, Yamile, additional, Reverter, Laia Peries, additional, Geldof, Jeroen, additional, and Lobatón, Triana, additional
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- 2024
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30. ‘Never again will I be carefree’: a qualitative study of the impact of hypoglycemia on quality of life among adults with type 1 diabetes
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Jill Carlton, Frans Pouwer, Simon Heller, Norbert Hermanns, Christel Hendrieckx, Stephanie Amiel, Hannah Chatwin, Melanie Broadley, Mette Valdersdorf Jensen, Bastiaan de Galan, and Katharina Finke-Groene
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Introduction Achieving glycemic targets and optimizing quality of life (QoL) are important goals of type 1 diabetes care. Hypoglycemia is a common barrier to achieving targets and can be associated with significant distress. However, the impact of hypoglycemia on QoL is not fully understood. The aim of this study was to explore how adults with type 1 diabetes are impacted by hypoglycemia in areas of life that are important to their overall QoL.Research design and methods Participants responded to a web-based qualitative survey involving a novel ‘Wheel of Life’ activity. Responses were analyzed using reflexive thematic analysis.Results The final sample included 219 adults with type 1 diabetes from Denmark, Germany, the Netherlands, and the UK. They had a mean±SD age of 39±13 years and diabetes duration of 20±14 years. Participants identified eight areas of life important to their overall QoL, including relationships and social life, work and studies, leisure and physical activity, everyday life, sleep, sex life, physical health, and mental health. Participants reported emotional, behavioral, cognitive, and social impacts of hypoglycemia within domains. Across domains, participants described interruptions, limited participation in activities, exhaustion, fear of hypoglycemia, compensatory strategies to prevent hypoglycemia, and reduced spontaneity.Conclusions The findings emphasize the profound impact of hypoglycemia on QoL and diabetes self-care behaviors. Diabetes services should be aware of and address the burden of hypoglycemia to provide person-centered care. Clinicians could ask individuals how hypoglycemia affects important areas of their lives to better understand the personal impact and develop tailored management plans.
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- 2021
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31. Long-term Evaluation of Spinal Cord Stimulation in Patients With Painful Diabetic Polyneuropathy
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Xander Zuidema, Elke van Daal, Iris van Geel, Thomas J. de Geus, Sander M.J. van Kuijk, Bastiaan E. de Galan, Nelleke de Meij, Jan Van Zundert, Anesthesiologie, MUMC+: MA Anesthesiologie (9), RS: MHeNs - R3 - Neuroscience, Epidemiologie, MUMC+: KIO Kemta (9), Interne Geneeskunde, MUMC+: MA Endocrinologie (9), RS: Carim - V01 Vascular complications of diabetes and metabolic syndrome, and MUMC+: CAKZ Pijnkennis Ane (9)
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Anesthesiology and Pain Medicine ,Neurology ,Neurology (clinical) ,General Medicine - Abstract
OBJECTIVE: This study aimed to evaluate the long-term effects of spinal cord stimulation (SCS) in patients with painful diabetic polyneuropathy (PDPN).MATERIALS AND METHODS: This prospective cohort study was the eight-to-ten-year follow-up of a previously performed pilot and randomized controlled trial on the effects of SCS in PDPN, initiated by the multidisciplinary pain center of Maastricht University Medical Center+. The study population consisted of a subgroup of patients who still used SCS treatment ≥ eight years after implantation (n = 19). Pain intensity scores (numeric rating scale [NRS]) during the day and night and data on secondary outcomes (ie, quality of life, depression, sleep quality) were reported during yearly follow-up consultations. Long-term efficacy of SCS was analyzed by comparing the most recently obtained data eight to ten years after implantation with those obtained at baseline.RESULTS: Pain intensity, day and night, was significantly (p < 0.01) reduced by 2.3 (NRS 6.6-4.3) and 2.2 (NRS 6.8-4.6) points, respectively, when comparing the long-term data with baseline. Moreover, for > 50% of patients, the pain reduction was > 30%, which is considered clinically meaningful. No differences were found regarding the secondary outcomes.CONCLUSION: This eight-to-ten-year follow-up study indicates that SCS can remain an effective treatment in the long term to reduce pain intensity in a subcohort of patients with PDPN who still had an SCS device implanted after eight years.
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- 2023
32. Socioeconomic inequalities in health-related functioning among people with Type 2 Diabetes
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Meisters, R, primary, Albers, J, additional, Sezer, B, additional, de Galan, B E, additional, Eussen, SJPM, additional, Stehouwer, CDA, additional, Schram, M T, additional, van Greevenbroek, MMJ, additional, Koster, A, additional, and Bosma, H, additional
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- 2023
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33. (Pre)diabetes and a higher level of glycaemic measures are continuously associated with corneal neurodegeneration assessed by corneal confocal microscopy: the Maastricht Study
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Mokhtar, Sara B. A., primary, van der Heide, Frank C. T., additional, Oyaert, Karel A. M., additional, van der Kallen, Carla J. H., additional, Berendschot, Tos T. J. M., additional, Scarpa, Fabio, additional, Colonna, Alessia, additional, de Galan, Bastiaan E., additional, van Greevenbroek, Marleen M. J., additional, Dagnelie, Pieter C., additional, Schalkwijk, Casper G., additional, Nuijts, Rudy M. M. A., additional, Schaper, Nicolaas C., additional, Kroon, Abraham A., additional, Schram, Miranda T., additional, Webers, Carroll A. B., additional, and Stehouwer, Coen D. A., additional
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- 2023
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34. No insulin degludec dose adjustment required after aerobic exercise for people with type 1 diabetes: the ADREM study
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Linda C. A. Drenthen, Mandala Ajie, Evertine J. Abbink, Laura Rodwell, Dick H. J. Thijssen, Cees J. Tack, Bastiaan E. de Galan, Interne Geneeskunde, MUMC+: MA Endocrinologie (9), and RS: Carim - V01 Vascular complications of diabetes and metabolic syndrome
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Dose adjustment ,POSTEXERCISE ,Endocrinology, Diabetes and Metabolism ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Type 1 diabetes mellitus ,Metabolic Disorders Radboud Institute for Molecular Life Sciences [Radboudumc 6] ,FREQUENCY ,IMPAIRED AWARENESS ,Women's cancers Radboud Institute for Health Sciences [Radboudumc 17] ,All institutes and research themes of the Radboud University Medical Center ,NOCTURNAL HYPOGLYCEMIA ,PHYSICAL-ACTIVITY ,Insulin treatment ,GLARGINE ,ADOLESCENTS ,Internal Medicine ,Hypoglycaemia ,Exercise - Abstract
Aims/hypothesis It is generally recommended to reduce basal insulin doses after exercise to reduce the risk of post-exercise nocturnal hypoglycaemia. Based on its long t½, it is unknown whether such adjustments are required or beneficial for insulin degludec. Methods The ADREM study (Adjustment of insulin Degludec to Reduce post-Exercise (nocturnal) hypoglycaeMia in people with diabetes) was a randomised controlled, crossover study in which we compared 40% dose reduction (D40), or postponement and 20% dose reduction (D20-P), with no dose adjustment (CON) in adults with type 1 diabetes at elevated risk of hypoglycaemia, who performed a 45 min aerobic exercise test in the afternoon. All participants wore blinded continuous glucose monitors for 6 days, measuring the incidence of (nocturnal) hypoglycaemia and subsequent glucose profiles. Results We recruited 18 participants (six women, age 38 ± 13 years, HbA1c 56 ± 8 mmol/mol [7.3 ± 0.8%], mean ± SD). Time below range (i.e. glucose p=0.043), without differences in the number of hypoglycaemic events. Time above range (i.e. glucose >10 mmol/l) was greater for D20-P vs CON (mean ± SEM, 584 ± 81 vs 364 ± 66 min, p=0.001) and D40 (385 ± 72 min, p=0.003). Conclusions/interpretation Post-exercise adjustment of degludec does not mitigate the risk of subsequent nocturnal hypoglycaemia in people with type 1 diabetes. Although reducing degludec reduced next-day time below range, this did not translate into fewer hypoglycaemic events, while postponing degludec should be avoided because of increased time above range. Altogether, these data do not support degludec dose adjustment after a single exercise bout. Trial registration EudraCT number 2019-004222-22 Funding The study was funded by an unrestricted grant from Novo Nordisk, Denmark. Graphical abstract
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- 2023
35. Machine learning-based glucose prediction with use of continuous glucose and physical activity monitoring data: The Maastricht Study.
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William P T M van Doorn, Yuri D Foreman, Nicolaas C Schaper, Hans H C M Savelberg, Annemarie Koster, Carla J H van der Kallen, Anke Wesselius, Miranda T Schram, Ronald M A Henry, Pieter C Dagnelie, Bastiaan E de Galan, Otto Bekers, Coen D A Stehouwer, Steven J R Meex, and Martijn C G J Brouwers
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Medicine ,Science - Abstract
BackgroundClosed-loop insulin delivery systems, which integrate continuous glucose monitoring (CGM) and algorithms that continuously guide insulin dosing, have been shown to improve glycaemic control. The ability to predict future glucose values can further optimize such devices. In this study, we used machine learning to train models in predicting future glucose levels based on prior CGM and accelerometry data.MethodsWe used data from The Maastricht Study, an observational population-based cohort that comprises individuals with normal glucose metabolism, prediabetes, or type 2 diabetes. We included individuals who underwent >48h of CGM (n = 851), most of whom (n = 540) simultaneously wore an accelerometer to assess physical activity. A random subset of individuals was used to train models in predicting glucose levels at 15- and 60-minute intervals based on either CGM data or both CGM and accelerometer data. In the remaining individuals, model performance was evaluated with root-mean-square error (RMSE), Spearman's correlation coefficient (rho) and surveillance error grid. For a proof-of-concept translation, CGM-based prediction models were optimized and validated with the use of data from individuals with type 1 diabetes (OhioT1DM Dataset, n = 6).ResultsModels trained with CGM data were able to accurately predict glucose values at 15 (RMSE: 0.19mmol/L; rho: 0.96) and 60 minutes (RMSE: 0.59mmol/L, rho: 0.72). Model performance was comparable in individuals with type 2 diabetes. Incorporation of accelerometer data only slightly improved prediction. The error grid results indicated that model predictions were clinically safe (15 min: >99%, 60 min >98%). Our prediction models translated well to individuals with type 1 diabetes, which is reflected by high accuracy (RMSEs for 15 and 60 minutes of 0.43 and 1.73 mmol/L, respectively) and clinical safety (15 min: >99%, 60 min: >91%).ConclusionsMachine learning-based models are able to accurately and safely predict glucose values at 15- and 60-minute intervals based on CGM data only. Future research should further optimize the models for implementation in closed-loop insulin delivery systems.
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- 2021
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36. The impact of hypoglycemia on quality of life and related outcomes in children and adolescents with type 1 diabetes: A systematic review.
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Manon Coolen, Melanie Broadley, Christel Hendrieckx, Hannah Chatwin, Mark Clowes, Simon Heller, Bastiaan E de Galan, Jane Speight, Frans Pouwer, and Hypo-RESOLVE Consortium
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Medicine ,Science - Abstract
ObjectiveTo conduct a systematic review to examine associations between hypoglycemia and quality of life (QoL) in children and adolescents with type 1 diabetes.MethodsFour databases (Medline, Cochrane Library, CINAHL, PsycINFO) were searched systematically in November 2019 and searches were updated in September 2021. Studies were eligible if they included children and/or adolescents with type 1 diabetes, reported on the association between hypoglycemia and QoL (or related outcomes), had a quantitative design, and were published in a peer-reviewed journal after 2000. A protocol was registered the International Prospective Register of Systematic Reviews (PROSPERO; CRD42020154023). Studies were evaluated using the Joanna Briggs Institute's critical appraisal tool. A narrative synthesis was conducted by outcome and hypoglycemia severity.ResultsIn total, 27 studies met inclusion criteria. No hypoglycemia-specific measures of QoL were identified. Evidence for an association between SH and (domains) of generic and diabetes-specific QoL was too limited to draw conclusions, due to heterogenous definitions and operationalizations of hypoglycemia and outcomes across studies. SH was associated with greater worry about hypoglycemia, but was not clearly associated with diabetes distress, depression, anxiety, disordered eating or posttraumatic stress disorder. Although limited, some evidence suggests that more recent, more frequent, or more severe episodes of hypoglycemia may be associated with adverse outcomes and that the context in which hypoglycemia takes places might be important in relation to its impact.ConclusionsThere is insufficient evidence regarding the impact of hypoglycemia on QoL in children and adolescents with type 1 diabetes at this stage. There is a need for further research to examine this relationship, ideally using hypoglycemia-specific QoL measures.
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- 2021
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37. Elevated brain glutamate levels in type 1 diabetes: correlations with glycaemic control and age of disease onset but not with hypoglycaemia awareness status
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Wiegers, Evita C., Rooijackers, Hanne M., van Asten, Jack J.A., Tack, Cees J., Heerschap, Arend, de Galan, Bastiaan E., and van der Graaf, Marinette
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- 2019
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38. Daily Physical Activity Patterns and Their Associations with Cardiometabolic Biomarkers: The Maastricht Study
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TUIJA LESKINEN, VALÉRIA LIMA PASSOS, PIETER C. DAGNELIE, HANS H. C. M. SAVELBERG, BASTIAAN E. DE GALAN, SIMONE J. P. M. EUSSEN, COEN D. A. STEHOUWER, SARI STENHOLM, and ANNEMARIE KOSTER
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Physical Therapy, Sports Therapy and Rehabilitation ,Orthopedics and Sports Medicine - Published
- 2022
39. High prevalence of impaired awareness of hypoglycemia and severe hypoglycemia among people with insulin-treated type 2 diabetes: The Dutch Diabetes Pearl Cohort
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Femke Rutters, Bastiaan E de Galan, Harold W de Valk, J Hans deVries, Miranda T Schram, Coen D A Stehouwer, Bruce H R Wolffenbuttel, Lian A van Meijel, Femmie de Vegt, Evertine J Abbink, Melanie M van der Klauw, Sarah Siegelaar, Behiye Özcan, Bianca Silvius, Nicolaas Schaper, and Cornelis J Tack
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
ObjectivePeople with type 2 diabetes on insulin are at risk for hypoglycemia. Recurrent hypoglycemia can cause impaired awareness of hypoglycemia (IAH), and increase the risk for severe hypoglycemia. The aim of this study was to assess the prevalence and determinants of self-reported IAH and severe hypoglycemia in a Dutch nationwide cohort of people with insulin-treated type 2 diabetes.Research design and methodsObservational study of The Dutch Diabetes Pearl, a cohort of people with type 2 diabetes treated in primary, secondary and tertiary diabetes care centers. The presence of IAH and the occurrence of severe hypoglycemia in the past year, defined as an event requiring external help to recover, were assessed using the validated Dutch version of the Clarke questionnaire. In addition, clinical variables were collected including age, diabetes duration, hemoglobin A1c, ethnicity and education.Results2350 people with type 2 diabetes on insulin were included: 59.1% men, mean age 61.1±10.4 years, mean diabetes duration 14.8±9.2 years and 79.5% on basal-bolus therapy. A total of 229 patients (9.7%) were classified as having IAH and 742 patients (31.6%) reported severe hypoglycemia. Increased odds for IAH were found with complex insulin regimens and lower odds with having a partner and body mass index ≥30 kg/m2. Severe hypoglycemia was associated with complex insulin regimens, non-Caucasian ethnicity and use of psychoactive drugs, and inversely with metformin use.ConclusionsIn this nationwide cohort, almost one out of ten people with type 2 diabetes on insulin had IAH and >30% had a history of severe hypoglycemia in the past year.
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- 2020
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40. Quantifying postprandial glucose responses using a hybrid modeling approach: Combining mechanistic and data-driven models in The Maastricht Study
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Erdős, Balázs, primary, van Sloun, Bart, additional, Goossens, Gijs H., additional, O’Donovan, Shauna D., additional, de Galan, Bastiaan E., additional, van Greevenbroek, Marleen M. J., additional, Stehouwer, Coen D. A., additional, Schram, Miranda T., additional, Blaak, Ellen E., additional, Adriaens, Michiel E., additional, van Riel, Natal A. W., additional, and Arts, Ilja C. W., additional
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- 2023
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41. Effect of Hypoglycemia on Heart Rate Variability in People with Type 1 Diabetes and Impaired Awareness of Hypoglycemia
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Bastiaan E. de Galan, Mats Koeneman, Marleen Olde Bekkink, Sebastian J.H. Bredie, Lian A. van Meijel, Interne Geneeskunde, MUMC+: MA Endocrinologie (9), and RS: Carim - V01 Vascular complications of diabetes and metabolic syndrome
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medicine.medical_specialty ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Biomedical Engineering ,Bioengineering ,Hypoglycemia ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,Heart Rate ,Internal Medicine ,medicine ,Heart rate variability ,Humans ,Hypoglycemic Agents ,Aged ,Type 1 diabetes ,business.industry ,nutritional and metabolic diseases ,Metabolic Disorders Radboud Institute for Molecular Life Sciences [Radboudumc 6] ,Middle Aged ,medicine.disease ,Diabetes Mellitus, Type 1 ,Emergency medicine ,Glucose Clamp Technique ,Female ,business - Abstract
Background: People with impaired awareness of hypoglycemia (IAH) are at elevated risk of severe, potentially hazardous, hypoglycemia and would benefit from a device alerting to hypoglycemia. Heart rate variability (HRV) changes with hypoglycemia due to sympathetic activity. Since IAH is associated with suppressed sympathetic activity, we investigated whether hypoglycemia elicits a measurable change in HRV in patients with T1D and IAH. Method: Eligible participants underwent a modified hyperinsulinemic euglycemic hypoglycemic clamp (glucose nadir, 43.1 ± 0.90 mg/dl), while HRV was measured by a VitalConnect HealthPatch. Measurements of HRV included Root Mean Square of the Successive Differences (RMSSD) and low to high frequency (LF:HF) ratio. Wilcoxon rank-sum test was used for testing within-subject HRV changes. Results: We included 12 participants (8 female, mean age 57 ± 12 years, mean HbA1c 57 ± 5 mmol/mol (7.4 ± 0.4%)). Symptoms increased from 4.0 (1.5-7.0) at euglycemia to 7.5 (5.0-11.0) during hypoglycemia ( P = .003). In response to hypoglycemia, the LF:HF ratio and RMSSD increased when normalized for data obtained during euglycemia (both P < .01). The LF:HF ratio increased in 6 participants (50%) and declined in one other participant (8%). The RMSSD decreased in 3 (25%) and increased in 4 (33%) participants. In 2 patients, no change in HRV could be detected in response to hypoglycemia. Conclusions: This study reveals that hypoglycemia-induced changes in HRV are retained in the majority of people with T1D and IAH, and that these changes can be detected by a wearable device. Real-time HRV seems usable for detection of hypoglycemia in patients with IAH.
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- 2022
42. Long-Term Environmental Hypoxia Exposure and Haematopoietic Prolyl Hydroxylase-1 Deletion Do Not Impact Experimental Crohn’s Like Ileitis
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Cara De Galan, Martine De Vos, Pieter Hindryckx, Debby Laukens, and Sophie Van Welden
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Ileal hypoxia ,TNF∆ARE/+ mice ,prolyl hydroxylase 1 ,immune cell-specific ,hypoxia-induced signalling pathways ,Biology (General) ,QH301-705.5 - Abstract
Environmental hypoxia and hypoxia-induced signalling in the gut influence inflammatory bowel disease pathogenesis, however data is limited to colitis. Hence, we investigated the effect of environmental hypoxia and immune cell-specific deletion of oxygen sensor prolyl hydroxylase (PHD) 1 in a Crohn’s like ileitis mouse model. Therefore, 5-week-old C57/BL6 TNF∆ARE/+ mice and wildtype (WT) littermates were housed in normoxia (21% O2) or hypoxia (8% O2) for 10 weeks. Systemic inflammation was assessed by haematology. Distal ileal hypoxia was evaluated by pimonidazole staining. The ileitis degree was scored on histology, characterized via qPCR and validated in haematopoietic Phd1-deficient TNF∆ARE/+ mice. Our results demonstrated that hypoxia did not impact body weight evolution in WT and TNF∆ARE/+ mice. Hypoxia increased red blood cell count, haemoglobin, haematocrit and increased pimonidazole intensity in the ileum. Interestingly, hypoxia evoked an increase in circulatory monocytes, ileal mononuclear phagocytes and proinflammatory cytokine expression in WT mice. Despite these alterations, no histological or ileal gene expression differences could be identified between TNF∆ARE/+ mice housed in hypoxia versus normoxia nor between haematopoietic Phd1-deficient TNF∆ARE/+ and their WT counterparts. Therefore, we demonstrated for the first time that long-term environmental hypoxia or haematopoietic Phd1-deletion does not impact experimental ileitis development.
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- 2021
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43. Effectiveness of educational and behavioural interventions for reducing fear of hypoglycaemia among adults with type 1 diabetes:Systematic review and meta-analyses
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Hannah Chatwin, Melanie Broadley, Bastiaan de Galan, Ellen Bazelmans, Jane Speight, Frans Pouwer, and Giesje Nefs
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education ,type 1 diabetes ,Endocrinology, Diabetes and Metabolism ,CLINICAL EFFECTIVENESS ,Metabolic Disorders Radboud Institute for Health Sciences [Radboudumc 6] ,Metabolic Disorders Radboud Institute for Molecular Life Sciences [Radboudumc 6] ,low blood glucose ,THERAPY ,PREVENTION ,VALIDATION ,Endocrinology ,All institutes and research themes of the Radboud University Medical Center ,QUALITY-OF-LIFE ,GLYCEMIC CONTROL ,ROUTINE CARE ,Internal Medicine ,AWARENESS TRAINING BGAT ,TRIAL ,SUBCUTANEOUS INSULIN INFUSION ,intervention ,fear of hypoglycaemia ,hypoglycaemia - Abstract
Contains fulltext : 291892.pdf (Publisher’s version ) (Open Access) AIMS: To summarize and critically appraise evidence regarding the effectiveness of educational and/or behavioural interventions in reducing fear of hypoglycaemia among adults with type 1 diabetes. METHODS: Systematic searches of medical and psychology databases were conducted. Risk-of-bias was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Data were synthesized using random-effects meta-analyses for randomized controlled trials (RCTs) and narrative synthesis for observational studies. RESULTS: Five RCTs (N = 682) and seven observational studies (N = 1519) met the inclusion criteria, reporting on behavioural, structured education and cognitive-behavioural therapy (CBT) interventions. Most studies assessed fear of hypoglycaemia using the Hypoglycaemia Fear Survey Worry (HFS-W) and Behaviour (HFS-B) subscales. Mean fear of hypoglycaemia at baseline was relatively low across studies. Meta-analyses showed a significant effect of interventions on HFS-W (SMD = -0.17, p = 0.032) but not on HFS-B scores (SMD = -0.34, p = 0.113). Across RCTs, Blood Glucose Awareness Training (BGAT) had the largest effect on HFS-W and HFS-B scores, and one CBT-based program was as effective as BGAT in reducing HFS-B scores. Observational studies showed that Dose Adjustment for Normal Eating (DAFNE) was associated with significant fear of hypoglycaemia reductions. CONCLUSIONS: Current evidence suggests that educational and behavioural interventions can reduce fear of hypoglycaemia. However, no study to date has examined these interventions among people with high fear of hypoglycaemia.
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- 2023
44. Complement factors D and C3 cross-sectionally associate with arterial stiffness, but not independently of metabolic risk factors: The Maastricht Study
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Shunxin Jin, Koen D. Reesink, Abraham A. Kroon, Bastiaan de Galan, Carla J.H. van der Kallen, Anke Wesselius, Casper G. Schalkwijk, Coen D.A. Stehouwer, Marleen M.J. van Greevenbroek, Interne Geneeskunde, RS: Carim - V01 Vascular complications of diabetes and metabolic syndrome, Biomedische Technologie, RS: Carim - H07 Cardiovascular System Dynamics, RS: Carim - V02 Hypertension and target organ damage, MUMC+: MA Alg Interne Geneeskunde (9), MUMC+: MA Endocrinologie (9), Maastricht Studie, RS: NUTRIM - R3 - Respiratory & Age-related Health, Complexe Genetica, and MUMC+: MA Interne Geneeskunde (3)
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Male ,Physiology ,Metabolic Disorders Radboud Institute for Molecular Life Sciences [Radboudumc 6] ,Complement C3 ,Middle Aged ,Pulse Wave Analysis ,Carotid Arteries ,Vascular Stiffness ,Diabetes Mellitus, Type 2 ,Risk Factors ,Internal Medicine ,Humans ,Complement Factor D ,Female ,Cardiology and Cardiovascular Medicine ,Aged - Abstract
BACKGROUND: Arterial stiffness predicts cardiovascular outcomes. The complement system, particularly the alternative complement pathway, has been implicated in cardiovascular diseases. We herein investigated the associations of factor D, the rate-limiting protease of the alternative pathway, and C3, the central complement component, with arterial stiffness.METHODS: In 3019 population-based participants (51.9% men, 60.1 ± 8.2 years, 27.7% type 2 diabetes [T2D], oversampled]), we measured carotid-femoral pulse wave velocity (cfPWV), carotid distensibility coefficient (DC) and carotid Young's elastic modulus (YEM), and plasma concentrations of factors D and C3. We conducted multiple linear regression to investigate the association of factors D and C3 (main independent variables, standardized) with cfPWV (primary outcome) and DC and YEM (secondary outcomes), adjusted for potential confounders.RESULTS: Per SD higher factors D and C3, cfPWV was 0.41 m/s [95% confidence interval: 0.34; 0.49] and 0.33 m/s [0.25; 0.41] greater, respectively. These associations were substantially attenuated when adjusted for age, sex, education, mean arterial pressure, and heart rate (0.08 m/s [0.02; 0.15] and 0.11 m/s [0.05; 0.18], respectively), and were not significant when additionally adjusted for T2D, waist circumference and additional cardiovascular risk factors (0.06 m/s [-0.01; 0.13] and 0.01 m/s [-0.06; 0.09], respectively). Results were comparable for carotid YEM and DC. In persons with T2D, but not in those without, the association between factors D and cfPWV was significant in the fully adjusted model (0.14 m/s, [0.01; 0.27], P = 0.038, Pinteraction CONCLUSION: The strong association of plasma factors D and C3 with arterial stiffness in this population-based cohort was not independent of T2D and other metabolic risk factors. Our data suggest that a possible causal pathway starting from alternative complement activation may via hypertension and T2D contribute to greater arterial stiffness.
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- 2022
45. Monitoring beta cell survival after intrahepatic islet transplantation using dynamic exendin PET imaging: a proof-of-concept study in individuals with type 1 diabetes
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Jansen, Theodorus J.P., primary, Buitinga, Mijke, additional, Boss, Marti, additional, Nijhoff, Michiel F., additional, Brom, Maarten, additional, de Galan, Bastiaan E., additional, van der Graaf, Marinette, additional, van Koeverden, Sebastiaan, additional, Vantyghem, Marie-Christine, additional, Beron, Amandine, additional, Pattou, François, additional, Engelse, Marten A., additional, Velikyan, Irina, additional, Eriksson, Olof, additional, de Koning, Eelco J.P., additional, and Gotthardt, Martin, additional
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- 2023
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46. Association of type 2 diabetes according to the number of risk factors within the recommended range with incidence of major depression and clinically relevant depressive symptoms: a prospective analysis
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van Gennip, April C E, primary, Schram, Miranda T, additional, Köhler, Sebastian, additional, Kroon, Abraham A, additional, Koster, Annemarie, additional, Eussen, Simone J P M, additional, de Galan, Bastiaan E, additional, van Sloten, Thomas T, additional, and Stehouwer, Coen D A, additional
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- 2023
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47. Monitoring beta-Cell Survival After Intrahepatic Islet Transplantation Using Dynamic Exendin PET Imaging : A Proof-of-Concept Study in Individuals With Type 1 Diabetes
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Jansen, Theodorus J. P., Buitinga, Mijke, Boss, Marti, Nijhoff, Michiel F., Brom, Maarten, de Galan, Bastiaan E., van der Graaf, Marinette, van Koeverden, Sebastiaan, Vantyghem, Marie-Christine, Beron, Amandine, Pattou, Francois, Engelse, Marten A., Velikyan, Irina, Eriksson, Olof, de Koning, Eelco J. P., Gotthardt, Martin, Jansen, Theodorus J. P., Buitinga, Mijke, Boss, Marti, Nijhoff, Michiel F., Brom, Maarten, de Galan, Bastiaan E., van der Graaf, Marinette, van Koeverden, Sebastiaan, Vantyghem, Marie-Christine, Beron, Amandine, Pattou, Francois, Engelse, Marten A., Velikyan, Irina, Eriksson, Olof, de Koning, Eelco J. P., and Gotthardt, Martin
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Intrahepatic transplantation of islets of Langerhans (ITx) is a treatment option for individuals with complicated type 1 diabetes and profoundly unstable glycemic control, but its therapeutic success is hampered by deterioration of graft function over time. To improve ITx strategies, technologies to noninvasively monitor the fate and survival of transplanted islets over time are of great potential value. We used [Ga-68]Ga-NODAGA-exendin-4 (Ga-68-exendin) positron emission tomography (PET)/computed tomography (CT) imaging to demonstrate the feasibility of quantifying b-cellmass in intrahepatic islet grafts in 13 individuals with type 1 diabetes, nine after ITx with functional islet grafts and four control patients not treated with ITx. beta-Cell function was measured by mixed-meal tolerance test. With dynamic Ga-68-exendin PET/CT images, we determined tracer accumulation in hepatic hotspots, and intrahepatic fat was assessed using MRI and spectroscopy. Quantification of hepatic hotspots showed a significantly higher uptake of Ga-68-exendin in the ITx group compared with the control group (median 0.55 [interquartile range 0.51-0.63] vs. 0.43 [0.42-0.45]). GLP-1 receptor expression was found in transplanted islets by immunohistochemistry. Intrahepatic fat was not detected in a majority of the individuals. Our study provides the first clinical evidence that radiolabeled exendin imaging can be used to monitor viable transplanted islets after intraportal ITx.
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- 2023
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48. Device-measured physical activity and cardiometabolic health : the Prospective Physical Activity, Sitting, and Sleep (ProPASS) consortium
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Blodgett, Joanna M., Ahmadi, Matthew N, Atkin, Andrew J, Chastin, Sebastien, Chan, Hsiu-Wen, Suorsa, Kristin, Bakker, Esmee A., Hettiarachchi, Pasan, Johansson, Peter, Sherar, Lauren B., Rangul, Vegar, Pulsford, Richard M, Mishra, Gita, Eijsvogels, Thijs M H, Stenholm, Sari, Hughes, Alun D, Teixeira-Pinto, Armando M, Ekelund, Ulf, Lee, I Min, Holtermann, Andreas, Koster, Annemarie, Stamatakis, Emmanuel, Hamer, Mark, Gupta, Nidhi, Stehouwer, Coen, Savelberg, Hans, de Galan, Bastiaan, van de Kallen, Carla, Thijssen, Dick H J, Blodgett, Joanna M., Ahmadi, Matthew N, Atkin, Andrew J, Chastin, Sebastien, Chan, Hsiu-Wen, Suorsa, Kristin, Bakker, Esmee A., Hettiarachchi, Pasan, Johansson, Peter, Sherar, Lauren B., Rangul, Vegar, Pulsford, Richard M, Mishra, Gita, Eijsvogels, Thijs M H, Stenholm, Sari, Hughes, Alun D, Teixeira-Pinto, Armando M, Ekelund, Ulf, Lee, I Min, Holtermann, Andreas, Koster, Annemarie, Stamatakis, Emmanuel, Hamer, Mark, Gupta, Nidhi, Stehouwer, Coen, Savelberg, Hans, de Galan, Bastiaan, van de Kallen, Carla, and Thijssen, Dick H J
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Background and Aims: Physical inactivity, sedentary behaviour (SB), and inadequate sleep are key behavioural risk factors of cardiometabolic diseases. Each behaviour is mainly considered in isolation, despite clear behavioural and biological interdependencies. The aim of this study was to investigate associations of five-part movement compositions with adiposity and cardiometabolic biomarkers. Methods: Cross-sectional data from six studies (n = 15 253 participants; five countries) from the Prospective Physical Activity, Sitting and Sleep consortium were analysed. Device-measured time spent in sleep, SB, standing, light-intensity physical activity (LIPA), and moderate-vigorous physical activity (MVPA) made up the composition. Outcomes included body mass index (BMI), waist circumference, HDL cholesterol, total:HDL cholesterol ratio, triglycerides, and glycated haemoglobin (HbA1c). Compositional linear regression examined associations between compositions and outcomes, including modelling time reallocation between behaviours. Results: The average daily composition of the sample (age: 53.7 ± 9.7 years; 54.7% female) was 7.7 h sleeping, 10.4 h sedentary, 3.1 h standing, 1.5 h LIPA, and 1.3 h MVPA. A greater MVPA proportion and smaller SB proportion were associated with better outcomes. Reallocating time from SB, standing, LIPA, or sleep into MVPA resulted in better scores across all outcomes. For example, replacing 30 min of SB, sleep, standing, or LIPA with MVPA was associated with −0.63 (95% confidence interval −0.48, −0.79), −0.43 (−0.25, −0.59), −0.40 (−0.25, −0.56), and −0.15 (0.05, −0.34) kg/m2 lower BMI, respectively. Greater relative standing time was beneficial, whereas sleep had a detrimental association when replacing LIPA/MVPA and positive association when replacing SB. The minimal displacement of any behaviour into MVPA for improved cardiometabolic health ranged from 3.8 (HbA1c) to 12.7 (triglycerides) min/day. Conclusions: Compositional data analyses reveal
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- 2023
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49. The impact of hypoglycaemia on quality of life among adults with type 1 diabetes:Results from “YourSAY: Hypoglycaemia”
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Chatwin, Hannah, Broadley, Melanie, Hendrieckx, Christel, Carlton, Jill, Heller, Simon, Amiel, Stephanie A., de Galan, Bastiaan, McCrimmon, Rory J., Pedersen-Bjergaard, Ulrik, Pouwer, Frans, Speight, Jane, Chatwin, Hannah, Broadley, Melanie, Hendrieckx, Christel, Carlton, Jill, Heller, Simon, Amiel, Stephanie A., de Galan, Bastiaan, McCrimmon, Rory J., Pedersen-Bjergaard, Ulrik, Pouwer, Frans, and Speight, Jane
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Aims: Research on hypoglycaemia and quality of life (QoL) has focused mostly on severe hypoglycaemia and psychological outcomes, with less known about other aspects of hypoglycaemia (e.g., self-treated episodes) and impacts on other QoL domains (e.g., relationships). Therefore, we examined the impact of all aspects of hypoglycaemia on QoL in adults with type 1 diabetes (T1DM). Methods: Participants completed an online survey, including assessment of hypoglycaemia-specific QoL (using the 12-item Hypoglycaemia Impact Profile). Mann-Whitney U tests examined differences in hypoglycaemia-specific QoL by hypoglycaemia frequency, severity, and awareness. Hierarchical linear regression examined associations with QoL. Results: Participants were 1028 adults with T1DM (M ± SD age: 47 ± 15 years; diabetes duration: 27 ± 16 years). Severe and self-treated hypoglycaemia and impaired awareness negatively impacted on overall QoL and several QoL domains, including leisure activities, physical health, ability to keep fit/be active, sleep, emotional well-being, spontaneity, independence, work/studies, and dietary freedom. Diabetes distress was most strongly associated with hypoglycaemia-specific QoL, followed by generic emotional well-being, fear of hypoglycaemia, and confidence in managing hypoglycaemia. Hypoglycaemia frequency and awareness were no longer significantly associated with QoL once psychological factors were considered. Conclusions: Hypoglycaemia negatively impacts on several QoL domains. Psychological factors supersede the effect of hypoglycaemia frequency and awareness in accounting for this negative impact.
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- 2023
50. Quantifying postprandial glucose responses using a hybrid modeling approach : Combining mechanistic and data-driven models in The Maastricht Study
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Erdős, Balázs, van Sloun, Bart, Goossens, Gijs H., O’Donovan, Shauna D., de Galan, Bastiaan E., van Greevenbroek, Marleen M.J., Stehouwer, Coen D.A., Schram, Miranda T., Blaak, Ellen E., Adriaens, Michiel E., van Riel, Natal A.W., Arts, Ilja C.W., Erdős, Balázs, van Sloun, Bart, Goossens, Gijs H., O’Donovan, Shauna D., de Galan, Bastiaan E., van Greevenbroek, Marleen M.J., Stehouwer, Coen D.A., Schram, Miranda T., Blaak, Ellen E., Adriaens, Michiel E., van Riel, Natal A.W., and Arts, Ilja C.W.
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Computational models of human glucose homeostasis can provide insight into the physiological processes underlying the observed inter-individual variability in glucose regulation. Modelling approaches ranging from “bottom-up” mechanistic models to “top-down” data-driven techniques have been applied to untangle the complex interactions underlying progressive disturbances in glucose homeostasis. While both approaches offer distinct benefits, a combined approach taking the best of both worlds has yet to be explored. Here, we propose a sequential combination of a mechanistic and a data-driven modeling approach to quantify individuals’ glucose and insulin responses to an oral glucose tolerance test, using cross sectional data from 2968 individuals from a large observational prospective population-based cohort, the Maastricht Study. The best predictive performance, measured by R2 and mean squared error of prediction, was achieved with personalized mechanistic models alone. The addition of a data-driven model did not improve predictive performance. The personalized mechanistic models consistently outperformed the data-driven and the combined model approaches, demonstrating the strength and suitability of bottom-up mechanistic models in describing the dynamic glucose and insulin response to oral glucose tolerance tests.
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- 2023
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