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Aim: To assess whether an intensive multifactorial treatment can reduce cognitive decrements and cognitive decline in screen-detected type 2 diabetes., Methods: The multinational ADDITION-study, a cluster-randomized parallel group trial in patients with screen-detected type 2 diabetes, compared the effectiveness of intensive multifactorial treatment (IT; lifestyle advice and strict regulation of metabolic parameters) with routine care (RC) on cardiovascular outcome. In The Netherlands randomization was stratified according to practice organization. Allocation was concealed from patients. The present study assessed the effect of IT on cognition through two neuropsychological assessments (NPA) on two occasions. The assessments took place three and six years after the start of the intervention. Non-diabetic controls served as reference group. The first NPA was performed in 183 patients (IT: 97; RC: 86) and 69 controls. The second NPA was performed in 135 patients (IT: 71; RC: 64) and 55 controls. Primary outcome was a composite score, including the domains memory, information-processing speed and attention and executive function. Comparisons between the treatment groups were performed with multi-level analyses., Results: The first NPA showed no differences between the treatment groups (mean difference composite z-score: 0.00; 95%-CI -0.16 to 0.16; IT vs RC). Over the next three years cognitive decline in the diabetic groups was within the range of the reference group and did not differ between the treatment arms (difference decline between diabetic groups -0.12; -0.24 to 0.01; IT vs RC)., Conclusions: Six years of IT in screen-detected type 2 diabetes had no benefit on cognitive functioning over RC., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Aim: To explore the knowledge, and health beliefs of patients with type 2 diabetes mellitus (T2DM) regarding management of infections of the urinary tract (UTIs) and lower respiratory tract (LRTIs)., Methods: Three semi-structured focus groups with 23 patients with T2DM were conducted and analyzed., Results: Only a few patients mentioned specific preventive measures for UTIs and LRTIs, like not smoking and taking enough fluids (n=3). Making a nuisance of oneself, denying the seriousness of the disease and fear of insulin therapy were barriers to health-seeking behaviour. Some people did not complete the course of antibiotics (n=2) or forgot to take the tablets, especially when tablets had to be taken more than once a day (n=4)., Conclusion: Our results showed that patients with T2DM lack knowledge and realistic health beliefs about common infections such as UTIs and LRTIs. Health education should aim to help patients with T2DM to interpret symptoms of infections correctly in order to take the appropriate action such as taking preventive measures or taking antibiotics. Identifying patients at high risk of a complicated infection may target education towards those who need it most., (Copyright © 2010 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: Women with diabetes have an increased risk of urinary tract infections (UTIs), especially recurrences. Aim. To investigate diabetes characteristics associated with the risk of recurrent lower UTIs and the antibiotic prescription pattern., Methods: In an exploratory retrospective study involving 7063 women aged>or=30 years, we studied the incidence of recurrent UTI (relapses and reinfection) in women with (n=340) and without diabetes (n=6618). Multivariable logistic regression and multilevel multinomial logistic analyses were used to determine the adjusted associations between diabetes characteristics and recurrent UTI [odds ratio (OR); 95% confidence interval (CI)] and the influence of diabetes on the pattern of antibiotic prescriptions for UTI, respectively., Results: Relapses and reinfections were reported in 7.1% and 15.9% of women with diabetes versus 2.0% and 4.1% of women without diabetes. There was an independent higher risk of recurrent UTI in women with diabetes compared with women without diabetes (OR 2.0; 95% CI 1.4-2.9). Women taking oral blood glucose-lowering medication (OR 2.1; 95% CI 1.2-3.5) or insulin (OR 3.0; 95% CI 1.7-5.1) or who had had diabetes for >or=5 years (OR 2.9; 95% CI 1.9-4.4) or who had retinopathy (OR 4.1; 95% CI 1.9-9.1) were at risk of recurrent UTI. The pattern of antibiotic prescriptions for UTI was not influenced by diabetes., Conclusions: Women with diabetes>or=5 years or with glucose-lowering medication or with retinopathy have an increased risk of recurrent UTI. Diabetes itself does not seem to influence the antibiotic prescription pattern. Research focusing on effective antibiotic treatment of UTI in women at risk of recurrence is needed and may help limit the development of antibiotic resistance.

Aims: Erectile dysfunction (ED) prevalence is usually based on questionnaires, too elaborate for daily practice. The single question for ED prevalence is unknown. Literature reports an independent association between ED and both cardiovascular disease (CVD) and diabetes. Whether routinely asking men with Type 2 diabetes (DM2) about ED identifies those at elevated risk for CVD is unknown. We assessed cardiovascular risk of DM2 men with ED., Design and Methods: This was a cross-sectional study in primary care. During annual check-up, the practice nurse asked 1823 DM2 men: "Do you have erection problems? Yes/no." ED prevalence rate was calculated. Age, medication, and other known factors associated with ED and/or CVD were used in univariate analysis (odds ratio [OR], Student's t test, and Mann-Whitney test). This revealed confounding variables used in the multivariable analysis. The association between ED and history of cardiovascular disease (HCVD) was assessed by logistic regression analysis. In patients with no HCVD, we assessed the association between ED and 10-year United Kingdom Prospective Diabetes Study (UKPDS) coronary heart disease risk by linear regression analysis., Results: The prevalence of ED in DM2 patients was 41.3%. There was no independent association between ED and HCVD [adjusted OR, 1.2 (95% CI, 0.9-1.5)]. The 10-year UKPDS CHD risk difference between men with and without ED was 5.9% (95% CI, 3.2-8.7), but after adjustment for age, this association disappeared [adjusted risk difference, 0.6% (95% CI, -1.5 to 2.7)]., Conclusion: The ED prevalence rate assessed by a single question was comparable to that assessed by questionnaires. ED neither did independently relate to patients' cardiovascular history nor to cardiovascular risk.

Background: Patients with diabetes have an elevated risk of developing complicated lower respiratory tract infections (LRTIs). However, up until now, GPs have not had the tools to assess individual risks., Aim: To assess the applicability of an existing prediction rule for complicated LRTI among patients with diabetes., Design of Study: Retrospective cohort study., Setting: The Utrecht GP Research Network., Method: An existing rule that was used estimates the risk of 30-day hospitalisation or death following an episode of LRTI. Predictors were exacerbation of chronic obstructive pulmonary disease, or pneumonia, increasing age, heart failure, number of hospitalisations in the previous year, use of antibiotics in the previous month, diabetes medication, and prednisone use. Discriminative capacity of the rule was estimated in patients with diabetes. Other potential predictors from the original study were examined, to test for a potentially improved model., Results: Of 445 episodes of LRTI in patients with diabetes, 68 had an outcome of hospitalisation or death within 30 days of diagnosis of LRTI (15.3%). Results showed good reliability of the model (goodness of fit test P=0.16) and discriminative properties (area under the receiver operating characteristic curve: 0.79, 95% confidence interval=0.73 to 0.86). No other predictors could be added. Patients with a lower-risk assignment (scoreor=7) had a probability of 36.6% for the composite endpoint of hospitalisation or death within 30 days of diagnosis of LRTI., Conclusion: The use of a prediction rule may help GPs to assess the risk of hospitalisation or death in patients with diabetes who have an episode of LRTI.

Aims: To determine cardiovascular risk of screen detected subjects with type 2 diabetes (T2DM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). To examine whether BMI is an effect modifier regarding the relation between level of glucose regulation and cardiovascular risk factors., Methods: From 2002 to 2003, 29,251 persons, aged 50-70 years, participated in a population-based diabetes screening programme. Diagnosis was based on the 1999 WHO criteria. Characteristics were assessed of 285 subjects with T2DM, 175 with IGT and 218 with IFG., Results: IFG did not resemble IGT and T2DM regarding weight and blood pressure. BMI (kg/m2) was 27.3+/-4.4, 29.5+/-5.7, 30.7+/-5.6 in IFG, IGT, DM, respectively; systolic blood pressure (mmHg) 150+/-25, 161+/-24, 162+/-23; diastolic blood pressure (mmHg) 84+/-12, 89+/-12, 90+/-11. The poorer the glycaemic control, the worse levels of BMI, blood pressure and lipids. When BMI was higher, cardiovascular risk factors were more adverse, especially in subjects with diabetes., Conclusions: Subjects with IFG had lower blood pressure and weight than subjects with IGT and T2DM suggesting IFG is a condition with less risk to develop cardiovascular diseases. Effect modification by BMI was found.

Abstract: Background: European studies on quality of diabetes care in an unselected primary care diabetes population are scarce. Research question: To test the feasibility of the set-up and logistics of a cross-sectional EUropean study on Care and Complications in patients with type 2 diabetes (T2DM) in Primary Care (EUCCLID) in 12 European countries. Method: One rural and one urban practice from each country participated. The central coordinating centre randomly selected five patients from each practice. Patient characteristics were assessed including medical history, anthropometric measures, quality indicators, UKPDS-risk engine, psychological and general well-being. Results: We included 103 participants from 22 GPs in 11 countries. Central data and laboratory samples were successfully collected. Of the participants 54% were female, mean age was 66 years and mean duration of diabetes was 9.6 years. Besides, 18% were using insulin, 31% had a history of cardiovascular disease, mean HbA1c was 7.1% (range 6.6–8.0), mean systolic blood pressure was 133.7mmHg (range 126.1–144.4) and mean total cholesterol was 4.9mmol/l (range 4.0–6.2). Conclusion: A European study on care and complications in a random selection of people with T2DM is feasible. There are large differences in indicators of metabolic control and wellbeing between countries. [Copyright &y& Elsevier]

Abstract: Aim: The EUCCLID study aims to compare the quality of type 2 diabetes (DM2) care and the prevalence of complications in primary care DM2 patients in Europe. Design: A cross-sectional survey consisting of three parallel studies: (1) study on actual clinical practice; (2) study on patient''s perspective of diabetes care; (3) study on general practitioner''s perspective of diabetes care. Methods: Patients will be randomly selected from a list of all patients known to the participating GPs with DM2 for whom the GP is the main diabetes care provider. Exclusion criteria will include people with type 1 diabetes mellitus, diabetes of pregnancy, serious mental illness, unable to complete a questionnaire in national language or unable to give written informed consent. Approximately 12,000 patients will be included. Participants will have a detailed medical history and anthropometric measurements, blood and urine will be collected and questionnaires will be taken. Endpoints will include quality indicators of clinical DM2 care, prevalence of diabetic complications, knowledge, attitudes, barriers and behaviour affecting good control in DM2 patients, quality of life and patients’ satisfaction with diabetes care. We will also determine primary care physician''s attitudes, behaviour and perception of barriers to deliver effective diabetes care. [Copyright &y& Elsevier]