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Abstract Background Treatment of diabetes mellitus has majorly improved over the past century, however, the disease burden is high and its prevalence still expanding. Further insight in the diabetes population is imperative to improve the quality of diabetes care by enhancement of knowledge-based diabetes management strategies. To this end, in 2017 a Dutch nationwide consortium of diabetologists, paediatric endocrinologists, and diabetes patients has founded a national outpatient diabetes care registry named Dutch Pediatric and Adult Registry of Diabetes (DPARD). We aim to describe the implementation of DPARD and to provide an overview of the characteristics of patients included during the first 2 years. Methods For the DPARD cohort with long-term follow-up of observational nature, hospital data are gathered directly from electronic health records and securely transferred and stored. DPARD provides weekly updated clinical information on the diabetes population care on a hospital-level benchmarked against the national average. Results Between November 2017 and January 2020, 20,857 patients were included from 8 (11%) Dutch hospitals with a level of care distribution representative of all diabetic outpatients in the Netherlands. Among patients with known diabetes type, 41% had type 1 diabetes, 51% type 2 diabetes, and 8% had diabetes due to other causes. Characteristics of the total patient population were similar to patients with unknown diabetes classification. HbA1c levels decreased over the years, while BMI levels showed an increase over time. Conclusions The national DPARD registry aims to facilitate investigation of prevalence and long-term outcomes of Dutch outpatients with diabetes mellitus and their treatment, thus allowing for quality improvement of diabetes care as well as allowing for comparison of diabetes care on an international level.

Abstract Introduction South Asians with diabetes have more severe diabetic retinopathy (DR) and cardiovascular complications than white Caucasians. However, how big this gap is and the relation with the severity of DR has not been studied. Here, we quantify the difference in time from diabetes diagnosis until a first non‐fatal Major Adverse Cardiovascular Event (TUF MACE) in different DR groups in South Asians and Europeans. Methods 3831 adults with type 2 diabetes, 1358 South Asians and 2473 Europeans, treated in our diabetes clinic between 2006 and 2017 were included. Data on risk factors, diabetes duration, age of diagnosis and diabetes complications were collected from the diabetes‐specific database and analysed using descriptive statistics and Cox regression. DR was graded in 3 categories, and non‐fatal MACE was pre‐specified. Results Prevalence of non‐fatal MACE was the same when DR was absent, increased with increasing severity of DR in both ethnic groups, but was more frequent in South Asians with DR (mild: 50 vs. 42% and severe 62 vs. 46%. Classic risk factors only differed in relation to smoking habits, which were significantly lower in South Asians. After correction for classic risk factors and age at diabetes diagnosis TUF MACE was significantly shorter in South Asians, an effect also seen in the no‐DR group (4.1 yrs. HR 1.5, 95% CI 1.3–1.8 and 7.4 yrs. earlier, HR 2.0, 95% CI 1.6–2.6 for no‐DR and severe DR, respectively). Conclusions When adjusted for age at diabetes diagnosis, we show that time until first non‐fatal MACE in South Asians is significantly shorter compared to Europeans and increases from no‐ to severe DR.

Abstract Background South Asians have a high risk to develop type 2 diabetes, which may be related to substantial ectopic fat deposition. Since glucagon-like peptide-1 analogues can reduce ectopic fat accumulation, the aim of the present study was to assess the effect of treatment with liraglutide for 26 weeks on ectopic fat deposition and HbA1c in South Asian patients with type 2 diabetes. Methods In a placebo-controlled trial, 47 South Asian patients with type 2 diabetes were randomly assigned to treatment with liraglutide (1.8 mg/day) or placebo added to standard care. At baseline and after 26 weeks of treatment we assessed abdominal subcutaneous, visceral, epicardial and paracardial adipose tissue volume using MRI. Furthermore, myocardial and hepatic triglyceride content were examined with proton magnetic resonance spectroscopy. Results In the intention-to-treat analysis, liraglutide decreased body weight compared to placebo (− 3.9 ± 3.6 kg vs − 0.6 ± 2.2 kg; mean change from baseline (liraglutide vs placebo): − 3.5 kg; 95% CI [− 5.3, − 1.8]) without significant effects on the different adipose tissue compartments. HbA1c was decreased in both groups without between group differences. In the per-protocol analysis, liraglutide did decrease visceral adipose tissue volume compared to placebo (− 23 ± 27 cm2 vs − 2 ± 17 cm2; mean change from baseline (liraglutide vs placebo): − 17 cm2; 95% CI [− 32, − 3]). Furthermore, HbA1c was decreased by liraglutide compared to placebo (− 1.0 ± 0.8% (− 10.5 ± 9.1 mmol/mol)) vs (− 0.6 ± 0.8% (− 6.1 ± 8.8 mmol/mol)), with a between group difference (mean change from baseline (liraglutide vs placebo): − 0.6% (− 6.5 mmol/mol); 95% CI [− 1.1, − 0.1 (− 11.5, − 1.5)]). Interestingly, the decrease of visceral adipose tissue volume was associated with the reduction of HbA1c (β: 0.165 mmol/mol (0.015%) per 1 cm2 decrease of visceral adipose tissue volume; 95% CI [0.062, 0.267 (0.006, 0.024%)]). Conclusions While the intention-to-treat analysis did not show effects of liraglutide on ectopic fat and HbA1c, per-protocol analysis showed that liraglutide decreases visceral adipose tissue volume, which was associated with improved glycaemic control in South Asians. Trial registration NCT02660047 (clinicaltrials.gov). Registered 21 January 2016

Aim An open label non-randomized observational study was performed to observe and investigate the process of switching from premixed human insulin 30/70 (BHI 30) in NovoLet® to biphasic insulin aspart 30/70 (BIAsp 30) in FlexPen® in an outpatient setting; in terms of insulin dose, efficacy, hypoglycemic episodes, quality of life (WHO-5) and treatment satisfaction (ITSQ; Insulin Treatment Satisfaction Questionnaire). Methods Type 2 diabetic patients (aged ≥ 18 yrs) treated with BHI30 in NovoLet® who were switched to BIAsp 30 in FlexPen® were included in an open-labeled, multicenter, non-randomized, observational study. At baseline and 8 ± 2 weeks after switching to BIAsp 30 FlexPen® HbA 1c , insulin dose, number of hypoglycemic events and quality of life were measured. Results A total of 196 patients (54.3% female, aged 64.8 ± 12 years) with type 2 diabetes completed the study. Total insulin dose remained stable 52.8 ± 24.9 units at baseline vs. 52.0 ± 25.6 units after 8 weeks of treatment, as did HbA1c, 7.7 ± 1.4% at baseline vs. 7.7% ± 1.4%. No weight change was reported (81.6 ± 16.6 kg vs. 81.5 ± 16.7 kg). With BIAsp 30, a significantly lower number of total hypoglycemic episodes were reported (127 compared to 188 with BHI 30, p < 0.001). Significance remained for the subclasses separately (daytime 142 vs. 98, p = 0.005; and nocturnal 46 vs. 29, p = 0.05). ITSQ results confirmed these findings: total score on ‘hypoglycemic’ subscale improved significantly from 78 ± 16.8 to 83 ± 16.0 (p = 0.009). The overall score improved significantly from 82.2 ± 14.6 to 85.5 ± 13.9 (p = 0.036). 85% percent of the patients were satisfied with the FlexPen® device and 89.1% wanted to continue treatment with FlexPen®. The WHO-5 scores after the final visit showed no general quality of life problems with average scores between 2.7 and 3.3. Conclusion The results of this study provided evidence that switching from BHI 30 NovoLet® to BIAsp 30 FlexPen® can be done easily on a unit by unit basis in daily practice in type 2 diabetic patients. After 8 weeks of treatment with BIAsp 30 there was a significant decrease in hypoglycemic episodes accompanied by a significant increase in treatment satisfaction.