Author: "Ole Lander Svendsen" - Searchworks@Jio Institute Digital Library Search Results

82 results on '"Ole Lander Svendsen"'

1. Risk factors for development of nephropathy in patients with a diabetic Charcot foot

Author: Rasmus Bo Jansen, Per E. Holstein, Bo Jørgensen, Klaus Kirketerp Møller, and Ole Lander Svendsen
Subjects: Diabetes mellitus, Charcot foot, Nephropathy, Foot ulcer treatment, Prolonged antibiotics, Risk factor, Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract: Abstract Objective Charcot foot is a rare complication to neuropathy and can cause severe foot deformities and ulcerations, which often require prolonged antibiotical treatment. The objective of this retrospective study was to investigate whether this treatment is associated to impaired renal function. Results In total, 163 patients were included, of whom 105 (64%) had received β-lactam antibiotics for a mean total duration of 13.0 months. There was a significant increase in the urine albumin/creatinine ratio in the group that received antibiotics (p = 0.017), and the use of antibiotics was associated to a subsequent diagnosis of nephropathy (p = 0.01). Patients treated with antibiotics had a 21.9% risk of developing subsequent nephropathy versus 5.2% for patients not treated with antibiotics. We suggest increased awareness on signs of nephropathy in patients with severe Charcot foot.
Published: 2021
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2. Long-Term Changes in Sarcopenia and Body Composition in Diabetes Patients with and without Charcot Osteoarthropathy

Author: Michael Zaucha Sørensen, Rasmus Bo Jansen, Tomas Møller Christensen, Per E. Holstein, and Ole Lander Svendsen
Subjects: Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract: Background. Charcot osteoarthropathy of the foot (COA) can currently only be treated using prolonged periods of immobilization of the affected extremity. Therefore, the hypothesis is that COA leads to altered body composition and increased sarcopenia. Objective. To investigate the changes over several years in sarcopenia, body composition, and fat distribution in diabetes patients with previous COA compared to diabetes patients without previous COA. Methods. Prospective observational clinical study. Twenty-one subjects were included and had two DXA scans done with mean 8.6-year intervals to compare changes in lean mass and fat distribution. The lean mass of limbs was used as an estimate of appendicular lean mass (aLM). Fat mass and aLM were then used to detect sarcopenic individuals using different methods. Results and Conclusions. As compared to baseline, both groups had significant loss of lean mass, and diabetics without COA had significant gain of total fat percentage. No statistically different prevalence of sarcopenia between the groups could be established. Likewise, no difference was found in total lean and fat mass changes. None of the groups had statistically significant changes of android fat distribution. As compared with published data on sarcopenia, people with diabetes might be more prone to sarcopenia than healthy individuals.
Published: 2022
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3. Study protocol for optimising glycaemic control in type 1 diabetes treated with multiple daily insulin injections: intermittently scanned continuous glucose monitoring, carbohydrate counting with automated bolus calculation, or both? A randomised controlled trial

Author: Anna Lilja Secher, Ulrik Pedersen-Bjergaard, Ole Lander Svendsen, Birthe Gade-Rasmussen, Thomas P Almdal, Liv Dørflinger, Dorte Vistisen, and Kirsten Nørgaard
Subjects: Medicine
Abstract: Introduction There are beneficial effects of advanced carbohydrate counting with an automatic bolus calculator (ABC) and intermittently scanned continuous glucose monitoring (isCGM) in persons with type 1 diabetes. We aim to compare the effects of isCGM, training in carbohydrate counting with ABC and the combination of the two concepts with standard care.Methods and analysis A multi-centre randomised controlled trial with inclusion criteria: ≥18 years, type 1 diabetes ≥1 year, injection therapy, HbA1c >53 mmol/mol, whereas daily use of carbohydrate counting and/or CGM/isCGM wear are exclusion criteria. Inclusion was initiated in October 2018 and is ongoing. Eligible persons are randomised into four groups: standard care, ABC, isCGM or ABC+isCGM. Devices used are FreeStyle Libre Flash and smart phone diabetes application mySugr. Participants attend group courses according to treatment allocation with different educational contents. Participants are followed for 26 weeks with clinical visits and telephone consultations. At baseline and at study end, participants wear blinded CGM, have blood samples performed and fill in questionnaires on person-related outcomes, and at baseline also on personality traits and hypoglycaemia awareness. The primary outcome is the difference in time spent in normoglycaemia (4–10 mmol/L) at study end versus baseline between the isCGM group and the standard care group. Secondary outcomes will also be analysed. Results are expected in 2020.Ethics and dissemination Regional Scientific Ethics Committee approval (H-17040573). Results will be sought disseminated at conferences and in high impact journals.Trial registration numberClinicalTrial.gov registry (NCT03682237).
Published: 2020
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4. Long-term effects on the progress of neuropathy after diabetic Charcot foot: an 8.5-year prospective case–control study

Author: Rasmus Bo Jansen, Tomas Møller Christensen, Jens Bülow, Lene Rørdam, Per E. Holstein, and Ole Lander Svendsen
Subjects: Diabetes, Neuropathy, Charcot foot, Follow-up, Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract: Abstract Objective Charcot foot is a severe complication to diabetes mellitus, associated with diabetic neuropathy. Any long-term effects of a Charcot foot on the progress of neuropathy are still largely unexplored. The objective was to investigate whether a previous Charcot foot had any long-term effects on the progress of neuropathy. Results An 8.5-year follow-up case–control study of 49 individuals with diabetes mellitus, 24 of whom also had Charcot foot at baseline visit in 2005–2007. Neuropathy was assessed with a questionnaire, biothesiometry, heart rate variability and venous occlusion plethysmography. Of the 49 baseline participants, 22 were able to participate in the follow-up. Twelve had passed away in the meantime. Heart rate variability was unchanged in both groups; from 9.7 to 7.2 beats/min (p = 0.053) in the Charcot group, and 14.3 to 12.6 beats/min (p = 0.762) in the control group. Somato-sensoric neuropathy showed no difference between baseline and follow-up in the Charcot group (from 39.1 to 38.5 V) (p = 0.946), but a significantly worsened sensitivity in the control group (from 25.1 to 38.9 V) (p = 0.002). In conclusion, we found that any differences in somatic or cardial autonomic neuropathy present at baseline had disappeared at follow-up after 8.5 years.
Published: 2018
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5. Healing of Diabetic Foot Ulcers in Patients Treated at the Copenhagen Wound Healing Center in 1999/2000 and in 2011/2012

Author: Marie Louise Buhl Sørensen, Rasmus Bo Jansen, Therese Wilbek Fabricius, Bo Jørgensen, and Ole Lander Svendsen
Subjects: Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract: Aim. To describe differences in healing time of diabetic foot ulcers for patients treated at the Copenhagen Wound Healing Center, Bispebjerg Hospital, between the years 1999/2000 and 2011/2012. The Center is highly specialized and receives diabetes patients with hard-to-heal foot ulcers. A further aim is to attempt to find predictors of healing time of diabetic foot ulcers. Methods. A retrospective descriptive study of records from patients with diabetic foot ulcer treated at the Copenhagen Wound Healing Center in 1999, 2000, 2011, or 2012. Follow-up data was collected until the 3rd of August 2018. Results. Median time (range) to healing was 6 (61.3) months in 1999/2000 and 6.6 (67.8) in 2011/2012 (p=0.2). About 33% of ulcers were healed, 17% were minor or major amputated, and 1.5% were dead within one year in 1999/2000, whereas 30% of ulcers were healed (p=0.6), 14% were amputated (p=0.2), and 12.8% were dead within one year in 2011/2012 (p
Published: 2019
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6. Markers of Local Inflammation and Bone Resorption in the Acute Diabetic Charcot Foot

Author: Rasmus Bo Jansen, Tomas Møller Christensen, Jens Bülow, Lene Rørdam, Niklas Rye Jørgensen, and Ole Lander Svendsen
Subjects: Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract: Objective. Due to the localized nature of Charcot foot, systemically altered levels of inflammation markers can be difficult to measure. The aim of this study was to investigate whether it is possible to detect an arteriovenous (A-V) flux in any locally produced inflammatory biomarkers from an acute Charcot foot by comparing local and systemic measurements. Methods. We included patients with acute diabetic Charcot foot. Blood was sampled from the vena saphena magna on the distal part of the crus bilaterally as well as from the arteria radialis. To minimize the A-V shunting effect, the feet were externally cooled with ice water prior to resampling. Results. Both before and after cooling, the A-V flux of interleukin-6 (IL-6) between the Charcot feet and the arterial level was significantly higher than the flux between the healthy feet and the arterial level (Δvaluebefore: 7.25 versus 0.41 pg/mL, resp., p=0.008; Δvalueafter: 10.04 versus 1.68 pg/mL, resp., p=0.032). There were no differences in the fluxes for other markers of inflammation. Conclusion. We have found an increased A-V flux of IL-6 in the acute diabetic Charcot foot compared to the healthy foot in the same patients.
Published: 2018
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7. Flash glucose monitoring and automated bolus calculation in type 1 diabetes treated with multiple daily insulin injections: a 26 week randomised, controlled, multicentre trial

Author: Birthe Gade-Rasmussen, Thomas Almdal, Kirsten Nørgaard, Dorte Vistisen, Linda Raimond, Anna Lilja Secher, Ulrik Pedersen-Bjergaard, and Ole Lander Svendsen
Subjects: Type 1 diabetes, medicine.medical_specialty, Continuous glucose monitoring, business.industry, Endocrinology, Diabetes and Metabolism, Insulin, medicine.medical_treatment, medicine.disease, Discontinuation, Carbohydrate counting, Diabetes mellitus, Statistical significance, Internal medicine, Internal Medicine, medicine, Bolus (digestion), business
Abstract: We aimed to compare the effects of intermittently scanned continuous glucose monitoring (isCGM) and carbohydrate counting with automated bolus calculation (ABC) with usual care. In a randomised, controlled, open-label trial carried out at five diabetes clinics in the Capital Region of Denmark, 170 adults with type 1 diabetes for ≥1 year, multiple daily insulin injections and HbA1c > 53 mmol/mol (7.0%) were randomly assigned 1:1:1:1 with centrally prepared envelopes to usual care (n = 42), ABC (n = 41), isCGM (n = 48) or ABC+isCGM (n = 39). Blinded continuous glucose monitoring data, HbA1c and patient-reported outcomes were recorded at baseline and after 26 weeks. The primary outcome was change in time in range using isCGM vs usual care. Baseline characteristics were comparable across arms: mean age 47 (SD 13.7) years, median (IQR) diabetes duration 18 (10–28) years and HbA1c 65 (61–72) mmol/mol (8.1% [7.7–8.7%]). Change in time in range using isCGM was comparable to usual care (% difference of 3.9 [−12–23], p = 0.660). The same was true for the ABC and ABC+isCGM arms and for hypo- and hyperglycaemia. Also compared with usual care, using ABC+isCGM reduced HbA1c (4 [95% CI 1, 8] mmol/mol) (0.4 [0.1, 0.7] %-point) and glucose CV (11% [4%, 17%]) and improved treatment satisfaction, psychosocial self-efficacy and present life quality. Treatment satisfaction also improved by using isCGM alone vs usual care. Statistical significance was maintained after multiple testing adjustment concerning glucose CV and treatment satisfaction with ABC+isCGM, and treatment satisfaction with isCGM. Discontinuation was most common among ABC only users, and among completers the ABC was used 4 (2–5) times/day and the number of daily isCGM scans was 5 (1–7) at study end. isCGM alone did not improve time in range, but treatment satisfaction increased in technology-naive people with type 1 diabetes and suboptimal HbA1c. The combination of ABC+isCGM appears advantageous regarding glycaemic variables and patient-reported outcomes, but many showed resistance towards ABC. ClinicalTrials.gov NCT03682237. The study is investigator initiated and financed by the Capital Region of Denmark.
Published: 2021
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8. Quality of diabetes treatment in four orthopaedic departments in the Capital Region of Denmark

Author: Peter Lommer, Kristensen, Anna, Jessen, Susanne Margrethe Myrup, Houe, Pernille, Banck-Petersen, Charlotte, Schiøtz, Katrine Bagge, Hansen, Ole Lander, Svendsen, Thomas, Almdal, and Ulla, Bjerre-Christensen
Subjects: Blood Glucose, Glycated Hemoglobin, Orthopedics, Denmark, Diabetes Mellitus, Humans
Abstract: Hyperglycaemia during hospitalisation is associated with a longer and more complicated admission and with increased mortality. Therefore, guidelines suggest that blood glucose should be less than 10 mmol/l. In this audit, we aimed to describe the prevalence of diabetes patients at four orthopaedic departments in the Capital Region of Denmark and to measure the quality of in-hospital diabetes management.We conducted audits of medical records in the electronic health record system for two months in 2019. All patients admitted were included in the audit. We gathered information on diabetes status, orthopaedic diagnosis, glycosylated haemoglobin and diabetes management.Among 2,463 included patients, 10% had diabetes. The three most frequent diagnosis groups were infection, fracture of lower extremity and hospitalised for alloplastic surgery. The number of blood glucose measurements during 24-hour perioperative care was 6.5. Among patients analysed, 10-20% did not have their blood glucose measured in the days following surgery. Among patients, 64% received insulin 1-50% of the required times.We demonstrated that 10% of hospitalised patients suffer from diabetes. The audit also showed that blood glucose is generally measured according to guidelines, whereas the treatment of an elevated blood glucose is far from being given according to guidelines. This may potentially delay recovery and prolong hospitalisation.none.not relevant.
Published: 2021

9. 150-OR: Intermittently Scanned Continuous Glucose Monitoring and Automated Bolus Calculation in Type 1 Diabetes Treated with Multiple Daily Insulin Injections: A Randomized Controlled Trial

Author: Ulrik Pedersen-Bjergaard, Thomas Almdal, Kirsten Nørgaard, Linda H. Raimond, Ole Lander Svendsen, Anna Secher, Dorte Vistisen, and Birthe Gade-Rasmussen
Subjects: medicine.medical_specialty, Type 1 diabetes, business.industry, Continuous glucose monitoring, Endocrinology, Diabetes and Metabolism, Insulin, medicine.medical_treatment, medicine.disease, law.invention, Carbohydrate counting, Randomized controlled trial, law, Statistical significance, Internal medicine, Multicenter trial, Internal Medicine, Medicine, Bolus (digestion), business
Abstract: In a randomized controlled multicenter trial, 170 adults with type 1 diabetes ≥1 year, multiple daily insulin injections, HbA1c >7.0% (53 mmol/mol), were randomized to usual care (n=42), carbohydrate counting with automated bolus calculation (ABC) (n=41), intermittently scanned continuous glucose monitoring (isCGM) (n=48), or ABC+isCGM (n=39). HbA1c, blinded CGM and patient-reported outcomes were recorded at baseline and after 26 weeks. Primary outcome was change in time in range (TIR) with isCGM vs. usual care. Baseline characteristics were comparable across intervention arms; median (Q1;Q3) diabetes duration 18 (10;28) years, HbA1c 8.1 (7.7;8.7) % (65 (61;72) mmol/mol) and mean (SD) BMI 26.7 (3.9) kg/m2. Changes in TIR, hypo- and hyperglycemia were similar in the intervention arms compared to usual care. Daytime TIR increased 22 (95% CI: 1;47) % with ABC and nighttime hyperglycemia increased 258 (40;814) % with isCGM compared to usual care. With ABC+isCGM, HbA1c was reduced 0.4 (0.1;0.7) % (4 (1;8) mmol/mol) and glucose coefficient of variation (CV) was reduced 11 (4;17) % compared to usual care. Treatment satisfaction improved with isCGM and ABC+isCGM. With ABC+isCGM, empowerment and present life quality also improved. Within the ABC and isCGM arms, we observed HbA1c reductions of 0.3 and 0.3% (4 and 3 mmol/mol), respectively, however not significantly different from usual care. Statistical significance was maintained after adjustment for multiple testing with regards to CV and treatment satisfaction with ABC+isCGM, and treatment satisfaction with isCGM only. In conclusion, although no significant improvement in TIR was achieved, simultaneous intervention with ABC+isCGM improved the coefficient of variation and treatment satisfaction compared to usual care, and HbA1c was clinically relevant reduced, in adult technology-naïve persons with type 1 diabetes and suboptimal HbA1c. Disclosure A. L. Secher: None. U. Pedersen-bjergaard: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis, Consultant; Self; Abbott, Speaker’s Bureau; Self; Novo Nordisk A/S. O. L. Svendsen: None. B. Gade-rasmussen: None. T. P. Almdal: None. L. H. Raimond: None. D. Vistisen: Stock/Shareholder; Self; Novo Nordisk A/S. K. Nørgaard: Advisory Panel; Self; Medtronic, Other Relationship; Self; Novo Nordisk Inc., Zealand Pharma A/S, Speaker’s Bureau; Self; Medtronic.
Published: 2021
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10. Fractures and Osteoporosis in Patients With Diabetes With Charcot Foot

Author: Oliver Christian Rabe, Kristine H. Allin, Matilde Winther-Jensen, and Ole Lander Svendsen
Subjects: congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Population, Osteoporosis, Cohort Studies, Risk Factors, Diabetes mellitus, Internal medicine, Internal Medicine, Diabetes Mellitus, Odds Ratio, Medicine, Humans, In patient, education, Advanced and Specialized Nursing, education.field_of_study, business.industry, Odds ratio, medicine.disease, Diabetic Foot, medicine.anatomical_structure, Ankle, business, Complication, Foot (unit), Osteoporotic Fractures
Abstract: OBJECTIVE Charcot foot is a serious complication of diabetes, with degeneration of the bones and joints in the foot and ankle. It is unknown whether patients with diabetes with a Charcot foot have an increased risk of osteoporosis and fractures. The aim of this study was to investigate whether patients with diabetes with a Charcot foot have an increased risk of fracture and/or osteoporosis compared with patients with diabetes without Charcot foot. RESEARCH DESIGN AND METHODS A Danish register-based, nationwide population-based matched cohort study was conducted. During 1995–2018, we identified 1,602 patients with diabetes with Charcot foot and matched them on sex and date of diagnosis of diabetes with 16,296 patients with diabetes without Charcot foot. We used logistic regression to estimate odds ratios (ORs) with 95% CIs for fracture and osteoporosis. Information about exposure, outcome, and comorbidities was retrieved from the Danish National Patient Register. RESULTS Diabetes patients with Charcot foot had higher risk of fractures compared with those without Charcot foot (i.e., ORs for any fracture, lower-leg fracture, foot fracture, and osteoporotic fracture were 1.8 [95% CI 1.6–2.0], 2.4 [2.0–2.8], 2.9 [2.6–3.3], and 1.3 [1.1–1.4], respectively). Furthermore, patients with diabetes with Charcot foot had higher risk of osteoporosis compared with the patients without Charcot foot, with an OR of 1.3 (95% CI 1.1–1.5). CONCLUSIONS Patients with diabetes with a Charcot foot have an increased risk of fractures and osteoporosis compared with patients with diabetes without a Charcot foot.
Published: 2021

11. How Common Is the Rare Charcot Foot in Patients With Diabetes?

Author: Matilde Winther-Jensen, Oliver Christian Rabe, Kristine H. Allin, and Ole Lander Svendsen
Subjects: Pediatrics, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Disease, Danish, 03 medical and health sciences, 0302 clinical medicine, Diabetic Neuropathies, Diabetes mellitus, Internal Medicine, medicine, Deformity, Humans, 030212 general & internal medicine, Advanced and Specialized Nursing, Foot, business.industry, Incidence (epidemiology), medicine.disease, Diabetic Foot, language.human_language, Diabetes Mellitus, Type 2, Amputation, language, Arthropathy, Neurogenic, medicine.symptom, Complication, business, Foot (unit)
Abstract: The Charcot foot is a devastating complication to diabetes (1). It manifests as an acute aseptic inflammation of bones and joints in the feet. If not diagnosed and treated in time, it may lead to collapse of bones in the foot, which causes deformity, foot ulcers, amputation, and death (1). The diagnosis of acute Charcot foot is often delayed due to little knowledge of the disease among patients and clinicians, probably because of its rarity. But how rare is it? To answer this, we have assessed the incidence and prevalence of the Charcot foot among all patients with diabetes in Denmark. The Danish National Patient Register contains information on all hospitalizations and information on outpatient visits and emergency room contacts from 1995 to present (2). Data about age, sex, and emigrations (temporary or permanent) were retrieved from The Danish Civil Registration System, and dates of death were found in the Death Register, Statistics Denmark (2). All individuals in the Danish National Patient …
Published: 2021
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12. Risk Factors for Premature Death in Diabetes Patients who Undergo Amputations below Ankle Level

Author: Bo Jørgensen, Therese Emilie Wilbek, Rasmus Bo Jansen, and Ole Lander Svendsen
Subjects: medicine.medical_specialty, Statin, medicine.drug_class, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Type 2 diabetes, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Risk factor, Type 1 diabetes, business.industry, Retrospective cohort study, General Medicine, medicine.disease, Surgery, medicine.anatomical_structure, Amputation, Ankle, business
Abstract: Aim To identify risk factors for early death in diabetes patients who undergo amputations below the ankle. Methods A retrospective study, where all hospital records of all diabetes patients who had undergone minimum one amputation below the ankle at the CWHC Bispebjerg Hospital, Denmark, in the period 1996–2013, were examined. The amputations were mainly trans-metatarsal amputations and partial amputations of toes. The participants were found via ICD10-codes. The included patients were followed from their first contact to the last registered contact. The statistical analysis in this article is performed on patients with a of minimum 5-year follow-up. Results The 5 year mortality was 42% for patients with type 2 diabetes, and 29% for patients with type 1 diabetes. For patients with type 2 diabetes, multivariable analysis showed that high age, peripheral arterial insufficiency and short time from first admission to amputation were independently statistically significantly associated with increased 5-years mortality. Use of statins was associated with decreased mortality. 35% died as a result of their diabetes, mostly due to cardiovascular causes. Conclusion Short time from first admission to amputation is a risk factor for early death. Arterial insufficiency and high age is also associated with increased mortality, whereas use of statin is associated with decreased mortality, in patients with type 2 diabetes.
Published: 2017
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13. The Diabetic Foot in a Multidisciplinary Team Setting. Number of Amputations below Ankle Level and Mortality

Author: Rasmus Bo Jansen, Ole Lander Svendsen, Bo Jørgensen, and Therese Emilie Wilbek
Subjects: Male, medicine.medical_specialty, Denmark, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, Multidisciplinary team, Amputation, Surgical, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Diabetes mellitus, Internal Medicine, medicine, Humans, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Mortality rate, Medical record, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Diabetic foot, Diabetic Foot, Surgery, medicine.anatomical_structure, Amputation, Female, Ankle, business
Abstract: Aim: To describe the number of minor lower extremity amputations and mortality for diabetes patients treated by a specialized multidisciplinary foot care team. Methods: A retrospective descriptive study of medical records from patients with diabetes treated with minor amputations at the Copenhagen Wound Healing Center (CWHC) at Bispebjerg Hospital from 1996–2013. Results: 777 diabetes patients treated with minor amputations were included. 77% were males and 23% were females. 80% had T2 diabetes and 20% had T1 diabetes. 89% of the patients had a foot ulcer at first contact. There was a total of 1 231 minor amputations. The amputations were mainly trans-metatarsal amputations and partial amputations of toes. There was an increase in the number of minor amputations, but there was also an increase in the number of referred diabetes patients, thus the ratio of amputations per admitted diabetes patient was constant. Time from first amputation to death was 2.5 years. The 5-year mortality rate was 43% and 52% for T1 and T2 diabetes patients, respectively. Conclusion: Due to increased number of referred diabetes patients, the number of diabetes patients undergoing minor amputations increased over the years. Patients with diabetes, who underwent minor amputation, had a high mortality averaging 2.5 year to death; comparable to many types of cancer.
Published: 2016
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14. Mortality and complications after treatment of acute diabetic Charcot foot

Author: Rasmus Bo Jansen, Ole Lander Svendsen, Bo Jørgensen, Per Holstein, and Klaus Kirketerp Møller
Subjects: Adult, Male, medicine.medical_specialty, Diabetic neuropathy, Endocrinology, Diabetes and Metabolism, Denmark, Population, 030209 endocrinology & metabolism, Type 2 diabetes, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Diabetic Neuropathies, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, education, Aged, Retrospective Studies, education.field_of_study, Type 1 diabetes, Wound Healing, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, Diabetic Foot, Diabetes Mellitus, Type 2, Acute Disease, Female, Arthropathy, Neurogenic, business, Complication, Foot (unit)
Abstract: Aims Charcot foot is a rare but disabling complication to diabetic neuropathy, and can cause permanent, limb-threatening deformities. The aim of this study was to investigate a population of patients a Charcot foot on a case-by-case basis, in order to assess the consequences of an acute Charcot foot and its complications. Methods The study was conducted a retrospective study of patients admitted to the Copenhagen Wound Healing Center between 1996 and 2015 with the diagnosis of Charcot foot (DM14.6) and diabetes mellitus type 1 or 2 (DE10.X and DE11.X). Physical and electronic records were used, and compared to data from the Danish Diabetes Registry. Results In total 392 patients were identified of which 173 were included. There were 26% with type 1 diabetes (initial HbA1c 81.7 ± 21.4 mmol/mol) and 74% with type 2 diabetes (initial HbA1c 66.5 ± 20.3 mmol/mol). Primary off-loading was with a removable walker in 95% of the cases (average off-loading time 8.3 months). The 5-year mortality was 14% with a mean survival time of 12.7 years. There was an association between lack of compliance and occurrence of foot complications, as well as between having a Charcot foot and leaving the workforce. Conclusion More patients had type 1 diabetes compared to the background population, and they had a higher HbA1c than the general population of diabetes patients. A total of 67% developed complications such as ulcers, while patients non-compliant to treatment did significantly worse than those being compliant. The 5-year mortality was low, 14%, and comparable to diabetes patients without Charcot foot.
Published: 2018

15. A review of bone metabolism and developments in medical treatment of the diabetic Charcot foot

Author: Ole Lander Svendsen and Rasmus Bo Jansen
Subjects: congenital, hereditary, and neonatal diseases and abnormalities, Diabetic neuropathy, Endocrinology, Diabetes and Metabolism, Anti-Inflammatory Agents, 030209 endocrinology & metabolism, Bioinformatics, Bone and Bones, Bone remodeling, 03 medical and health sciences, Fractures, Bone, 0302 clinical medicine, Endocrinology, Diabetic Neuropathies, Diabetes mellitus, Internal Medicine, Medicine, Humans, 030212 general & internal medicine, Bone Resorption, Medical treatment, Bone Density Conservation Agents, Diphosphonates, business.industry, Foot, medicine.disease, Diabetic Foot, nervous system diseases, Inflammatory pathways, Arthropathy, Neurogenic, business, Foot (unit)
Abstract: Charcot foot is a rare but severe, and possibly limb-threatening, complication to neuropathy and diabetes mellitus. The current treatment consists of long-term off-loading, and has a large negative impact on the patient's life. Much research has gone into understanding the condition and its biochemical mechanisms, however, the underlying pathogenesis of a Charcot foot is not yet fully understood. In the recent decades several key advances in our understanding of the Charcot foot have been made, both in regards to the changes in bone metabolism and structure an acute Charcot foot can cause, and to the molecular pathways involved in this. This review summerizes the available research into the bone metabolism around a Charcot foot, with an emphasis on the biochemical profile. The existing data regarding attempts at medical treatment is also reviewed, including novel trials targetting specific inflammatory pathways upregulated in the acute diabetic Charcot foot.
Published: 2018

16. Sarcopenia and body composition in diabetic Charcot osteoarthropathy

Author: Rasmus Bo Jansen, Lene Rørdam, Ole Lander Svendsen, Per Holstein, Tomas Møller Christensen, and Jens Bülow
Subjects: Adult, Male, Sarcopenia, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Population, Severity of Illness Index, Gastroenterology, Body Mass Index, Cohort Studies, Absorptiometry, Photon, Age Distribution, Endocrinology, Predictive Value of Tests, Reference Values, Spinal osteoarthropathy, Internal medicine, Diabetes mellitus, Osteoarthritis, Diabetes Mellitus, Internal Medicine, medicine, Humans, Sex Distribution, education, Aged, Analysis of Variance, education.field_of_study, business.industry, Incidence, Amyotrophic Lateral Sclerosis, Case-control study, Middle Aged, Prognosis, medicine.disease, Case-Control Studies, Body Composition, Lean body mass, Population study, Female, business, Body mass index
Abstract: Background Treatment of Charcot osteoarthropathy (COA) requires restricted walking and offloading for several months, which lead to fat re-distribution and increased sarcopenia. Objectives/Aim To investigate whether subjects with COA have an altered body composition compared to controls. Methods Cross-sectional case-control study of people with diabetes with acute or chronic Charcot osteoarthropathy, matched with otherwise healthy people with diabetes. A total of 49 subjects (distribution ~ 1:1) had a total body DXA-scanning, measuring appendicular lean mass, android/gynoid and truncal/total body fat distribution ratios. Results Sarcopenia frequency was higher in the total population with diabetes overall (9–40%), compared to normal materials. Using two different models for correlating appendicular lean mass to sarcopenia, there were no differences in sarcopenia-rates between the groups (P = 0.413 and 0.948 respectively). There was no significant difference in lean tissue mass between the affected and the unaffected leg in the immobilised subject group (P = 0.830). The average fat percentage was (29.4–37.7%) in the population with diabetes, compared to a matching background population (24.5–31.9%), whereas there were no significant differences found between the groups (P = 0.065). Neither truncal/total fat percent nor android/gynoid fat percent ratios showed differences between the groups. Conclusion To our knowledge, this is the first published dataset investigating body composition in subjects with Charcot osteoarthropathy. The study population of diabetics were more fat and sarcopenic than normal subjects, whereas no statistically significant impact of Charcot osteoarthropathy was found.
Published: 2015
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17. Bone Loss in Women with Type 1 Diabetes

Author: Ole Lander Svendsen, Maj-Britt Tanderup Jørgensen, and Jesper Olund Christensen
Subjects: Bone mineral, Type 1 diabetes, education.field_of_study, business.industry, Osteoporosis, Population, Physiology, medicine.disease, Bone remodeling, medicine.anatomical_structure, Forearm, medicine, Outpatient clinic, education, business, Femoral neck
Abstract: Background: Although osteoporosis has been investigated and debated in the diabetic population over the past decades, very little is known about the spontaneous changes in bone mineral density (BMD) and biochemical markers of bone turnover in pre- and postmenopausal type 1 diabetic (T1DM) women over time. Aim: To measure spontaneous changes in BMD and biochemical markers of bone turnover in pre- and postmenopausal T1DM women. Subjects: 53 T1DM women (31 premenopausal and 22 postmenopausal) from the outpatient clinic were enrolled in the study in 1993 and 35 (22 premenopausal, 13 postmenopausal) were reexamined in 1997. Method: BMD was measured at femoral neck (f.n.), spine (L2 - L4), total body and forearm with DXA or SXA in 53 T1DM women. 4 years later a re-scan was carried out on 35 T1DM. Results: In premenopausal subjects a yearly decrease less than 1% at f.n., spine, forearm and total body was observed, though only statistically significant (s.s.) at f.n., p ≤ 0.05. In postmenopausal subjects a s.s. decrease less than 2% was observed at f.n., forearm and total body, p ≤ 0.05. In general, osteopenic or osteoporotic values were observed at the measured skeletal sites. Only at f.n. a lower s.s. BMD compared to age-matched reference women was seen. Conclusion: Small or non-significant changes in BMD and biochemical markers of bone turnover were observed in pre- and postmenopausal T1DM subjects after a 4-year period.
Published: 2015
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18. Bone mineral density and markers of bone turnover and inflammation in diabetes patients with or without a Charcot foot: An 8.5-year prospective case-control study

Author: Per Holstein, Tomas Møller Christensen, Lene Rørdam, Niklas Rye Jørgensen, Ole Lander Svendsen, Rasmus Bo Jansen, and Jens Bülow
Subjects: Male, Time Factors, Bone markers, Endocrinology, Diabetes and Metabolism, Osteoporosis, RANK-L, Bone remodeling, Diabetes mellitus, 0302 clinical medicine, Endocrinology, Diabetic Neuropathies, Bone Density, Charcot foot, 030212 general & internal medicine, Longitudinal Studies, Bone mineral, Middle Aged, Diabetic Foot, Female, Bone Remodeling, medicine.symptom, Arthropathy, Neurogenic, Foot (unit), musculoskeletal diseases, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, 030209 endocrinology & metabolism, Inflammation, 03 medical and health sciences, Internal medicine, Bone mineral density, Internal Medicine, medicine, Diabetes Mellitus, Humans, Aged, business.industry, Case-control study, medicine.disease, Neuropathy, nervous system diseases, Surgery, Peripheral neuropathy, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Case-Control Studies, business, Biomarkers, Follow-Up Studies
Abstract: BACKGROUND AND AIMS: Charcot foot is a rare but severe complication to diabetes and peripheral neuropathy. It is still unclear if an acute Charcot foot has long-term effects on the bone metabolism. To investigate this, we conducted a follow-up study to examine if a previously acute Charcot foot has any long-term effects on bone mineral density (BMD) or local or systemic bone metabolism.METHODS: An 8.5-year follow-up case-control study of 44 individuals with diabetes mellitus, 24 of whom also had acute or chronic Charcot foot at the baseline visit in 2005-2007, who were followed up in 2015 with DXA scans and blood samples.RESULTS: 21 of the 44 baseline participants participated in the follow-up. There were no difference in the change in total hip BMD from baseline to follow-up in either the Charcot or the control group (p = 0.402 and 0.517), and no increased risk of osteoporosis in the previous Charcot feet either. From baseline to follow-up, there was a significant difference in the change in levels of fsRANK-L in the Charcot group, but not in the control group (p = 0.002 and 0.232, respectively). At follow-up, there were no differences in fsRANK-L between the groups. The fsRANK-L/OPG ratio also significantly decreased from baseline to follow-up in the Charcot group (3.4 versus 0.5) (p = 0.009), but not in the control group (1.3 versus 1.1) (p = 0.302).CONCLUSION: We found that diabetes patients with an acute Charcot foot have an elevated fsRANK-L/OPG ratio, and that the level decreased from baseline to follow-up to be comparable to the level in diabetes patients without previous or current Charcot foot. We found no permanent effect of an acute Charcot foot on hip or foot BMD.
Published: 2017
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19. Clinical management of acute diabetic Charcot foot in Denmark

Author: Rasmus Bo, Jansen, Ole Lander, Svendsen, and Klaus, Kirketerp-Møller
Subjects: Denmark, Population Surveillance, Disease Management, Humans, Morbidity, Podiatry, Diabetic Foot
Abstract: Charcot foot is a severe complication to diabetes mellitus and treatment involves several different clinical specialities. Our objective was to describe the current awareness, knowledge and treatment practices of Charcot foot among doctors who handle diabetic foot disorders.This study is based on a questionnaire survey sent out to healthcare professionals, primarily doctors, working with diabetic foot ulcers and Charcot feet in the public sector of the Danish healthcare system.The survey obtained a 52% response rate. A temperature difference of2 °C between the two feet was the most used method of diagnosing Charcot foot. Along with clinical inspection, temperature difference was also the measurement used for monitoring of healing. None of the suggested formalised classification systems were used to any extent. Most responders use detachable bandages for offloading (83%). All centres use some form of a multidisciplinary team, with the most common permanent members being orthopaedic surgeons (71%), wound specialist nurses (76%), podiatrists (65%), endocrinologists (47%) and diabetes specialist nurses (41%).We conducted a survey of the diagnosis and treatment practices of acute diabetic Charcot foot at diabetes foot clinics in Denmark. The responders seem to follow the international recommendations and guidelines on management of the acute diabetic Charcot foot, despite a lack of Danish guidelines.none.not relevant.
Published: 2016

20. Design, history and results of the Thiazolidinedione Intervention with vitamin D Evaluation (TIDE) randomised controlled trial

Author: MOSES ELISAF, Salim Yusuf, Gianpaolo Reboldi, Ole Lander Svendsen, A.S. Ametov, Fernando Lanas, Nicolae Hancu, Asad Bhorat, Jose Sgarbi, Irina Chazova, Hertzel Gerstein, Jackie Bosch, JOSE PAZ-IBARRA, Fernando Manzur, Jurisic-Erzen Dubravka, and Andrzej Budaj
Subjects: Vitamin, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Type 2 diabetes, Placebo, law.invention, Rosiglitazone, chemistry.chemical_compound, Randomized controlled trial, Double-Blind Method, law, Risk Factors, Internal medicine, Neoplasms, Internal Medicine, medicine, Vitamin D and neurology, Humans, Hypoglycemic Agents, placebocontrolled randomised trial, pioglitazone, studio clinico randomizzato contro placebo, cardiovascular disease, vitamina d, diabete di tipo 2, placebo-controlled randomised trial, rosiglitazone, type 2 diabetes, vitamin d, patologie cardiovascolari, Aged, Cholecalciferol, Dose-Response Relationship, Drug, Pioglitazone, business.industry, Incidence, Middle Aged, medicine.disease, Combined Modality Therapy, chemistry, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Dietary Supplements, Early Termination of Clinical Trials, Physical therapy, Female, Thiazolidinediones, business, medicine.drug
Abstract: Aims/objective Conflicting data regarding cardiovascular effects of thiazolidinediones (TZDs) and extra-skeletal effects of vitamin D supported the need for a definitive trial. The Thiazolidinedione Intervention with vitamin D Evaluation (TIDE) trial aimed to assess the effects of TZDs (rosiglitazone and pioglitazone) on cardiovascular outcomes and the effects of vitamin D (cholecalciferol) on cancers and mortality. Methods A large multicentre 3 × 2 factorial double-blind placebo-controlled randomised trial recruited from outpatient primary care and specialty clinics in 33 countries. From June 2009 to July 2010, 1,332 people with type 2 diabetes and other cardiovascular risk factors aged ≥ 50 years whose HbA(1c) was 6.5-9.5% (48-80 mmol/mol) when using two or fewer glucose-lowering drugs were randomised by a central computer system to placebo (n = 541), rosiglitazone 4-8 mg/day (n = 399) or pioglitazone 30-45 mg/day (n = 392); 1,221 participants were randomised to placebo (n = 614) or vitamin D 1,000 IU/day (n = 607). Participants and all study personnel were blind to treatment allocation. The primary outcome for the TZD arm was the composite of myocardial infarction, stroke or cardiovascular death, and for the vitamin D arm it was cancer or all-cause death. All randomised participants were included in the primary analysis. Results From the study design, 16,000 people were to be followed for approximately 5.5 years. However, the trial was stopped prematurely because of regulatory concerns after a mean of 162 days without consideration of the accrued data. In the TZD arm, the cardiovascular outcome occurred in five participants (0.9%) in the placebo groups and three participants (0.4%) in the TZD groups (two allocated to pioglitazone, one to rosiglitazone). In the vitamin D arm, the primary outcome occurred in three participants (0.5%) in the placebo group and in two participants (0.3%) receiving vitamin D. Adverse events were comparable in all groups. Conclusions/interpretation Uncertainty persists regarding the clinically relevant risks and benefits of TZDs and vitamin D because of the early cancellation of this comprehensive trial.
Published: 2016
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21. Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker

Author: Lis W. Pedersen, Ole Lander Svendsen, Per Holstein, Birthe Gade-Rasmussen, Tomas Møller Christensen, and Eva Hommel
Subjects: Adult, medicine.medical_specialty, Time Factors, Exacerbation, Endocrinology, Diabetes and Metabolism, medicine.disease_cause, Severity of Illness Index, Walkers, Weight-bearing, Weight-Bearing, Endocrinology, Diabetic Neuropathies, Recurrence, Spinal osteoarthropathy, Edema, Severity of illness, Arthropathy, Internal Medicine, Humans, Medicine, Aged, Retrospective Studies, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, Diabetic Foot, Exercise Therapy, Surgery, Casts, Surgical, Regimen, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Arthropathy, Neurogenic, medicine.symptom, business, Follow-Up Studies
Abstract: Objective Recent literature on acute diabetic Charcot osteoarthropathy (CA) reports unusually long periods of off-loading. Data suggest that this might increase the re-currence rate. Subsequently we evaluated the influence of duration of off-loading on the risk of required re-casting. Research Design and Methods In this retrospective consecutive series from 2000 to 2005, 56 people with diabetes and an acute Charcot foot were included. The inclusion criteria were an initial persistent temperature difference more than 2°C between the two feet, oedema, and typical hot spots on a bone scintigram, radiology, and a typical clinical course. Treatment was off-loading in a removable cast and 2 crutches. In-door walking was allowed. Gradually augmented weight bearing was prescribed when the skin temperature difference had decreased to a level less than 2°C and edema had subsided. Re-casting was required for immediate exacerbation during re-load as well as for recurrence — defined as new swelling and skin temperature difference of more than 2°C in the same foot occurring after a stable interval of at least one month after full weight bearing. Results The duration of off-loading for all patients was 141±21days (mean±SD). Three patients (5%) were re-casted immediately for exacerbation after re-load and 7 patients (12 %) after recurrence of the CA. Duration of re-casting was 79±44days. The primary period of off-loading was not statistically significantly different for those not requiring versus those requiring re-casting: 142±24days compared to 134±41days. Neither were the differences in demographic data, metabolic regulation, BMI or localization of CA. Conclusions Patients with risk of exacerbation or recurrence of CA could not be identified in the present study and there was no relation to the duration of off-loading. Nevertheless off-loading periods with immobilisation should be kept as short as possible, due to other side effects. This can be obtained by early gradual augmented re-loading.
Published: 2012
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22. Efficacy and safety of the PPARγ partial agonist balaglitazone compared with pioglitazone and placebo: a phase III, randomized, parallel-group study in patients with type 2 diabetes on stable insulin therapy

Author: Kim, Henriksen, Inger, Byrjalsen, Per, Qvist, Henning, Beck-Nielsen, Gitte, Hansen, Bente J, Riis, Hans, Perrild, Ole Lander, Svendsen, Jeppe, Gram, Morten A, Karsdal, Claus, Christiansen, and Hannu, Haapamäki
Subjects: Blood Glucose, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Urology, Type 2 diabetes, Weight Gain, Placebo, Partial agonist, law.invention, Endocrinology, Double-Blind Method, Randomized controlled trial, Bone Density, law, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, Hypoglycemic Agents, Insulin, Aged, Glycated Hemoglobin, Dose-Response Relationship, Drug, Pioglitazone, business.industry, Middle Aged, Water-Electrolyte Balance, medicine.disease, PPAR gamma, Diabetes Mellitus, Type 2, Body Composition, Quinazolines, Drug Therapy, Combination, Female, Thiazolidinediones, medicine.symptom, business, Weight gain, medicine.drug
Abstract: Background Treatment of patients with perioxisome proliferator-activated receptor-γ full agonists are associated with weight gain, heart failure, peripheral oedema, and bone loss. However, the safety of partial perioxisome proliferator-activated receptor-γ agonists has not been established in a clinical trial. The BALaglitazone glucose Lowering Efficacy Trial aimed to establish the glucose-lowering effects and safety parameters of the perioxisome proliferator-activated receptor-γ partial agonist balaglitazone in diabetic patients on stable insulin therapy. Methods Four hundred and nine subjects from three countries with type 2 diabetes on stable insulin therapy were randomized to 26 weeks of double-blind treatment with once daily doses of 10 or 20 mg balaglitazone, 45 mg pioglitazone, or matching placebo (n ≥ 99 in each group). The primary endpoint was the efficacy of balaglitazone 10 and 20 mg versus placebo on the absolute change in haemoglobin A1c. Secondary endpoints included levels of fasting serum glucose, and changes in body composition and bone mineral density as measured by dual energy X-ray absorptiometry, in comparison to pioglitazone 45 mg. This study is registered with Clinicaltrials.gov identifier: NCT00515632. Results In the 10- and 20-mg balaglitazone groups, and in the 45-mg pioglitazone group, significant reductions in haemoglobin A1c levels were observed (−0.99, − 1.11, and − 1.22%, respectively; p < 0.0001) versus placebo. Fasting serum glucose was similarly reduced in all treatment arms. Dual energy X-ray absorptiometry analyses showed that, while balaglitazone at 10 mg caused weight gain and fluid retention compared to placebo, the magnitude of these effects was significantly smaller than that of pioglitazone 45 mg and balaglitazone 20mg. Balaglitazone at either dose did not appear to reduce bone mineral density, while Pioglitazone showed a trend towards a reduction. Conclusion Patients treated with balaglitazone at 10 mg and 20 mg and pioglitazone at 45 mg showed clinically meaningful improvements in glucose levels and HbA1c. With the 10 mg dose, the benefits (glucose & HgA1c lowering) and untoward effects (fluid and fat accumulation) were less, results that encourage further studies of this drug candidate. Copyright © 2011 John Wiley & Sons, Ltd.
Published: 2011
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23. Aliskiren Combined with Losartan in Type 2 Diabetes and Nephropathy

Author: Katarina Kos, Giuseppe Remuzzi, Frederik Persson, Ole Lander Svendsen, Tatiana Adasheva, Vladimir Zadionchenko, ANNA OLIVERAS, Davide Carvalho, and Luis M Ruilope
Subjects: medicine.medical_specialty, business.industry, Urology, General Medicine, Aliskiren, Placebo, medicine.disease, Angiotensin II, Nephropathy, Diabetic nephropathy, chemistry.chemical_compound, Endocrinology, Losartan, Blood pressure, chemistry, Internal medicine, medicine, business, medicine.drug, Kidney disease
Abstract: Background Diabetic nephropathy is the leading cause of end-stage renal disease in developed countries. We evaluated the renoprotective effects of dual blockade of the renin−angio tensin−aldosterone system by adding treatment with aliskiren, an oral direct renin inhibitor, to treatment with the maximal recommended dose of losartan (100 mg daily) and optimal antihypertensive therapy in patients who had hypertension and type 2 diabetes with nephropathy. Methods We enrolled 599 patients in this multinational, randomized, double-blind study. After a 3-month, open-label, run-in period during which patients received 100 mg of losartan daily, patients were randomly assigned to receive 6 months of treatment with aliskiren (150 mg daily for 3 months, followed by an increase in dosage to 300 mg daily for another 3 months) or placebo, in addition to losartan. The primary outcome was a reduction in the ratio of albumin to creatinine, as measured in an earlymorning urine sample, at 6 months. Results The baseline characteristics of the two groups were similar. Treatment with 300 mg of aliskiren daily, as compared with placebo, reduced the mean urinary albumin-tocreatinine ratio by 20% (95% confidence interval, 9 to 30; P
Published: 2008
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24. Treatment of diabetic ketoacidosis in adults in Denmark: A national survey

Author: Julie B. Prahl, Otto M. Henriksen, Ole Lander Svendsen, and Michael E Røder
Subjects: Adult, medicine.medical_specialty, Isotonic saline, Diabetic ketoacidosis, Denmark, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Sodium Chloride, Diabetic Ketoacidosis, law.invention, Endocrinology, law, Surveys and Questionnaires, Diabetes mellitus, Internal Medicine, medicine, Humans, Insulin, Practice Patterns, Physicians', Intensive care medicine, Adult patients, business.industry, General Medicine, medicine.disease, Intensive care unit, Patient Care Management, Ketoacidosis, Clinical trial, Bicarbonates, Intensive Care Units, Health Care Surveys, Practice Guidelines as Topic, Emergency medicine, Fluid Therapy, Isotonic Solutions, business
Abstract: The aims of this study were to investigate management routines of diabetic ketoacidosis (DKA) in adult patients in departments of internal medicine in Denmark and to relate current routines of treatment to available evidence. A questionnaire requesting information on management routines of DKA was sent to all departments of internal medicine in Denmark responsible of managing DKA. Fifty-nine departments (88%) returned the questionnaire and/or a copy of their management protocol. At 19 departments (32%), all patients with DKA were managed in an intensive care unit (ICU). Twenty-four different insulin regimens and 21 fluid protocols were identified. Routines of insulin therapy varied in terms of doses and routes of administration. Fifty-eight departments (97%) used isotonic saline for hydration. Potassium supplements were administered as a separate infusion of either isotonic potassium-sodium-chloride (83%) or isotonic potassium-chloride (10%). Recommended volumes to be administered during the first 8 h of treatment varied significantly (median 4800 ml, range 3750–7700 ml). Use of bicarbonate was endorsed by 80%. This study shows significant variations in management routines of DKA in Denmark. In many cases, the treatment routines employed are not supported by evidence from clinical trials. We recommend implementation of national and/or European guidelines for management of DKA in adult patients.
Published: 2007
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25. Diabetic ketoacidosis in Denmark

Author: Otto M. Henriksen, Ole Lander Svendsen, Michael E Røder, and Julie B. Prahl
Subjects: medicine.medical_specialty, education.field_of_study, Pediatrics, Diabetic ketoacidosis, business.industry, Endocrinology, Diabetes and Metabolism, Incidence (epidemiology), Population, General Medicine, Type 2 diabetes, medicine.disease, Surgery, Ketoacidosis, Endocrinology, Diabetes mellitus, Epidemiology, Internal Medicine, medicine, business, education, Cause of death
Abstract: The aims of this study were to estimate incidence of diabetic ketoacidosis and mortality from diabetic ketoacidosis using data from public health registries. Four thousand eight hundred and seven admissions in the period 1996-2002 and 137 deaths in the period 1996-2000 with a diagnosis of diabetic ketoacidosis were identified from the Danish National Patient Registry and Danish Cause of Death Registry, respectively. Annual incidence of diabetic ketoacidosis in the general population was estimated to 12.9 per 100,000, being higher in males than in females (14.4 versus 11.4 per 100,000, p 50 years. Overall mortality was 4%, being higher in patients >70 years than in patients < or =70 years (15% versus 2%, p
Published: 2007
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26. The management of diabetic foot ulcers in Danish hospitals is not optimal

Author: Klaus, Kirketerp-Møller, Ole Lander, Svendsen, and Rasmus Bo, Jansen
Subjects: Patient Care Team, Clinical Protocols, Denmark, Surveys and Questionnaires, Practice Guidelines as Topic, Hospital Departments, Disease Management, Humans, Guideline Adherence, Diabetic Foot
Abstract: The diabetic foot is a complicated health issue which ideally involves several different specialists to ensure the most effective treatment. The Danish Health and Medicines Authority recently published a national guideline to address the implementation of multidisciplinary teams in the treatment. The objective of this study was to describe the treatment practices at the time the guidelines were launched.A questionnaire-based survey was conducted among Danish hospital departments working with diabetic feet. All public departments were invited by e-mail to participate and the participant answering the questionnaire was identified as knowledgeable about the department's procedures on treatment of diabetic feet. Only one questionnaire per department was allowed.A total of 62 questionnaires were sent out. We achieved a response rate of ~37% (n = 23). Respondents (n = 13) were mostly orthopaedic surgeons. A classification system of the diabetic foot was rarely or never used, and eight respondents (42%) reported having a multidisciplinary team in accordance with the national guidelines. 73% of the respondents performed some form of surgical intervention on diabetic feet, mainly minor procedures.The study demonstrated that several areas of treatment practices relating to the diabetic foot had potential for improvement as they did not adhere to national Danish guidelines. A follow-up survey, allowing time for local implementation, seems warranted.
Published: 2015

27. The effect of oral loading doses of cholecalciferol on the serum concentration of 25-OH-vitamin-D

Author: Rasmus Bo Jansen and Ole Lander Svendsen
Subjects: Adult, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Urology, Medicine (miscellaneous), Loading dose, vitamin D deficiency, Body Mass Index, chemistry.chemical_compound, Internal medicine, medicine, Vitamin D and neurology, Humans, Prospective Studies, Vitamin D, Aged, Cholecalciferol, Retrospective Studies, Nutrition and Dietetics, Dose-Response Relationship, Drug, business.industry, General Medicine, Serum concentration, Middle Aged, medicine.disease, Vitamin D Deficiency, Endocrinology, chemistry, Dietary Supplements, Female, business, Algorithms
Abstract: Background/Objectives: Severe vitamin D deficiency can be treated with oral loading doses of cholecalciferol. Our objective was to develop an algorithm to accurately calculate the amount of cholecalciferol needed for a loading dose, and what factors should be taken into account.Methods: Two studies were conducted on subjects with Vitamin D deficiency. Study 1 was observational, retrospective and included 88 subjects treated with a daily supplementation of cholecalciferol. 60 of these furthermore received a loading dose, calculated by an algorithm.Study 2 was prospective and included 29 subjects treated with a cholecalciferol loading dose, calculated by an algorithm developed based on data from study 1, which included BMI.Results: Baseline 25OH-vit.D was below 25 nmol/L (study 1) and 23 nmol/L (study 2). Subjects were given a single loading dose of cholecalciferol, averaging 172,000 IU (study 1) and 212,000 IU (study 2), based on their baseline 25OH-vit.D level.25OH-vit.D increased by 35 nmol/L (study 1) and 56 nmol/L (study 2)(range 113.0, SD 29.79) respectively. In study 2 the increase lead to an end 25OH-vit.D of 79 nmol/L - not significantly different from the target value of 80 nmol/L (P = 0.46). The increase in 25OH-vit.D in study 1 was significantly lower than in study 2 (P
Published: 2015

28. Abnormal bone collagen morphology and decreased bone strength in growth hormone-deficient rats

Author: Klaus Qvortrup, Ole Lander Svendsen, Ulla Feldt-Rasmussen, Michael M. Petersen, Allan Flyvbjerg, Jette Nowak, Klaus Olgaard, and Martin Lange
Subjects: Male, medicine.medical_specialty, Histology, Morphology (linguistics), Bone density, Physiology, Fibrillar Collagens, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Bone and Bones, Growth hormone deficiency, Absorptiometry, Photon, Bone strength, Microscopy, Electron, Transmission, Bone Density, Internal medicine, medicine, Animals, Insulin-Like Growth Factor I, Bone mineral, Bone collagen, business.industry, Growth factor, medicine.disease, Biomechanical Phenomena, Extracellular Matrix, Rats, Insulin-Like Growth Factor Binding Protein 3, medicine.anatomical_structure, Endocrinology, Growth Hormone, Microscopy, Electron, Scanning, Female, Cortical bone, Collagen, business
Abstract: Patients with growth hormone deficiency (GHD) have an increased risk of bone fractures. In these patients, the well-described decrease in bone mineral density (BMD) and content (BMC) may, however, not alone explain the increase in fracture rate. Accordingly, the aim of this study was to evaluate collagen morphology and bone mineralisation in cortical bone as well as bone strength in GHD rats to try to clarify the explanation for the increased fracture rate. The Dw-4 rat was used as a model for GHD. This strain of rats has an autosomal recessive disorder, reducing GH synthesis to approximately 10% and growth rate to approximately 40-50% when compared to normal control rats. Five male Dw-4 rats were examined at age 12 weeks and five healthy Lewis rats served as age-matched controls. The animals were examined for (1) bone mineral status by dual energy X-ray absorptometry (DXA) and ash weight/bone volume, (2) biomechanical properties, (3) serum insulin-like growth factor I (IGF-I) and IGF binding protein 3 (IGFBP-3), and (4) collagen morphology of cortical bone from the right femurs was examined by scanning and transmission electron microscopy. A significant decrease was found in serum IGF-I, IGFBP-3 and biomechanical properties in GHD rats compared to controls (P < 0.009). While DXA-derived BMD was decreased, no significant difference was found in ash weight/bone volume. Electron microscopy showed a significant decrease in the number and a significant increase in the diameter of collagen microfibrils in GHD rats as compared to their controls (P < 0.009). In conclusion, we report for the first time that collagen morphology in bone is markedly altered in rats with isolated GHD. Whether similar conditions are present in GHD patients need further investigations. The changes described, however, may provide a co-explanation for the increased fracture rate in GHD.
Published: 2004
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29. High Risk of Adrenal Insufficiency in Adults Previously Treated for Idiopathic Childhood Onset Growth Hormone Deficiency

Author: Anders Juul, Ole Lander Svendsen, Ulla Feldt-Rasmussen, Martin Lange, K W Kastrup, and Jørn Müller
Subjects: Adult, Male, medicine.medical_specialty, Hydrocortisone, Cross-sectional study, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Clinical Biochemistry, Risk Assessment, Biochemistry, Growth hormone deficiency, Endocrinology, Internal medicine, medicine, Adrenal insufficiency, Humans, Insulin, Insulin-Like Growth Factor I, Pathological, Somatotropin Deficiency, Human Growth Hormone, business.industry, Biochemistry (medical), Insulin tolerance test, Liter, medicine.disease, Cross-Sectional Studies, Cosyntropin, Female, business, Metabolism, Inborn Errors, Adrenal Insufficiency
Abstract: The aim was to reevaluate a group of adults treated for idiopathic childhood onset GH deficiency (GHD) after 18 yr without GH treatment. Twenty-six (11 females) patients participated. All but two had isolated GHD. Childhood diagnosis was established by insulin tolerance test (ITT). The patients were retested with an ITT to evaluate adult GH status. In five patients, an arginine and a synacthen test were performed instead of an ITT. Eleven of 25 patients had a subnormal cortisol response to ITT or synacthen. Ten patients had a GH peak less than 3.0 μg/liter (0.5. ± 0.5 μg/liter), whereas 16 patients displayed a normal GH response (12.3 ± 10.6 μg/liter) after ITT. IGF-I values were decreased in the patients with a pathological retest as well as in patients with a normal GH response compared with controls (P < 0.005). In 26 idiopathic childhood onset GHD patients, 44% of the patients had developed adrenal insufficiency; 38.5% had persistent GHD in adulthood, using the same test in both childhood and adulthood. Patients having a normal GH test had decreased IGF-I levels, compared with controls, indicating impaired function of a seemingly normal GH axis. It is imperative that pituitary axes other than the GH axis are tested at regular intervals, even in the absence of GHD in adulthood.
Published: 2003
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30. Variations in percentage of body fat within different BMI groups in young, middle-aged and old women

Author: Philip J. Larsen, Claus Christiansen, László B. Tankó, Lusine Movsesyan, and Ole Lander Svendsen
Subjects: medicine.medical_specialty, Physiology, business.industry, Cross-sectional study, nutritional and metabolic diseases, General Medicine, Anthropometry, Overweight, medicine.disease, Obesity, Middle age, Endocrinology, Classification of obesity, Physiology (medical), Internal medicine, Medicine, Underweight, medicine.symptom, business, Body mass index, Demography
Abstract: Summary Objectives: The objective of the present study was to characterize age-dependent variations in percentage of body fat within different body mass index (BMI) classes in healthy Danish women. Design: Cross-sectional analysis. Settings: The study was done at the Center for Clinical and Basic Research, Ballerup, Denmark. Subjects: Four hundred and four healthy women aged 18–75 years were included in the present study. Measurements: Fat tissue mass was estimated using dual-energy X-ray absorptiometry. Menopausal status and physical characteristics were also registered. Results: Mean values of percentage of body fat calculated in the normal and overweight BMI groups were higher in middle-aged and old women compared with young women. No significant differences were seen in the underweight and obese BMI groups. The cut-off levels between normal and overweight and between overweight and obesity were 35–43% and 40–50%, respectively. Conclusion: The percentage of body fat is dependent on both age and menopausal status within each of the following BMI classes: from 20 to 25 and from 25 to 30, further emphasizing that BMI has limitations when used generally as an indicator of body fatness, and argues for defining BMI cut-off values age-specifically.
Published: 2003
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31. Comparisons of leptin, incretins and body composition in obese and lean patients with hypopituitarism and healthy individuals

Author: Henriette Mersebach, Arne Astrup, Ulla Feldt-Rasmussen, Ole Lander Svendsen, and Jens J. Holst
Subjects: Anterior hypopituitarism, medicine.medical_specialty, business.industry, Cross-sectional study, Endocrinology, Diabetes and Metabolism, Leptin, Insulin, medicine.medical_treatment, Case-control study, Hypopituitarism, medicine.disease, Glucagon-like peptide-1, Obesity, Endocrinology, Internal medicine, Medicine, business
Abstract: Summary objective To identify possible abnormalities specific for obesity in hypopituitary patients. study design Cross-sectional case–control study. measurements and study subjects Body composition (DEXA) and measurements of fasting plasma levels of glucose-dependent insulinotropic polypeptide (GIP), glucagon-like peptides (GLPs), insulin, C-peptide, glucose, leptin and lipids were performed in 25 hypopituitary patients (15 obese, 10 normal weight) and 26 BMI and age-matched healthy controls (16 obese, 10 normal weight). All hypopituitary patients had GH deficiency and received adequate substitution therapy on this and other deficient axes (3 ± 1). results Fasting GIP-levels were significantly higher in obese hypopituitary patients compared to lean hypopituitary patients (P
Published: 2003
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32. Are soft tissue composition of bone and non-bone pixels in spinal bone mineral measurements by DXA similar? Impact of weight loss

Author: Anders Gotfredsen, Ole Lander Svendsen, Helle W. Hendel, Birthe Højlund Pedersen, and Teis Andersen
Subjects: musculoskeletal diseases, Bone mineral, Bone density, medicine.diagnostic_test, Physiology, business.industry, musculoskeletal, neural, and ocular physiology, Radiography, Soft tissue composition, Soft tissue, General Medicine, musculoskeletal system, Weight loss, Physiology (medical), Medicine, medicine.symptom, business, Nuclear medicine, Densitometry, Dual-energy X-ray absorptiometry
Abstract: Weight loss seems associated with a decrease in bone mineral density (BMD) as measured by absorptiometry, which may be the result of accuracy errors caused by differences in soft tissue between non-bone and bone pixels. The aim was to study the abdominal fat% and thickness in regions corresponding to non-bone, soft tissue-only and bone pixels for spinal BMD measurements by dual energy X-ray absorptiometry (DXA), and to calculate the theoretical errors in measurement of changes in BMD by DXA as a result of changes in soft tissue heterogeneity with weight loss. Abdominal computed tomography (CT) and DXA scans were performed in 34 obese subjects (42.1+/-10.1 years (mean +/- SD), wt: 102.1+/-12.8 kg and BMI: 36.6+/-3.8 kg m(-2)) before and after weight loss (11.3+/-6.9 kg after 1 year). There were some significant differences in fat% and thickness of soft tissue between abdominal regions corresponding to non-bone and bone pixels, respectively, for spinal BMD measurements by DXA, both before and after weight loss. With weight loss there were some changes in the soft tissue heterogeneity, which caused a minor theoretical error (apparent, but false decrease of 1-2%) of borderline significance for the anterior-posterior (AP) spinal BMD by DXA.
Published: 2002
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33. Are soft tissue composition of bone and non-bone pixels in spinal bone mineral measurements by DXA similar? Impact of weight loss

Author: Ole Lander, Svendsen, Helle W, Hendel, Anders, Gotfredsen, Birthe Højlund, Pedersen, and Teis, Andersen
Subjects: Adult, Male, Orlistat, Radiography, Abdominal, Physiology, General Medicine, Middle Aged, Spine, Lactones, Absorptiometry, Photon, Bone Density, Weight Loss, Humans, Female, Anti-Obesity Agents, Obesity, Tomography, X-Ray Computed
Abstract: Weight loss seems associated with a decrease in bone mineral density (BMD) as measured by absorptiometry, which may be the result of accuracy errors caused by differences in soft tissue between non-bone and bone pixels. The aim was to study the abdominal fat% and thickness in regions corresponding to non-bone, soft tissue-only and bone pixels for spinal BMD measurements by dual energy X-ray absorptiometry (DXA), and to calculate the theoretical errors in measurement of changes in BMD by DXA as a result of changes in soft tissue heterogeneity with weight loss. Abdominal computed tomography (CT) and DXA scans were performed in 34 obese subjects (42.1+/-10.1 years (mean +/- SD), wt: 102.1+/-12.8 kg and BMI: 36.6+/-3.8 kg m(-2)) before and after weight loss (11.3+/-6.9 kg after 1 year). There were some significant differences in fat% and thickness of soft tissue between abdominal regions corresponding to non-bone and bone pixels, respectively, for spinal BMD measurements by DXA, both before and after weight loss. With weight loss there were some changes in the soft tissue heterogeneity, which caused a minor theoretical error (apparent, but false decrease of 1-2%) of borderline significance for the anterior-posterior (AP) spinal BMD by DXA.
Published: 2002
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34. Efficacy and Safety of the Partial PPARγ Agonist Balaglitazone Compared with Pioglitazone and Placebo: A Phase III, Randomized, Parallel-Group Study in Patients with Type 2 Diabetes on Stable Insulin Therapy

Author: Kim Henriksen, Inger Byrjalsen, Per Qvist, Henning Beck-Nielsen, Gitte Hansen, Bente Juul Riis, Hans Perrild, Ole Lander Svendsen, Jeppe Gram, Morten Asser Karsdal, and Claus Christiansen
Published: 2011
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35. Accuracy of measurements of body composition by dual-energy x-ray absorptiometry in vivo

Author: Jens Haarbo, Christian Hassager, Ole Lander Svendsen, and C. Christiansen
Subjects: Adult, Male, Swine, Analytical chemistry, Medicine (miscellaneous), Adipose tissue, Sensitivity and Specificity, Dual energy absorptiometry, Absorptiometry, Photon, In vivo, medicine, Animals, Humans, Dual-energy X-ray absorptiometry, Aged, Bone mineral, Nutrition and Dietetics, medicine.diagnostic_test, business.industry, Chemistry, Lean tissue, Middle Aged, Percent fat, Body Composition, Lean body mass, Female, Nuclear medicine, business
Abstract: The accuracy of body-composition measurements in vivo by dual-energy x-ray absorptiometry (DEXA) was assessed in seven pigs (weight: 35-95 kg) by measurement by DEXA in vivo and chemical analysis after postmortem homogenization. The regression lines between these measurements were not significantly different from the line of identity (P > 0.05), the r values were > 0.97, and the corresponding SEEs were 2.9%, 1.9 kg, and 2.7 kg for percent fat, fat tissue mass, and lean body mass, respectively. Changes in fat and lean tissue mass (simulated by placing 8.8 kg porcine lard on the trunk of six women) were accurately measured by DEXA. The measured total-body bone mineral (TBBM) was significantly affected by the lard (P < 0.05). In conclusion, DEXA is an accurate method for measurement of soft-tissue body composition. TBBM measurements in longitudinal studies may, however, be difficult to interpret if considerable change in soft-tissue composition has occurred.
Published: 1993
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36. Sympathetic neuropathy in diabetes mellitus patients does not elicit Charcot osteoarthropathy

Author: Lene Simonsen, Per Holstein, Ole Lander Svendsen, Tomas Møller Christensen, and Jens Bülow
Subjects: Male, medicine.medical_specialty, Sympathetic Nervous System, Endocrinology, Diabetes and Metabolism, Diaphragmatic breathing, Hyperemia, Autonomic Nervous System, Severity of Illness Index, Amputation, Surgical, Orthostatic vital signs, Endocrinology, Diabetic Neuropathies, Spinal osteoarthropathy, Heart Rate, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Heart rate variability, Edema, Humans, Aged, Reflex, Abnormal, business.industry, Foot, Middle Aged, Toes, medicine.disease, Diabetic foot, Diabetic Foot, Surgery, Plethysmography, Regional Blood Flow, Cardiology, Axon reflex, Female, Arthropathy, Neurogenic, business, Foot (unit)
Abstract: Aim The aim of the study was to determine the degree of neuropathy (autonomic and somatic) in patients with diabetes mellitus with or without Charcot osteoarthropathy (CA). Methods Forty-nine patients with diabetes mellitus type 1 or 2 were investigated. The patient population of interest was the patients with acute Charcot foot ( n =17) or chronic Charcot foot ( n =7). The inclusion criterion for an acute Charcot foot was a temperature difference of more than 2° between the two feet, oedema of the affected foot, typical hotspots in a bone scintigram and a typical clinical course. In addition, patients with first toe amputation ( n =5), a high-risk group for development of CA, and two control groups consisting of diabetes patients with ( n =9) or without somatic neuropathy ( n =11) were investigated. Regional blood flow in the feet was measured by venous occlusion plethysmography. Quantitation of somatic neuropathy was done by the Neuropathy Disability Score and modified Neuropathy Symptom Score. Quantitation of autonomic neuropathy was done by measurements of local venoarteriolar sympathetic axon reflex in the feet and of heart rate variability during deep breathing and orthostatic challenge. Results The patients with acute Charcot foot and first toe amputation had an increased blood flow in the affected foot and weakened but not absent venoarteriolar sympathetic axon reflex. In the other patient groups, a normal venoarteriolar sympathetic axon reflex in the feet was found. Conclusions Peripheral sympathetic neuropathy is not likely to be the pathophysiologic mechanism behind the hyperemia in the foot during an acute attack of CA. The hyperemia is more likely secondary to local inflammatory events.
Published: 2010

37. Bone mineral density in diabetes mellitus patients with and without a Charcot foot

Author: Jens Bülow, Tomas Møller Christensen, Lene Simonsen, Per Holstein, and Ole Lander Svendsen
Subjects: musculoskeletal diseases, medicine.medical_specialty, Bone density, Physiology, Population, Osteoporosis, Urology, Amputation, Surgical, Bone remodeling, Absorptiometry, Photon, Diabetic Neuropathies, Spinal osteoarthropathy, Bone Density, Physiology (medical), medicine, Humans, education, Gait Disorders, Neurologic, Aged, Bone mineral, Aged, 80 and over, education.field_of_study, Hip, Lumbar Vertebrae, business.industry, General Medicine, Middle Aged, Toes, musculoskeletal system, medicine.disease, Surgery, Osteopenia, Calcaneus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, business, Biomarkers
Abstract: Summary Objective: To measure bone mineral density in patients with diabetes mellitus and the complication Charcot osteoarthropathy (CA). Research design and methods: A total of 49 patients with diabetes were investigated. The population consisted of patients with an acute CA (n = 17) or chronic CA (n = 7). Control groups consisted of diabetes patients with (n = 9) and without neuropathy (n = 11) and who had an amputation of the first toe (n = 5). Values measured were bone mineral density (BMD) in lumbar spine, hip and calcaneus, using lunar DEXA scanner. The bone turnover markers CTX-1 and N-MID were measured. Results: There were no differences in BMD measured in the spine and hip. There was an increase in the markers of bone turnover in the patients with acute CA. The BMD of the calcaneus was statistically lower in the affected foot in patients with chronic Charcot (P
Published: 2010

38. Changes in calcanean bone mineral occurring spontaneously and during hormone replacement therapy in early post-menopausal women

Author: C. Christiansen, Ulla Marslew, Ole Lander Svendsen, and Christian Hassager
Subjects: musculoskeletal diseases, medicine.medical_specialty, Clinical Biochemistry, Levonorgestrel, Post menopausal, Body weight, Forearm, Bone Density, Internal medicine, medicine, Humans, Longitudinal Studies, Bone mineral, Estrogens, Conjugated (USP), Lumbar Vertebrae, Estradiol, business.industry, Estrogen Replacement Therapy, General Medicine, Middle Aged, musculoskeletal system, Calcaneus, Endocrinology, medicine.anatomical_structure, Transgender hormone therapy, Photon absorptiometry, Drug Therapy, Combination, Female, Menopause, business, Hormone
Abstract: The spontaneous calcanean bone loss occurring in healthy early post-menopausal women and the effect of two hormone replacement therapies (HRT's) were investigated in a longitudinal study. There was no difference between the right and left calcanean BMC or BMD (p0.15). The spontaneous bone loss was similar at all the skeletal sites measured, with a mean spontaneous loss in calcanean BMD of 1.6% over one year. Both HRT's significantly (p0.01) prevented the bone loss from all skeletal sites irrespective of the weight-bearing or content of trabecular bone, and (for the weight-bearing bones) there was even a gain in calcanean BMC and BMD and spinal BMD (p0.01). Bone mineral of the calcaneus and the spine correlated equally to body weight (r approximately 0.4, p0.001), whereas bone mineral in the forearm was not correlated to body weight. The correlations between the changes in bone mineral at the sites measured were all significant (r approximately 0.2-0.4).
Published: 1992
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39. Does abdominal obesity have a similar impact on cardiovascular disease and diabetes? A study of 91,246 ambulant patients in 27 European countries

Author: Keith Fox, Vincent Maher, Frank Visseren, Ole Lander Svendsen, Hans-Ulrich Wittchen, Vytautas Kasiulevicius, John Deanfield, Krzysztof Narkiewicz, and Philippe Amouyel
Subjects: Adult, Male, medicine.medical_specialty, Diabetes risk, Adolescent, Body Mass Index, Young Adult, Age Distribution, Residence Characteristics, Risk Factors, Diabetes mellitus, medicine, Diabetes Mellitus, Humans, Risk factor, Sex Distribution, Abdominal obesity, Aged, Aged, 80 and over, business.industry, Odds ratio, Middle Aged, medicine.disease, Obesity, Surgery, Europe, Cross-Sectional Studies, Cardiovascular Diseases, Obesity, Abdominal, Female, Metabolic syndrome, medicine.symptom, Waist Circumference, Cardiology and Cardiovascular Medicine, business, Body mass index, Demography
Abstract: Aims Differences in cardiovascular risk factors across Europe provide an opportunity to examine the impact of adiposity on the frequency of diabetes and cardiovascular disease (CVD). Methods and results The International Day for Evaluation of Abdominal obesity (IDEA) study evaluated the prevalence of abdominal obesity, elevated body mass index (BMI), and other cardiometabolic risk factors among primary care patients. Abdominal obesity predicted increased diabetes risk, despite socio-economic, demographic, and risk factor differences. Cardiovascular disease was at least two-fold more frequent in Eastern Europe vs. Northwest Europe ( P < 0.0001) and 2.5-fold more vs. Southern Europe ( P < 0.0001). Waist circumference (WC) predicted increased ( P < 0.0001) age- and BMI-adjusted risks of CVD and diabetes. In women, odds ratios (95% confidence intervals) for CVD per 1 SD increase in WC were: Northwest Europe 1.28 (1.18–1.40); Southern Europe 1.26 (1.16–1.37); and Eastern Europe 1.10 (1.03–1.18). Values for diabetes were 1.72 (1.58–1.88), 1.45 (1.35–1.56), and 1.59 (1.46–1.73), with similar findings in men. Conclusion Abdominal obesity impacted similarly on the frequency of diabetes across Europe, despite regional differences in cardiovascular risk factors and CVD rates. Increasing abdominal obesity may offset future declines in CVD, even where CVD rates are lower.
Published: 2009

40. Measurement of body fat in elderly subjects by dual-energy x-ray absorptiometry, bioelectrical impedance, and anthropometry

Author: Anders Gotfredsen, Ole Lander Svendsen, Jens Haarbo, Claus Christiansen, and Bent L Heitmann
Subjects: Male, Denmark, Medicine (miscellaneous), Body weight, Absorptiometry, Photon, Sex Factors, Sex factors, Humans, Medicine, Elderly people, Dual-energy X-ray absorptiometry, Aged, Nutrition and Dietetics, Anthropometry, medicine.diagnostic_test, business.industry, Body Weight, Electric Conductivity, Skinfold Thickness, Skinfold thickness, Adipose Tissue, Body Composition, Regression Analysis, Female, business, Nuclear medicine, Bioelectrical impedance analysis
Abstract: Body fat was measured in 46 elderly subjects by dual-energy x-ray absorptiometry [BF(DEXA)], bioelectrical impedance analysis (BIA), and anthropometry. Equations for prediction of the body fat (by DEXA) of elderly people by BIA and/or anthropometry were developed. The prediction of body fat (by DEXA) by anthropometric variables alone gave an r2 of 0.94 and the corresponding SEEs were 1.61 kg for men and 2.43 kg for women. When BIA variables were added as predictors, r2 increased by 2-5% (P less than 0.05) and the corresponding SEE decreased by 25% (P less than 0.05). The prediction of body fat (by DEXA) in elderly subjects and by BIA or anthropometry with equations developed in populations of young healthy adults (adapted from the literature) was generally not good although the correlation coefficients were high (r greater than 0.9, P less than 0.001), which suggests that our equations may improve prediction of body fat in elderly subjects.
Published: 1991
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41. [Charcot's arthropathy]

Author: Tomas Møller, Christensen, Knud, Yderstraede, Niels, Ejskjaer, Poul Erik, Jakobsen, Inge Lunding, Kjaer, Steen, Levin, Anne Lervang, Nielsen, Ole Lander, Svendsen, and Per, Holstein
Subjects: Diagnosis, Differential, Diabetic Neuropathies, Humans, Arthropathy, Neurogenic, Diabetic Foot
Abstract: Charcot's arthropathy is a rare complication to diabetes with peripheral neuropathy. The diagnosis is based on a red, oedematous foot with 2 degrees C difference in skin temperature between the affected foot compared to the unaffected foot. The condition is characterised by fractures, dislocation of joints and deformity. The treatment is off-loading. When the off-loading treatment is completed, the patient should gradually adjust to wearing bespoken shoes. Lifelong control of the feet and shoes is necessary.
Published: 2008

42. Den diabetiske Charcots fod

Author: Tomas Møller Christensen, Knud Yderstraede, Niels Ejskjaer, Poul Erik Jakobsen, Inge Lunding Kjaer, Steen Levin, Anne Lervang Nielsen, Ole Lander Svendsen, and Per Holstein
Published: 2008

43. [Treatment of diabetic ketoacidosis in adults in Denmark--need for national guidelines. Secondary publication]

Author: Otto Mølby, Henriksen, Michael Einar, Røder, and Ole Lander, Svendsen
Abstract: This study examines variations in treatment routines for diabetic ketoacidosis (DKA) in Denmark. All departments of internal medicine in Denmark managing DKA were invited to complete a questionnaire. 88% replied. The study shows significant variations in management routines of DKA in Denmark. In many cases, the routines are not supported by evidence from clinical trials. National guidelines for the management of DKA in adult patients are needed.
Published: 2007

44. Diabetic ketoacidosis in Denmark Incidence and mortality estimated from public health registries

Author: Otto M, Henriksen, Michael E, Røder, Julie B, Prahl, and Ole Lander, Svendsen
Subjects: Adult, Male, Denmark, Incidence, Middle Aged, Diabetic Ketoacidosis, Age Distribution, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Cause of Death, Humans, Female, Public Health, Registries, Aged
Abstract: The aims of this study were to estimate incidence of diabetic ketoacidosis and mortality from diabetic ketoacidosis using data from public health registries. Four thousand eight hundred and seven admissions in the period 1996-2002 and 137 deaths in the period 1996-2000 with a diagnosis of diabetic ketoacidosis were identified from the Danish National Patient Registry and Danish Cause of Death Registry, respectively. Annual incidence of diabetic ketoacidosis in the general population was estimated to 12.9 per 100,000, being higher in males than in females (14.4 versus 11.4 per 100,000, p0.0001). Twelve percent of all patients were classified as Type 2 diabetes, predominantly in patients50 years. Overall mortality was 4%, being higher in patients70 years than in patientsor =70 years (15% versus 2%, p0.0001). One or more additional somatic diagnoses were stated on 77% of the death certificates, most often a diagnosis of cardiovascular (47%) or infectious (30%) diseases. Compared to previous studies, the incidence in the general population seems to have remained unaltered the past 25 years, but may have decreased in younger patients. Older patients with diabetic ketoacidosis differed from younger patients in having a higher mortality and a larger proportion of patients classified as Type 2 diabetes.
Published: 2006

45. [Drug treatment of obesity]

Author: Ole Lander, Svendsen, Søren, Toubro, Leif, Breum, Jens Meldgaard, Bruun, and Arne V, Astrup
Subjects: Orlistat, Time Factors, Lactones, Piperidines, Appetite Depressants, Weight Loss, Diethylpropion, Humans, Pyrazoles, Anti-Obesity Agents, Obesity, Enzyme Inhibitors, Rimonabant, Cyclobutanes, Randomized Controlled Trials as Topic
Abstract: Acceptable adverse effects and a clinical relevant weight loss of 3 to 5 kilograms have been found in long-term randomized clinical trials for sibutramine (Reductil) and orlistat (Xenical); these drugs may be prescribed for treatment of obesity for a duration of one and four years, respectively. This also seems to be the case for rimonabant (Acomplia), which is expected to receive approval in 2005 or 2006. However, until data on morbidity and mortality are available from RCTs, there is no absolute indication for prescribing drugs for treatment of obesity.
Published: 2006

46. The impact of idiopathic childhood-onset growth hormone deficiency (GHD) on bone mass in subjects without adult GHD

Author: Ulla Feldt-Rasmussen, Jørn Müller, Martin Lange, Ole Lander Svendsen, K W Kastrup, and Anders Juul
Subjects: Peak bone mass, Adult, Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, Growth hormone deficiency, Endocrinology, Absorptiometry, Photon, Bone Density, Internal medicine, medicine, Humans, Young adult, Age of Onset, Insulin-Like Growth Factor I, Child, Growth Disorders, Femoral neck, Lumbar Vertebrae, business.industry, Femur Neck, Insulin tolerance test, Case-control study, medicine.disease, medicine.anatomical_structure, Case-Control Studies, Growth Hormone, Body Composition, Female, Age of onset, business, Body mass index, Follow-Up Studies
Abstract: Objective Despite seemingly adequate growth hormone (GH) treatment during childhood, children with GH deficiency (GHD) have reduced bone mineral density (BMD) at final height. The aim was to evaluate BMD and bone mineral content (BMC) in adults treated for idiopathic childhood-onset (CO) GHD, 18 years after stopping GH treatment. Subjects and methods Twenty-six (11 females) patients with idiopathic CO GHD participated. All patients but two had been treated for isolated GHD in childhood. The childhood diagnosis was established by an insulin tolerance test (ITT) and reassessed in adulthood by an ITT (N = 21) or arginine test (n = 5), revealing that 10 patients had GHD according to adult criteria. Accordingly, the patient group was divided into (1) patients who did not have persistent GHD in adulthood and (2) patients who did have persistent adult GHD. Twenty-six healthy subjects acted as age-, gender- and body mass index (BMI)-matched controls. Results The patients who did not have persistent GHD had significantly lower IGF-I values and whole-body, femoral neck and lumbar spine BMD compared to controls [0.994 +/- 0.10 vs. 1.114 +/- 0.11 g/cm2 (P = 0.003), 0.842 +/- 0.12 vs. 0.962 +/- 0.11 g/cm2 (P = 0.006) and 1.026 +/- 0.14 vs. 1.127 +/- 0.13 g/cm2 (P = 0.004), respectively]. Femoral neck BMD was significantly reduced in the patients who had persistent GHD, compared to controls (0.842 +/- 0.09 vs. 0.938 +/- 0.11, P = 0.04). Significant correlations were observed between all bone variables and IGF-I in all subjects, whereas no correlations were observed between bone variables and GH peak levels in the 26 patients. Conclusion In conclusion, we found that (1) patients with idiopathic CO GHD, who at retest in adulthood did not have GHD according to adult criteria, had reduced serum IGF-I and BMD/BMC compared to controls. (2) This observation was also made in the patients who did have persistent GHD in adulthood. The findings may reflect the fact that the present diagnostic criteria for adult GHD (i.e. response to the ITT) do not reflect the clinical consequences of disordered GH-IGF axis in CO GHD young adults who were treated with GH in childhood. Alternatively, despite seemingly adequate GH treatment in childhood an optimal peak bone mass in adolescence may never have been reached in either of the groups. (3) IGF-I levels correlated with clinical signs of the adult GHD syndrome. We believe that further studies on the indications and diagnostic procedures for GH treatment after cessation of linear growth are necessary.
Published: 2005

47. Combined dietary and pharmacological weight management in obese hypopituitary patients

Author: Henriette Mersebach, Arne Astrup, Marianne Klose, Ulla Feldt-Rasmussen, and Ole Lander Svendsen
Subjects: Adult, Blood Glucose, Leptin, Male, medicine.medical_specialty, Waist, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Blood lipids, Hypopituitarism, Type 2 diabetes, Endocrinology, Weight loss, Pregnancy, Internal medicine, Weight management, Appetite Depressants, Weight Loss, Medicine, Humans, Obesity, Exercise, Anthropometry, business.industry, Human Growth Hormone, Public Health, Environmental and Occupational Health, Middle Aged, medicine.disease, Combined Modality Therapy, Lipids, Cholesterol, Body Composition, Female, medicine.symptom, business, Cyclobutanes, Food Science, Sibutramine, medicine.drug
Abstract: MERSEBACH, HENRIETTE, MARIANNE KLOSE, OLE L. SVENDSEN, ARNE ASTRUP, AND ULLA FELDTRASMUSSEN. Combined dietary and pharmacological weight management in obese hypopituitary patients. Obes Res. 2004;12:1835–1843. Objective: The high prevalence of obesity and cardiovascular risk factors in hypopituitarism affirms the need for effective weight loss intervention. In this study, we investigated the combined effect of sibutramine, diet, and exercise in obese hypopituitary patients (HPs). Research Methods and Procedures: In an open-label prospective intervention trial, 14 obese well-substituted nondiabetic HPs and 14 matched simple obese controls were allocated to 11-month treatment with sibutramine (10 to 15 mg), diet (600 kcal/d deficit), and exercise. Anthropometric indices and body composition (obtained from DXA scan) were assessed monthly for the first 5 months and thereafter every second month for the next 6 months. Results: Mean (SD) weight loss at 11 months was 11.3 4.8 kg in patients vs. 10.7 4.7 kg in controls. The HPs exhibited the same improvements in body composition, waist circumference, blood lipids, and fasting glucose as the simple obese. In a multivariate model, baseline weight, duration of growth hormone replacement therapy, and duration of pituitary disease explained 79% (p 0.001) of the variation in weight loss at 4 months in the HPs. Only baseline weight and waist circumference could predict weight loss at 11 months. Discussion: HPs are not resistant to weight loss therapy. Almost all will achieve at least 5% weight loss, and 60% can lose 10% weight within 11 months. However, the long-term effect on risk factors associated with type 2 diabetes and cardiovascular disease as well as on mortality needs to be established.
Published: 2004

48. 40(th) EASD Annual Meeting of the European Association for the Study of Diabetes : Munich, Germany, 5-9 September 2004

Author: S. Artigas, A V Dreval, Mark I. McCarthy, C Watson, Peter H. Bennett, M Quint, Y Ikeda, E Alpert, F Schiele, H Sekihara, Erik Gylfe, P Lowe, J Kuhlmann, Alain Golay, V Longo, Shahidul Alam Khan Akm., L G Mantovani, M Zawodniak-Szalapska, G Winkler, T Harrity, L Virág, U Johne, Kuo S-W., Linda C Tapsell, J Rodriguez, Michel Komajda, K Kankova, Carole A. Cull, M Sporna, E Estilles, U Ribel, M C Spruce, E Buzzigoli, T Prazak, J K McLaughlin, M K Lingohr, M Lim, F Calara, A Siebenhofer, G Meregalli, Roberto Anichini, A D Baron, R Kurashvili, P C Butler, G I Fantus, T. E. De Gooyer, Park Y-M., R. Walther, S Heinrich, Agnieszka Zawiejska, S Mukherjee, Nikolaos Papanas, G Wong, Ian D. Caterson, David M. Maahs, Shuichi Kaneko, Alexandra E. Butler, Francisco Javier Ampudia-Blasco, O N Kong, Attali J-R., C A Hedman, K Oshinyemi, Nicolle Müller, I C Cranston, N Okumus, M V Vlaiculescu, Balasubramanian Ravikumar, W W Cheatham, K Mukasa, K B Biswas, Annunziata Lapolla, Phil McEwan, G Mader, Gilles Chassot, Dragi Anevski, Werner A. Scherbaum, M Donath, C Hesselmann, R A Gandhi, David E. Moller, Ezio Bonifacio, C Garcia, V Ifandi, P Hornnes, Nieuwenhoven Fav., C Puech, S Pérez-Del-Pulgar, Kim S-R., G Hines, C Rubio Terrés, Michael Gaster, N. Hosszufalusi, A Scholze, Andrew A. Young, Stavros Liatis, F Hariri, S Tan, Paul Valensi, Allan E. Karlsen, J Kim, E. Moberg, J Kaiser, L Berman, G Nelson, A Altkrüger, P Kothare, D B Cook, S Doran, G. van Dijk, Shahnaz Shahinfar, Kim C-S., P Stahl, M Manousaki, S Sigrist, S K Lim, M. P. Stern, A Guberti, C Rezzani, J McKenney, Karl Thomaseth, Sofia Carlsson, M Julia, R Brillante, I Rubesova, T Darkow, E Matsumoto, Wendy M. Macfarlane, M Di Martino, G Bardini, Rossella Menghini, D Duhot, E Farcasiu, Annalisa Natalicchio, I Lindner, J Buvat, Christian L. Brand, Harry Dorchy, Iwona Pietrzak, Z T Luo, P Home, M Ekelund, Jesper Gromada, Kristine Færch, F Piarulli, H Kim, R Mentel, Zsuzsanna K. Zsengellér, Dullaart Rpf., Anton Luger, Thomas A. Pearson, V Manicardi, P Rösen, Feng Y-M., R Morganti, Lars Hansen, Demuth H-U., Haruo Kasai, A Shostak, Rudi Steffensen, G Taylor, Markolf Hanefeld, C Santini, E Hamaguchi, Roberto Miccoli, F Storms, M Cooper, Y Lee, Allison E. Aiello, P Smith, T Suehiro, K Treece, M Waluś, Timothy A Welborn, Simone Baltrusch, E Kontela, S Chai, J Crean, H Yokoyama, Johan G. Eriksson, Rafael Hernández Hernández, J Rodríguez-Saldaña, M P Tornero, G Formoso, D. Lovell, E Bingham, A Mylonakis, M Manteghetti, D Fedele, Antonio Martín-Duce, Ralph A. DeFronzo, D Salcedo, Kurt Højlund, Antonio Petrone, Sheu Whh., C Gutierrez, Flavia Pricci, S Kurita, Z G Abbas, M M Benedetti, Philippe A. Halban, Daniel J. Cox, O Ljungkvist, Justine Davies, J Palsgaard, Lars Sjöström, E Bosi, L Janin-Manificat, W. F. Kelly, M. Fernandez, E Colak, O V Mulyarchik, B Kronshage, F Lang, M Erfurth, Takashi Kadowaki, N Jendrike, U Walter, J Wishart, Y. Neye, D Kim, N Furuhashi, M Barsotti, D Florow, L Ke, L Borgquist, N C Jackson, Ffolliott M. Fisher, V Baskar, K Yoshioka, Bryan A. Wolf, G Chabrier, R Skoumal, Livio Luzi, H Kose, I Pharisien, B. Klein, H Winiarska, M C Johnson, L Griffiths, Nonna Kravchun, C Combe, Baptist Gallwitz, J Zdychova, L Skorda, Jorma Ilonen, W Gao, I N Steen, A Terrinoni, P D Ambery, W Kern, C M Kusminski, Cho M-H., Paolo Pozzilli, Louise G. Grunnet, E Schönle, David R Matthews, Robert W. Taylor, Y Cohen, Kim H-S., M P Eccles, N B Tutuncu, D McDowell, Richard M. Bergenstal, K Takamatsu, T Steiner, Jaan Palgi, Valdemar Grill, N Niculescu, G Federici, S Lehto, P. M. McKeigue, M Barone, Michael E. 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Dell'Antonio, G, Maestroni, A, Ruggieri, D, Luzi, L, Piemonti, L, Zerbini, G, Anafaroglu, I, Tutuncu, N, Sultana, M, Siddiqua, N, Iwasaki, T, Nakajima, A, Yoneda, M, Mukasa, K, Tanaka, S, and Sekihara, H
Subjects: 0303 health sciences, medicine.medical_specialty, business.industry, EASD, Endocrinology, Diabetes and Metabolism, Human physiology, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Family medicine, Internal Medicine, Medicine, business, 030217 neurology & neurosurgery, 030304 developmental biology
Published: 2004

49. Abnormal sympathoadrenal activity, but normal energy expenditure in hypopituitarism

Author: Ulla Feldt-Rasmussen, Ole Lander Svendsen, Arne Astrup, and Henriette Mersebach
Subjects: Adult, medicine.medical_specialty, Sympathetic Nervous System, Epinephrine, Endocrinology, Diabetes and Metabolism, Urinary system, media_common.quotation_subject, Clinical Biochemistry, Appetite, Hypopituitarism, Biochemistry, Endocrinology, Heart Rate, Internal medicine, Adrenal Glands, medicine, Sympathoadrenal system, Humans, Obesity, Exercise, media_common, Hydrocortisone, Anthropometry, business.industry, Biochemistry (medical), Middle Aged, medicine.disease, Case-Control Studies, Basal metabolic rate, Lean body mass, Body Composition, business, Energy Metabolism, Oxidation-Reduction, medicine.drug
Abstract: In this study of 23 hypopituitary patients and 26 healthy controls, we have addressed whether the obese state of substituted hypopituitary patients is facilitated by abnormal sympathoadrenal activity or energy expenditure (EE). All patients received adequate substitution therapy including GH therapy. The investigation program included assessment of sympathoadrenal activity (urinary catecholamines), body composition (dual-energy x-ray absorptiometry), appetite sensations (visual analog scale), and EE (indirect calorimetry in respiration chamber). Twenty-four-hour urinary epinephrine adjusted for lean body mass and fat mass was significantly lower in patients compared with controls. GH and hydrocortisone were single negative predictors of urinary epinephrine. The major determinants of EE in patients were lean body mass and fat mass, explaining 96, 95, and 80% of the variance in 24-h EE, sleeping EE, and basal metabolic rate, respectively. Addition of urinary catecholamines explained another 1–4% of the variance in 24-h EE and basal metabolic rate, respectively. Lean patients exhibited significantly more hunger than obese patients and lean controls. In conclusion, hypopituitary patients have lower sympathoadrenal activity but normal EE, compared with healthy controls. This may reflect a central defect in hypopituitarism, however the possible impact of long-term GH and hydrocortisone treatment requires further attention.
Published: 2003

50. [Obesity in Danish hospitals--treatment in the year 2000]

Author: Maria L B, Fischer-Nielsen and Ole Lander, Svendsen
Subjects: Denmark, Health Care Surveys, Surveys and Questionnaires, Hospital Departments, Internal Medicine, Humans, Refusal to Treat, Obesity, Practice Patterns, Physicians', Referral and Consultation, Follow-Up Studies
Abstract: Obesity is of increasing public health concern. The aim of the study was to investigate the treatment of obesity at Danish hospitals in the year 2000, and to compare the results with a similar study from 1987.A questionnaire was sent to the heads of departments of internal medicine at all Danish hospitals where such departments exist (64).Ninety-one percent of the questionnaires were answered. Fewer hospitals (76%) in Denmark treated obesity in 2000 compared to 1987. About 1400 patients were referred, and the treatment of 500-900 patients was concluded yearly. Many departments reject patients when the primary diagnosis for referral is obesity, often because they lack resources or do not have the capacity. Except for university hospitals, obesity was more often treated on an outpatient basis in 2000 than in 1987. Apart from surgery, the same methods were used to treat obesity at the different types of hospitals. Instructions for treatment, long-term outpatient follow-up, quality assurance, evaluation of the treatment, and research in obesity are carried out to some degree at the university hospitals, and only to a small extent at other types of hospitals.Although obesity is becoming an increasing threat to public health, treatment at Danish hospitals has decreased over the last ten years, and in the year 2000 only a few per thousand obese patient were offered treatment by a hospital. Increased focus and resources, as well as development and research targeted specifically on the treatment of obesity are needed.
Published: 2002

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