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Gyberg V.,Karolinska University Hospital | Gyberg V.,Karolinska Institutet | Bacquer D.,European Society of Cardiology | Bacquer D.,Ghent University | And 57 more authors.
Cardiovascular Diabetology | Year: 2015

Background: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. Methods: A total of 6187 patients (18-80years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. Results: A total of 2846 (46%) patients had no diabetes, 1158 (19%) newly diagnosed diabetes and 2183 (35%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60%, respectively. A blood pressure target of <140/90mmHg was achieved in 68, 61, 54% and a LDL-cholesterol target of <1.8mmol/L in 16, 18 and 28%. Patients with newly diagnosed and previously known diabetes reached an HbA1c <7.0% (53mmol/mol) in 95 and 53% and 11% of those with previously known diabetes had an HbA1c >9.0% (>75mmol/mol). Of the patients with diabetes 69% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40%) and only 27% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. Conclusions: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease. © 2015 Gyberg et al.

Lehtisalo J.,Finnish National Institute for Health and Welfare | Lehtisalo J.,University of Helsinki | Lindstrom J.,Finnish National Institute for Health and Welfare | Ngandu T.,Finnish National Institute for Health and Welfare | And 17 more authors.
Diabetes/Metabolism Research and Reviews | Year: 2016

Background: Type 2 diabetes is linked with cognitive dysfunction and dementia in epidemiological studies, but these observations are limited by lack of data on the exact timing of diabetes onset. We investigated diabetes, dysglycaemia, and cognition in the Finnish Diabetes Prevention Study, in which the timing and duration of diabetes are well documented. Methods: The Finnish Diabetes Prevention Study comprised middle-aged, overweight participants with impaired glucose tolerance but no diabetes at baseline (n=522), randomized to lifestyle intervention or a control group. After an intervention period (mean duration 4 years) and follow-up (additional 9 years), cognitive assessment with the CERAD test battery and Trail Making Test A (TMT) was executed twice within a 2-year interval. Of the 364 (70%) participants with cognitive assessments, 171 (47%) had developed diabetes. Results: Cognitive function did not differ between those who developed diabetes and those who did not. Lower mean 2-h glucose at an oral glucose tolerance test (OGTT) and HbA1C during the intervention period predicted better performance in the TMT (p=0.012 and 0.024, respectively). Those without diabetes or with short duration of diabetes improved in CERAD total score between the two assessments (p=0.001) whereas those with long duration of diabetes did not (p=0.844). Conclusions: Better glycemic control among persons with baseline impaired glucose tolerance predicted better cognitive performance 9 years later in this secondary analysis of the Finnish Diabetes Prevention Study population. In addition, learning effects in cognitive testing were not evident in people with long diabetes duration. © 2016 John Wiley & Sons, Ltd.

Raisanen A.,Aino Health Management | Eklund J.,Aino Health Management | Calvet J.-H.,Impeto Medical | Tuomilehto J.,Danube University Krems | And 3 more authors.
International Journal of Environmental Research and Public Health | Year: 2014

Physical inactivity is a modifiable risk factor for cardiovascular (CV) and metabolic disorders. VO2max is the best method to assess cardio-respiratory fitness level but it is poorly adopted in clinical practice. Sudomotor dysfunction may develop early in metabolic diseases. This study aimed at comparing established CV risk evaluation techniques with SUDOSCAN; a quick and non-invasive method to assess sudomotor function. A questionnaire was filled-in; physical examination and VO2max estimation using a maximal test on a bicycle ergometer were performed on active Finish workers. Hand and foot electrochemical skin conductance (ESC) were measured to assess sudomotor function. Subjects with the lowest fitness level were involved in a 12 month training program with recording of their weekly physical activity and a final fitness level evaluation. Significant differences in BMI; waist and body fat were seen according to SUDOSCAN risk score classification. Correlation between the risk score and estimated VO2max was r = -0.57, p < 0.0001 for women and -0.48, p < 0.0001 for men. A significant increase in estimated VO2max, in hand and foot ESC and in risk score was observed after lifestyle intervention and was more important in subjects with the highest weekly activity. SUDOSCAN could be used to assess cardio-metabolic disease risk status in a working population and to follow individual lifestyle interventions. © 2014 by the authors; licensee MDPI, Basel, Switzerland.

Rautio N.,University of Oulu | Jokelainen J.,University of Oulu | Oksa H.,Pirkanmaa Hospital District | Saaristo T.,Pirkanmaa Hospital District | And 11 more authors.
Diabetic Medicine | Year: 2015

Aim: To examine changes in glucose metabolism (fasting and 2-h glucose) during follow-up in people with impaired fasting glucose in comparison with changes in people with isolated impaired glucose tolerance, people with impaired fasting glucose and impaired glucose tolerance combined and people with screening-detected Type 2 diabetes at baseline, among those who participated in a diabetes prevention programme conducted in Finland. Methods: A total of 10 149 people at high risk of Type 2 diabetes took part in baseline examination. Of 5351 individuals with follow-up ≥ 9 months, 1727 had impaired glucose metabolism at baseline and completed at least one lifestyle intervention visit. Most of them (94.6%) were overweight/ obese. Results: Fasting glucose decreased during follow-up among overweight/obese people in the combined impaired fasting glucose and impaired glucose tolerance group (P = 0.044), as did 2-h glucose in people in the isolated impaired glucose tolerance group (P = 0.0014) after adjustment for age, sex, medication and weight at baseline, follow-up time and changes in weight, physical activity and diet. When comparing changes in glucose metabolism among people with different degrees of glucose metabolism impairment, fasting glucose concentration was found to have increased in those with isolated impaired glucose tolerance (0.12 mmol/l, 95% Cl 0.05 to 0.19) and it decreased to a greater extent in those with screening-detected Type 2 diabetes (-0.54 mmol/l, 95% Cl -0.69 to -0.39) compared with those with impaired fasting glucose (-0.21 mmol/l, 95% Cl -0.27 to -0.15). Furthermore, 2-h glucose concentration decreased in the isolated impaired glucose tolerance group (-0.82 mmol/l, 95% Cl -1.04 to -0.60), in the combined impaired fasting glucose and impaired glucose tolerance group (-0.82 mmol/l, 95% Cl -1.07 to -0.58) and in the screening-detected Type 2 diabetes group (-1.52, 95% Cl -1.96 to -1.08) compared with those in the impaired fasting glucose group (0.26 mmol/l, 95% Cl 0.10 to 0.43). Results were statistically significant even after adjustment for covariates (P < 0.001 in all models). Conclusions: Changes in glucose metabolism differ in people with impaired fasting glucose from those in people with isolated impaired glucose tolerance, people with impaired fasting glucose and impaired glucose tolerance combined and people with screening-detected Type 2 diabetes. © 2015 Diabetes UK.

Wennberg M.,The Baker IDI Heart and Diabetes Institute | Wennberg M.,Umeå University | Soderberg S.,The Baker IDI Heart and Diabetes Institute | Soderberg S.,Umeå University | And 11 more authors.
Diabetic Medicine | Year: 2015

Aims: To investigate if consumption of pulses was associated with a reduced risk of developing abnormal glucose metabolism, increases in body weight and increases in waist circumference in a multi-ethnic cohort in Mauritius. Methods: Population-based surveys were performed in Mauritius in 1992 and in 1998. Pulse consumption was estimated from a food frequency questionnaire in 1992 and outcomes were measured in 1998. At both time points, anthropometry was undertaken and an oral glucose tolerance test was performed. Results: Mauritian women with the highest consumption of pulses (highest tertile) had a reduced risk of developing abnormal glucose metabolism [odds ratio 0.52; 95% CI 0.27, 0.99) compared with those with the lowest consumption, and also after multivariable adjustments. In women, a high consumption of pulses was associated with a smaller increase in BMI. Conclusions: High consumption of pulses was associated with a reduced risk of abnormal glucose metabolism and a smaller increase in BMI in Mauritian women. Promotion of pulse consumption could be an important dietary intervention for the prevention of Type 2 diabetes and obesity in Mauritius and should be examined in other populations and in clinical trials. © 2014 Diabetes UK.

Luchsinger J.A.,Columbia University | Lehtisalo J.,Finnish National Institute for Health and Welfare | Lindstrom J.,Finnish National Institute for Health and Welfare | Ngandu T.,Finnish National Institute for Health and Welfare | And 10 more authors.
Diabetes Research and Clinical Practice | Year: 2015

We studied cognition in the Finnish Diabetes Prevention Study (DPS), a trial of lifestyle intervention that prevented diabetes in persons with impaired glucose tolerance. Cognition was similar in the randomization arms 9 years after the intervention in 364 participants, suggesting that the intervention did not benefit cognition. © 2015 Elsevier Ireland Ltd.

Katoh S.,Jikei University School of Medicine | Peltonen M.,Finnish National Institute for Health and Welfare | Wada T.,Jikei University School of Medicine | Zeniya M.,Jikei University School of Medicine | And 6 more authors.
Journal of International Medical Research | Year: 2014

Objectives: To examine the association between glycosylated haemoglobin (HbA1c) and fatty liver markers. Methods: This cross-sectional analysis stratified subjects into quintiles based on HbA1c. Fatty liver using ultrasonography scores (FLUS) were assigned as follows: 2 points, moderate or severe fatty liver; 1 point, mild fatty liver; and 0 points, normal liver. Subjects with viral hepatitis, alcohol intake >175 g/week or receiving hypoglycaemic treatment were excluded. Results: The study included 5384 subjects. Serum cholinesterase (ChE) and FLUS showed a significant graded increase with increasing HbA1c. In linear regression analysis stratified by body mass index (BMI) and age, ChE and FLUS were significantly associated with lower (1+2) and higher (3+4+5) HbA1c quintiles, respectively, independent of BMI and age. Conclusions: The findings show that both ChE and FLUS are significantly correlated with HbA1c, independent of BMI and age. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Standl E.,Helmholtz Center Munich | Theodorakis M.J.,University of Oxford | Erbach M.,Helmholtz Center Munich | Schnell O.,Helmholtz Center Munich | And 4 more authors.
Cardiovascular Diabetology | Year: 2014

In the emerging landscape of cardiovascular (CV) outcome trials evaluating the effects of blood glucose lowering drugs in individuals with type 2 diabetes, it is becoming increasingly apparent that since the promising signals coming from the United Kingdom Prospective Diabetes Study (UKPDS) no unequivocal benefits have been established for any single therapy thus far. There is an unmet need for introducing an effective pharmacological agent which could target both correlates of glycaemic regulation and CV risk factors, to ameliorate the enormous burden of fatal and non-fatal CV events in diabetic patients. Acarbose, like other alpha-glucosidase inhibitors (AGIs), has been proven to be an effective antidiabetic treatment for decades, but the overall significant impact of this class of drugs on modulating CV risk has only recently been appreciated. Accumulating evidence has shown that apart from its multiple effects on primarily postprandial glucose dysmetabolism, a key component of mechanisms linked to increased incidence of CV events, acarbose therapy also associates with a favorable impact on an array of surrogate markers of CV disease. Data stemming from in vitro testing of human cell lines as well as from preliminary trials in diabetic populations, like the Study to Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) trial, have highlighted - though not undisputed - the potential beneficial effects of the drug on CV morbidity. Large scale trials, like the ongoing Acarbose Cardiovascular Evaluation (ACE) trial, aim at conclusively establishing such a positive effect in patients with coronary heart disease and impaired glucose tolerance. In view of its usually acceptable level of side effects that are, if they occur, mostly limited to transient gastrointestinal symptoms, acarbose could well be a strong future player in CV disease secondary prevention. Current discouraging results from many trials of antidiabetic medications to significantly lower CV event rates in diabetic patients, should only draw further attention on alternative glucose lowering agents, among which acarbose is indeed promising. © 2014 Standl et al.; licensee BioMed Central Ltd.

Gyberg V.,Karolinska University Hospital | Gyberg V.,Karolinska Institutet | De Bacquer D.,European Society of Cardiology | De Bacquer D.,Ghent University | And 14 more authors.
European Heart Journal | Year: 2015

Aims Three methods are used to identify dysglycaemia: fasting plasma glucose (FPG), 2-h post-load plasma glucose (2hPG) from the oral glucose tolerance test (OGTT), and glycated haemoglobin A1c (HbA1c). The aim was to describe the yield and concordance of FPG, HbA1c, and 2hPG alone, or in combination, to identify dysglycaemia in patients with coronary artery disease. Methods and results In EUROASPIRE IV, a cross-sectional survey of patients aged 18-80 years with coronary artery disease in 24 European countries, 4004 patients with no reported history of diabetes had FPG, 2hPG, and HbA1c measured. All participants were divided into different glycaemic categories according to the ADA and WHO criteria for dysglycaemia. Using all screening tests together, 1158 (29%) had undetected diabetes. Out of them, the proportion identified by FPG was 75%, by 2hPG 40%, by HbA1c 17%, by FPG + HbA1c 81%, and by OGTT (=FPG + 2hPG) 96%. Only 7% were detected by all three methods FPG, 2hPG, and HbA1c. The ADA criteria (FPG + HbA1c) identified 90% of the population as having dysglycaemia compared with 73% with the WHO criteria (OGTT = FPG + 2hPG). Screening according to the ADA criteria for FPG + HbA1c identified 2643 (66%) as having a 'high risk for diabetes', while the WHO criteria for FPG + 2hPG identified 1829 patients (46%). Conclusion In patients with established coronary artery disease, the OGTT identifies the largest number of patients with previously undiagnosed diabetes and should be the preferred test when assessing the glycaemic state of such patients. © 2015 The Author.

Rautio N.,Pirkanmaa Hospital District | Jokelainen J.,University of Oulu | Korpi-Hyovalti E.,Seinajoki Central Hospital | Oksa H.,Pirkanmaa Hospital District | And 11 more authors.
Journal of Women's Health | Year: 2014

Background: Lifestyle interventions are effective in preventing type 2 diabetes (T2D). Women with history of gestational diabetes mellitus (GDM) may have barriers to lifestyle changes, and the previous results of lifestyle interventions are contradictory reporting either favorable outcomes or no significant beneficial effects. Our aim was to compare cardio-metabolic risk profile and responses to a 1-year lifestyle intervention program in women with and without history of GDM. Methods: The Implementation Project of the Program for Prevention of Type 2 Diabetes (FIN-D2D) was conducted in Finland in five hospital districts. Altogether 1,661 women aged ≤45 years participated in the program. One-year follow-up was available for 393 women who did not have screen-detected T2D at baseline, and 265 of them had at least one intervention visit [115 (43.4%) women with history of GDM and 150 (56.6%) without history of GDM]. Results: At baseline, women with GDM had similar baseline glucose tolerance but better anthropometric characteristics, blood pressure, and lipid profile than women without GDM after adjustment for age. Beneficial changes in cardiovascular risk profile existed among women with and without GDM during follow-up and the effect of lifestyle intervention was similar between the groups, except that low-density lipoprotein cholesterol improved only in women with GDM. Altogether, 4.0% of those with GDM and 5.0% of those without GDM developed T2D (p=0.959 adjustment for age). Conclusions: The effect of a 1-year lifestyle intervention in primary healthcare setting was similar regardless of history of GDM, both women with and without GDM benefitted from participation in the lifestyle intervention. © Mary Ann Liebert, Inc.

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