Search

Aims: There are sex differences in the excess risk of diabetes‐associated cardiovascular disease. However, it is not clear whether these sex differences exist with regard to other complications like mental health aspects. Therefore, we investigated sex differences in the association of prediabetes and type 2 diabetes (T2D) with cognitive function, depression, and quality of life (QoL). Materials and Methods: In a population‐based cross‐sectional cohort study (n = 7639; age 40–75 years, 50% women, 25% T2D), we estimated sex‐specific associations, and differences therein, of prediabetes and T2D (reference: normal glucose metabolism) with measures of cognitive function, depression, and physical and mental QoL. Sex differences were analysed using multiple regression models with interaction terms. Results: In general, T2D, but not prediabetes, was associated with higher odds of cognitive impairment, major depressive disorder, and poorer QoL. The odds ratio (OR) of cognitive impairment associated with T2D was 1.29 (95% CI: 0.96–1.72) for women and 1.39 (1.10–1.75) for men. The OR of major depressive disorder associated with T2D was 1.19 (0.69–2.04) for women and 1.68 (1.02–2.75) for men. The mean difference of the physical QoL score (ranging from 0 to 100, with 100 indicating the best possible QoL) associated with T2D was −2.09 (−2.92 to −1.25) for women and −1.81 (−2.48 to −1.13) for men. The mean difference of the mental QoL score associated with T2D was −0.90 (−1.79 to −0.02) for women and −0.52 (−1.23 to 0.20) for men. There was no clear pattern of sex differences in the associations of either prediabetes or T2D with measures of cognitive function, depression, or QoL. Conclusions: In general, T2D was associated with worse cognitive function, depression, and poorer QoL. The strength of these associations was similar among women and men. [ABSTRACT FROM AUTHOR]

The definition of health has been shifting from disease absence to physical, emotional and social well‐being. To demedicalise societal problems, the term Positive Health (PH) was introduced—a concept focused on the ability to adapt and to self‐manage, in the face of physical, emotional and social challenges. The concept of PH receives broad attention, among others because a PH dialogue tool is intensively being used as a communication instrument while reflecting on patients' health, but a PH measurement instrument is not yet fully established. Recently, however, a 17‐item PH measurement model was proposed. In this paper, a factor analysis and regression analyses were performed to test the factorial validity and concurrent validity of this PH measurement model based on a representative sample of the Dutch population (n = 1016, 50.0% women; age: from 15 until 39 = 29.8%, from 40 until 65 = 43.0%, older than 65 = 27.2%; education levels: low = 28.7%, medium = 42.6%, high = 28.7%). These tests are crucial to understand how well the PH measurement model is suitable as a measurement instrument. The factor analysis provided support for the factorial validity of the proposed PH measurement model. When comparing the proposed PH measurement model with domains of other measurements of health (i.e. BRS, HR‐SWB, ICECAP, and EQ5D), to test the concurrent validity, the model explained more than half of the variance in measurements of the domains happiness (R2 = 0.60) and overall self‐rated health (R2 = 0.57), but explained less than a quarter of the variance in measurements of autonomy (R2 = 0.17 / R2 = 0.13), personal growth (R2 = 0.21), stability (R2 = 0.20), self‐care (R2 = 0.15), and resilience (R2 = 0.24). Two of the six domains of the PH measurement model—mental functioning and daily functioning—were weakly related to the other measurements of health. The results of this study imply that the PH measurement model is suitable to measure multiple dimensions of health. They also suggest that the PH measurement model may not be an encompassing measure for the concepts measured through other health measurements and might explain variance in health beyond these other measurements. [ABSTRACT FROM AUTHOR]

Aims: To determine the association between registered mental illness and type 2 diabetes mellitus treatment targets, while taking into account the effects of health expenditure and social determinants of health. Methods: This observational cross‐sectional study was based on routine primary care data, linked to socio‐economic and medical claims data. The main outcomes, analysed by multivariate logistic regression, were achieving primary care guideline treatment targets for HbA1c, systolic blood pressure (SBP) and LDL‐cholesterol in 2017. We examined the association with diagnosed mental illness registered by the general practitioner (GP) or treated via specialist' mental healthcare between 2016 and 2018, adjusting for, medication use, body mass index, co‐morbidity, smoking, and additionally examining effect‐modification of healthcare expenditures, migration status, income and demographics. Results: Overall (N = 2862), 64.0% of participants achieved their treatment targets for HbA1c, 65.1% for SBP and 53.0% for LDL‐cholesterol. Adjusted for migrant background, income and care expenditures, individuals <65 years of age with mental illness achieved their HbA1c treatment target more often than those without (OR (95% CI)): treatment by GP: 1.46 (1.01, 2.11), specialist care: 1.61 (1.11, 2.34), as did men with mental illness for SBP: GP OR 1.61 (1.09, 2.40), specialist care OR 1.59 (1.09, 2.45). LDL‐cholesterol target was not associated with mental illness. A migrant background or low income lowered the likelihood of reaching HbA1c targets. Conclusions: People with registered mental illness appear comparable or better able to achieve diabetes treatment targets than those without. Achieving HbA1c targets is influenced by social disadvantage. [ABSTRACT FROM AUTHOR]

Aims: To investigate changes in physical activity (PA) and psychological factors during societal lockdown in people with type 2 diabetes. Methods: A cross‐sectional study among Dutch adults with type 2 diabetes. Data were collected using online questionnaires. A multivariate multinomial logistic regression was performed with change in PA during societal lockdown as outcome and perceived change in stress, anxiety, perceived risk for COVID‐19 infection, emotional well‐being and former PA status as determinants. Results: Five hundred and sixty seven respondents filled out the questionnaire, 536 were included in the final analysis: mean age of 65.9 ± 7.9 years; mean diabetes duration 13.3 ± 8 years; 54% men; 47% reported no change in PA, 27% became less active and 26% became more active during societal lockdown. Participants who were more likely to become less active were participants who experienced more stress (OR: 2.27; 95% CI 1.25–4.13) or less stress (OR: 2.20; 95% CI 1.03–4.71). Participants who were more likely to become more active were participants who experienced more stress (OR: 2.31; 95% CI 1.25, 4.26). Participants with higher emotional well‐being (OR: 0.98; 95% CI 0.97, 0.99) were less likely to become less active than to report no change in PA. Conclusions: Changes in PA in people with type 2 diabetes during societal lockdown are associated with changes in psychological factors such as perceived stress and emotional well‐being. People with diabetes and their caregivers should be aware of these possible changes. Physical activity is important for the management of diabetes and is influenced by daily life structures. Physical activity behaviour changed in people with type 2 diabetes during the societal lockdown in times of the COVID‐19 pandemic. Stress and well‐being are associated with change in physical activity. [ABSTRACT FROM AUTHOR]

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

Aims: Short‐term weight loss may lead to remission of type 2 diabetes but the effect of maintained weight loss on cardiovascular disease (CVD) is unknown. We quantified the associations between changes in weight 5 years following a diagnosis of diabetes, and incident CVD events and mortality up to 10 years after diagnosis. Materials and methods: Observational analysis of the ADDITION‐Europe trial of 2730 adults with screen‐detected type 2 diabetes from the UK, Denmark and the Netherlands. We defined weight change based on the maintenance at 5 years of weight loss achieved during the year after diabetes diagnosis, and as 5‐year overall change in weight. Incident CVD events (n = 229) and all‐cause mortality (n = 225) from 5 to 10 years follow‐up were ascertained from medical records. Results: Gaining >2% weight during the year after diabetes diagnosis was associated with higher hazard of all‐cause mortality versus maintaining weight [hazard ratio (95% confidence interval): 3.18 (1.30‐7.82)]. Losing ≥5% weight 1 year after diagnosis was also associated with mortality, whether or not weight loss was maintained at 5 years: 2.47 (0.99‐6.21) and 2.72 (1.17‐6.30), respectively. Losing ≥10% weight over 5 years was associated with mortality among those with body mass index <30 kg/m2 [4.62 (1.87‐11.42)]. Associations with CVD incidence were inconclusive. Conclusions: Both weight loss and weight gain after screen‐detected diabetes diagnosis were associated with higher mortality, but not CVD events, particularly among participants without obesity. The clinical implications of weight loss following a diagnosis of diabetes probably depend on its magnitude and timing, and may differ by body mass index status. Personalization of weight loss advice and support may be warranted. [ABSTRACT FROM AUTHOR]

Given that there are indications of overtreatment in older patients with type 2 diabetes in both the United States and Europe, we assessed the level of personalized diabetes treatment for older patients in primary care, focusing on overtreatment. Based on Dutch guidelines individuals aged ≥70 years were classified into 3 glycated haemoglobin (HbA1c) treatment target groups: 7% (53 mmol/mol), 7.5% (58 mmol/mol) and 8% (64 mmol/mol). In our cohort of 1002 patients (n = 319 aged ≥70 years), the 165 patients with HbA1c targets >7% had more micro‐ and macrovascular complications, more often used ≥5 medicines and were more often frail compared with those with an HbA1c target ≤7%. Of these 165 patients, 64 (38.8%) were overtreated; that is, 20% of all people aged ≥70 years. The majority of overtreated people were frail and used ≥5 medicines. Hypoglycaemia occurred in 20.3% of these patients and almost 30% reported accidents involving falls. Personalized treatment in older people with type 2 diabetes is not common practice. A substantial number of older people are overtreated, with probable harmful consequences. To prevent overtreatment, definition of lower HbA1c limits might be helpful. [ABSTRACT FROM AUTHOR]

Aim: To examine the efficacy of child-focused, context-focused, and regular care approaches, delivered in a rehabilitation setting by physical or occupational therapists to preschool children with cerebral palsy (CP), in optimizing the child's self-care and mobility capabilities.Method: A multicentre randomized controlled trial clustered at therapist level was conducted in 13 rehabilitation centres. It included 68 children with CP (38 males, 30 females; mean age 3y, SD 6mo, range 1y 11mo-4y), classified as Gross Motor Function Classification System levels I to IV, who were already receiving therapy. Children received a child-focused, context-focused, or regular care approach during a 6-month period. Self-care and mobility capabilities were assessed with the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory.Results: The child-focused, context-focused, and regular care approaches all resulted in significant but similar improvements in self-care (regular: reference; child-focused: β=-0.11, 95% confidence interval [CI] -0.68 to 0.46; context-focused: β=0.13, CI -0.38 to 0.64) and mobility (regular: reference; child-focused: β=-0.09, CI=-0.93 to 0.75; and context-focused: β=0.14, CI -0.65 to 0.94) capabilities.Interpretation: The results suggest that the three therapy approaches were equally efficacious for preschool children with CP. Depending on a child's individual situation each approach can be selected. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to determine the developmental trajectories of expressive (speech) and receptive (spoken and written language) communication by type of motor disorder and intellectual disability in individuals with cerebral palsy ( CP). Method The development of 418 participants (261 males, 157 females; mean age 9y 6mo [ SD 6y 2mo], range 1-24y; Gross Motor Function Classification System ( GMFCS) level I [ n=206], II [ n=57], III [ n=59], IV [ n=54], V [ n=42]) was followed for 2 to 4 years in a longitudinal study. Communication performance was measured using the Vineland Adaptive Behavior Scales. The type of motor disorder was differentiated by type of CP as unilateral spastic ( USCP, n=161), bilateral spastic ( BSCP, n=202), and non-spastic ( NSCP, n=55), while intellectual disability was determined by IQ or school type (regular or special). A multilevel analysis was then used to model the developmental trajectories. Results The most favourable development of expressive communication was seen in USCP (vs BSCP β [ SE]-2.74 [1.06], NSCP β [ SE]-2.67 [1.44]). The difference between the development trajectory levels of children with and without intellectual disability was smaller for children with USCP than for those with BSCP and NSCP. For receptive communication, the most favourable development was found for all children with USCP and for BSCP or NSCP without intellectual disability (vs intellectual disability β [ SE]-4.00 [1.16]). Development of written language was most favourable for children without intellectual disability (vs intellectual disability β [ SE]-23.11 [2.85]). Interpretation The development of expressive communication was found to be most closely related to type of motor disorder, whereas the development of receptive communication was found to be most closely related to intellectual disability. [ABSTRACT FROM AUTHOR]

Aim This study aimed to determine the developmental trajectories of social participation, by level of gross motor function and intellectual disability, in a Dutch population of individuals with cerebral palsy ( CP) aged 1 to 24 years. Method As part of the Pediatric Rehabilitation Research in the Netherlands ( PERRIN+), 424 individuals with CP (261 males, 163 females; mean age [ SD] 9y 6mo [6y 2mo]; Gross Motor Function Classification [ GMFCS] levels I- V [50% level I]; 87% with spastic CP; 26% with intellectual disability) were longitudinally followed for up to 4 years between 2002 and 2007. Social participation was assessed with the Vineland Adaptive Behavior Scales survey. Effects of age, GMFCS level and intellectual disability were analysed using multilevel modelling. Results The developmental trajectories for individuals in GMFCS levels I to IV did not significantly differ from each other. For individuals without intellectual disability, the degree of social participation increased with age and stabilized at about 18 years. These individuals reached social participation levels similar to typically developing individuals. The trajectories were significantly less favourable for individuals in GMFCS level V and individuals with intellectual disability. Interpretation Intellectual disability is more distinctive for the development of social participation than GMFCS level. The developmental trajectories will support individuals with CP and their families in setting realistic goals and professionals in optimizing the choice of interventions at an early age. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to describe patterns for gross motor development by level of severity in a Dutch population of individuals with cerebral palsy ( CP). Method This longitudinal study included 423 individuals (260 males, 163 females) with CP. The mean age at baseline was 9 years 6 months ( SD 6y 2mo, range 1-22y). The level of severity of CP among participants, according to the Gross Motor Function Classification System ( GMFCS), was 50% level I, 13% level II, 14% level III, 13% level IV, and 10% level V. Participants had been assessed up to four times with the Gross Motor Function Measure ( GMFM-66) at 1- or 2-year intervals between 2002 and 2009. Data were analysed using non-linear mixed effects modelling. For each GMFCS level, patterns were created by contrasting a stable limit model ( SLM) with a peak and decline model ( PDM), followed by estimating limits and rates of gross motor development. Results The SLM showed a better fit for all GMFCS levels than the PDM. Within the SLM, significant differences between GMFCS levels were found for both the limits (higher values for lower GMFCS levels) and the rates (higher values for GMFCS levels I- II vs level IV and for GMFCS levels I- IV vs level V) of gross motor development. Interpretation The results validate the existence of five distinct patterns for gross motor development by level of severity of CP. [ABSTRACT FROM AUTHOR]

Objective. This study aims to evaluate the effect of a multidisciplinary treatment of obesity on plasma concentrations of several gut hormones in fasting condition and in response to a mixed meal in children. Methods. Complete data were available from 36 obese children (age 13 3± 2.0 yr). At baseline and after the 3-month multidisciplinary treatment, fasting and postprandial blood samples. were taken for glucose, insulin, ghrelin, peptide YY (PYY), and glucagon-like peptide 1 (GLP-1). Results. BMI-SDS was significantly reduced by multidisciplinary treatment (from 4.2. ± 0.7 to 4 .0 ± 0.9, P <.01). The intervention significantly increased the area under the curve (AUC) of ghrelin (from 92.3 ± 18.3 to 9 7.9 ± 18.2p g / L, P <.01), but no significant changes were found for PYY . or GLP-1 concentrations (in fasting or postprandial condition). The insulin resistance index (HOMA-IR) remained unchanged as well. Conclusion. Intensive multidisciplinary treatment induced moderate weight loss and increased ghrelin secretion, but serum PYY and GLP-1 concentrations and insulin sensitivity remained unchanged. [ABSTRACT FROM AUTHOR]

Given that there are indications of overtreatment in older patients with type 2 diabetes in both the United States and Europe, we assessed the level of personalized diabetes treatment for older patients in primary care, focusing on overtreatment. Based on Dutch guidelines individuals aged ≥70 years were classified into 3 glycated haemoglobin (HbA1c) treatment target groups: 7% (53 mmol/mol), 7.5% (58 mmol/mol) and 8% (64 mmol/mol). In our cohort of 1002 patients (n = 319 aged ≥70 years), the 165 patients with HbA1c targets >7% had more micro- and macrovascular complications, more often used ≥5 medicines and were more often frail compared with those with an HbA1c target ≤7%. Of these 165 patients, 64 (38.8%) were overtreated; that is, 20% of all people aged ≥70 years. The majority of overtreated people were frail and used ≥5 medicines. Hypoglycaemia occurred in 20.3% of these patients and almost 30% reported accidents involving falls. Personalized treatment in older people with type 2 diabetes is not common practice. A substantial number of older people are overtreated, with probable harmful consequences. To prevent overtreatment, definition of lower HbA1c limits might be helpful., (© 2017 John Wiley & Sons Ltd.)