BRING SUNDHEDSDATA I SPIL

Size: px
Start display at page:

Download "BRING SUNDHEDSDATA I SPIL"

Transcription

1 BRING SUNDHEDSDATA I SPIL PROF. DANIEL R. WITTE AARHUS UNIVERSITY, DEPARTMENT OF PUBLIC HEALTH DANISH DIABETES ACADEMY AARHUS

2

3 GLUCOSE, INSULIN AND THE PANCREAS

4 THE MAIN COMPLICATIONS OF DIABETES Re9nopathy Coronary Heart Disease Cerebrovascular Disease Nephropathy Neuropathy Peripheral Vascular Disease

5 DIABETES SUBTYPES (2014) Groop & Pociot. Mol Cell Endocrinol Jan 25;382(1):726-39

6 CHALLENGES Understanding mechanisms that lead to diabetes and its complications Preventing diabetes: Physiology Screening? Primary prevention Changing health behaviours Improving patient care: Treatment effectiveness Understanding risk Removing barriers

7 CHALLENGES Understanding mechanisms that lead to diabetes and its complications Preventing diabetes: Physiology Screening? Primary prevention Changing health behaviours Improving patient care: Treatment effectiveness Understanding risk Removing barriers

8 CHALLENGES Understanding mechanisms that lead to diabetes and its complications Preventing diabetes: Physiology Screening? Primary prevention Changing health behaviours Improving patient care: Treatment effectiveness Understanding risk Removing barriers

9 CHALLENGES Understanding mechanisms that lead to diabetes and its complications Preventing diabetes: Physiology Screening? Primary prevention Changing health behaviours Improving patient care: Treatment effectiveness Understanding risk Removing barriers In a more personalised way

10 CENTRAL CONSIDERATIONS IN EPIDEMIOLOGY Is an observed association true? What are the alternatives? Chance Bias Selection Information Confounding

11 THE WHITEHALL II STUDY British observational, occupational cohort study 10,308 participants years old Men (70%) and women (30%) Started in years of follow-up with OGTT ( ) Phase 3 Phase 5 Phase 7 Phase 9 Phase 4 Ques9onnaire Phase 6 Ques9onnaire Phase 8 Ques9onnaire OGTT Clinical exam. Ques9onnaire OGTT Clinical exam. Ques9onnaire OGTT Clinical exam. Ques9onnaire OGTT Clinical exam. Ques9onnaire

12 Window of opportunity for preven9on Tabák AG, Lancet Jun 27;373(9682): Tabák AG, Lancet Jun 16;379(9833):

13 FINDING DIABETES PATIENTS IN THE GENERAL POPULATION General Population High Risk Population Patients with undiagnosed diabetes Patients with known diabetes

14 THE ADDITION STUDY Denmark UK Netherlands Annelli Sandbæk, Guy Ruden, Stephen Sharp, Nick Wareham, Else-Marie Dalsgaard, Rimke Vos, David Webb, Greg Irving, Daniel Wide, Torsten Lauritzen, Melanie Davies, Kamlesh Khun9, Simon Griffin Clinical trial registra:on number NCT

15 HOW WAS THE POPULATION IDENTIFIED? Denmark: Postal questionnaire Random BG, HbA 1c Netherlands: Postal questionnaire Random BG Cambridge: Medical records Random BG, HbA 1c WHO criteria for diabetes Leicester: Practice register OGTT Risk Risk assessment assessment Identification Hyperglycaemia of hyperglycaemi a Diagnosis Diagnosis of diabetes Included 3,057 Target population Invited to be tested Test positive population

16 INTERVENTION general prac9ce units screened their popula9ons 161 GP units Intensive treatment group 156 GP units Rou9ne Care group Treatment protocol Educa9on Feed back Peer visit Reminders Follow na9onal guidelines

17 Baseline Follow up Baseline Follow up Baseline Follow Baseline Follow up up Baseline Follow up Baseline Follow up 0 10 % of participants prescribed medication BP-lowering Statins Glucose-lowering 100 Routine care Intensive treatment PRESCRIBED TREATMENT AT BASELINE AND 5 YEAR FOLLOW-UP

18 Griffin et al. Lancet 2011:378: IT RC Number at risk Years of follow-up 0 Primary composite endpoint (%) p= Routine care Intensive treatment PRIMARY ENDPOINT: CUMULATIVE INCIDENCE OF COMPOSITE CVD ENDPOINT

19 PRIMARY OUTCOME AT FIVE YEAR: RELATIVE RISK OF COMPOSITE CVD ENDPOINT AS A FIRST EVENT Country Hazard Ratio (95% CI) Denmark 0.83 (0.59 to 1.16) UK 0.80 (0.55 to 1.17) Netherlands 0.96 (0.45 to 2.03) Overall (I-squared = 0.0%) 0.83 (0.65 to 1.05) Favours Favours intensive treatment Favours routine care care Griffin et al. Lancet 2011:378:156-67

20 DANISH REGISTERS

21 Scan J Pub Health, 2011; 39(Suppl 7): 12 16

22 Scan J Pub Health, 2011; 39(Suppl 7): 12 16

23 DIABETES PREVALENCE IN DENMARK Carstensen B. Diabetologia (2008)

24 DIABETES INCIDENCE IN DENMARK Carstensen B. Diabetologia (2008)

25 AGE DISTRIBUTION OF PEOPLE WITH DIABETES IN DENMARK Carstensen B. Diabetologia (2008)

26 MORTALITY IN PEOPLE WITH DIABETES IN DENMARK Carstensen B. Diabetologia (2008)

27 MAPPING PATIENT ADHERENCE Jensen ML. Value in Health 17 (2014)

28 MAPPING PATIENT ADHERENCE Jensen ML. Value in Health 17 (2014)

29 MAPPING PATIENT ADHERENCE Jensen ML. Value in Health 17 (2014)

30 BRING SUNDHEDSDATA I SPIL DR. ADAM HULMAN AARHUS UNIVERSITY, DEPARTMENT OF PUBLIC HEALTH DANISH DIABETES ACADEMY AARHUS

31 EXAMPLES Glucose curves during an oral glucose challenge test (Study 1) Prediction of cardiovascular disease in type 1 diabetes patients (Study 2)

32 STUDY 1 Diabetes diagnosis is traditionally based on a glucose challenge test Fasting plasma glucose FPG 2-hour post-load glucose (2hPG) (HbA 1c ) Modest overlap between groups diagnosed by different methods Diabetes is a heterogeneous disease What if we have measurements at more than two time points? Can we explain some of the heterogeneity?

33 STUDY 1 Pooling of available datasets Repeated measurements (n=5-11 per person)

34 STUDY 1 Data-driven analysis approach Latent class trajectory analysis iden9fies subgroups with similar developmental paderns over 9me Descrip9on of iden9fied classes regarding cardiometabolic risk profiles

35 READ MORE:

36 STUDY 2 Clinical need Prediction of cardiovascular disease for type 1 diabetes patients Datasets: Steno Diabetes Center (model development) Funen Diabetes Database (external validation) Combined modeling approach Data-driven: random forest, decision tree Conventional: Poisson regression (survival analysis)

37 Random forest (variable importance) STUDY 2 Decision tree (discover interac9ons)

38 STUDY 2 Accuracy & calibration

39 STUDY 2 Poisson regression Needs clinical implementa9on!

40 steno.dk/t1riskengine

41 READ MORE:

42 BRING SUNDHEDSDATA I SPIL PROF. DANIEL R. WITTE AARHUS UNIVERSITY, DEPARTMENT OF PUBLIC HEALTH DANISH DIABETES ACADEMY AARHUS

43

44

45 COST PER GENOME

46

47 Nature 2014; 506,

48 Nature Immunology 16, (2015)

49

50

51

52

53

54

55

56

57

58

59

60

61

62 CENTRAL CONSIDERATIONS IN EPIDEMIOLOGY Is an observed association true? What are the alternatives? Chance Bias Selection Information Confounding

63 TAK FOR OPMÆRKSOMHEDEN!

SHORT COMMUNICATION. Diabetologia DOI /s

SHORT COMMUNICATION. Diabetologia DOI /s DOI 10.1007/s00125-017-4230-6 SHORT COMMUNICATION Does training of general practitioners for intensive treatment of people with screen-detected diabetes have a spillover effect on mortality and cardiovascular

More information

Preventive Health Checks and Screening for Diabetes. Interventions in General Practice. Transferable to Arctic Health?

Preventive Health Checks and Screening for Diabetes. Interventions in General Practice. Transferable to Arctic Health? Preventive Health Checks and Screening for Diabetes. Interventions in General Practice. Transferable to Arctic Health? Ebeltoft Health Promotion Project Denmark UK Netherlands www.addition.au.dk Clinical

More information

Preventive Cardiology Scientific evidence

Preventive Cardiology Scientific evidence Preventive Cardiology Scientific evidence Professor David A Wood Garfield Weston Professor of Cardiovascular Medicine International Centre for Circulatory Health Imperial College London Primary prevention

More information

Why is Earlier and More Aggressive Treatment of T2 Diabetes Better?

Why is Earlier and More Aggressive Treatment of T2 Diabetes Better? Blood glucose (mmol/l) Why is Earlier and More Aggressive Treatment of T2 Diabetes Better? Disclosures Dr Kennedy has provided CME, been on advisory boards or received travel or conference support from:

More information

HEALTH TECHNOLOGY ASSESSMENT

HEALTH TECHNOLOGY ASSESSMENT HEALTH TECHNOLOGY ASSESSMENT VOLUME 20 ISSUE 64 AUGUST 2016 ISSN 1366-5278 A randomised trial of the effect and cost-effectiveness of early intensive multifactorial therapy on 5-year cardiovascular outcomes

More information

A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes

A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes A factorial randomized trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Hypotheses: Among individuals with type 2 diabetes, the risks of major microvascular

More information

Estimation and prediction in multistate models

Estimation and prediction in multistate models Estimation and prediction in multistate models Bendix Carstensen Steno Diabetes Center, Gentofte, Denmark & Department of Biostatistics, University of Copenhagen b@bxc.dk http://bendixcarstensen.com University

More information

Kristine Færch, Bendix Carstensen, Thomas Peter Almdal, and Marit Eika Jørgensen. Steno Diabetes Center, DK-2820 Gentofte, Denmark

Kristine Færch, Bendix Carstensen, Thomas Peter Almdal, and Marit Eika Jørgensen. Steno Diabetes Center, DK-2820 Gentofte, Denmark JCEM ONLINE Brief Report Endocrine Care Improved Survival Among Patients With Complicated Type 2 Diabetes in Denmark: A Prospective Study (2002 2010) Kristine Færch, Bendix Carstensen, Thomas Peter Almdal,

More information

ESM1 for Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study

ESM1 for Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study ESM1 for Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study Statistical modelling details We used Cox proportional-hazards

More information

Community Based Diabetes Prevention

Community Based Diabetes Prevention Community Based Diabetes Prevention Melanie Davies Professor of Diabetes Medicine Outline NIHR Programme Grant proposal and update to progress The Vascular Check programme HbA1c debate Algorithm to detect

More information

Microvascular Complications in Diabetes:

Microvascular Complications in Diabetes: Microvascular Complications in Diabetes: Perspectives on Glycemic Control to Prevent Microvascular Complications Discussion Outline: Glycemia and Microvascular Compliations Clinical Trials - A Brief History

More information

Diabetes mellitus The "diabetes epidemic, improved survival and strategies for rehabilitation

Diabetes mellitus The diabetes epidemic, improved survival and strategies for rehabilitation Diabetes mellitus The "diabetes epidemic, improved survival and strategies for rehabilitation Knut Borch-Johnsen Research Center for Quality in Health Care Inst. Public Health University of Southern Denmark

More information

Type 2 Diabetes. Treat to: limit complications maintain quality of life Improve survival

Type 2 Diabetes. Treat to: limit complications maintain quality of life Improve survival Type 2 Diabetes Treat to: limit complications maintain quality of life Improve survival 1 Criteria for the diagnosis of diabetes 1. HbA1C 6.5% (rounded to 50mmol/mol). 2. FPG 7.0 mmol/l. 3. 2-h plasma

More information

Problem solving therapy

Problem solving therapy Introduction People with severe mental illnesses such as schizophrenia may show impairments in problem-solving ability. Remediation interventions such as problem solving skills training can help people

More information

ARTICLE. Diabetologia (2018) 61:

ARTICLE. Diabetologia (2018) 61: Diabetologia (2018) 61:1306 1314 https://doi.org/10.1007/s00125-018-4594-2 ARTICLE Effect of screening for type 2 diabetes on healthcare costs: a register-based study among 139,075 individuals diagnosed

More information

Epidemiology of Diabetes, Impaired Glucose Homeostasis and Cardiovascular Risk. Eberhard Standl

Epidemiology of Diabetes, Impaired Glucose Homeostasis and Cardiovascular Risk. Eberhard Standl Epidemiology of Diabetes, Impaired Glucose Homeostasis and Cardiovascular Risk Eberhard Standl European Heart House Sophia Antipolis Thursday, June 17, 2010 IDF Diabetes Atlas 2009: Global Numbers Still

More information

Cedars Sinai Diabetes. Michael A. Weber

Cedars Sinai Diabetes. Michael A. Weber Cedars Sinai Diabetes Michael A. Weber Speaker Disclosures I disclose that I am a Consultant for: Ablative Solutions, Boston Scientific, Boehringer Ingelheim, Eli Lilly, Forest, Medtronics, Novartis, ReCor

More information

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN)

NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia. Produced by: National Cardiovascular Intelligence Network (NCVIN) NHS Diabetes Prevention Programme (NHS DPP) Non-diabetic hyperglycaemia Produced by: National Cardiovascular Intelligence Network (NCVIN) Date: August 2015 About Public Health England Public Health England

More information

Getting serious about preventing cardiovascular disease

Getting serious about preventing cardiovascular disease Getting serious about preventing cardiovascular disease Southwark s Experience Professor Kevin Fenton Director of Health and Wellbeing, London Borough of Southwark February 2018 Twitter: @ProfKevinFenton

More information

The University of Mississippi School of Pharmacy

The University of Mississippi School of Pharmacy LONG TERM PERSISTENCE WITH ACEI/ARB THERAPY AFTER ACUTE MYOCARDIAL INFARCTION: AN ANALYSIS OF THE 2006-2007 MEDICARE 5% NATIONAL SAMPLE DATA Lokhandwala T. MS, Yang Y. PhD, Thumula V. MS, Bentley J.P.

More information

ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES

ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES Pr. Michel KOMAJDA Institute of Cardiology - IHU ICAN Pitie Salpetriere Hospital - University Pierre and Marie Curie, Paris (France) DEFINITION A

More information

Adherence to therapy. Kamlesh Khunti University of Leicester, UK. William Polonsky University of California San Diego, USA

Adherence to therapy. Kamlesh Khunti University of Leicester, UK. William Polonsky University of California San Diego, USA Adherence to therapy Kamlesh Khunti University of Leicester, UK William Polonsky University of California San Diego, USA 1 Dualities of interest Kamlesh Khunti: Honoraria for speaking, advising or research

More information

Syddansk Universitet. Published in: Diabetologia. DOI: /s Publication date: 2017

Syddansk Universitet. Published in: Diabetologia. DOI: /s Publication date: 2017 Syddansk Universitet Effect of population screening for type 2 diabetes and cardiovascular risk factors on mortality rate and cardiovascular events a controlled trial among 1,912,392 Danish adults Simmons,

More information

Diabete: terapia nei pazienti a rischio cardiovascolare

Diabete: terapia nei pazienti a rischio cardiovascolare Diabete: terapia nei pazienti a rischio cardiovascolare Giorgio Sesti Università Magna Graecia di Catanzaro Cardiovascular mortality in relation to diabetes mellitus and a prior MI: A Danish Population

More information

American Academy of Insurance Medicine

American Academy of Insurance Medicine American Academy of Insurance Medicine October 2012 Dr. Alison Moy Liberty Mutual Dr. John Kirkpatrick Thrivent Financial for Lutherans 1 59 year old male, diagnosed with T2DM six months ago Nonsmoker

More information

Pharmaco-epidemiological outcome research

Pharmaco-epidemiological outcome research Pharmaco-epidemiological outcome research Using the PHARMO-Eindhoven Cancer Registry linkage Lonneke van de Poll-Franse Professor of Cancer Epidemiology and Survivorship, Tilburg University & Head department

More information

SUPPLEMENTAL MATERIAL

SUPPLEMENTAL MATERIAL SUPPLEMENTAL MATERIAL A Meta-analysis of LDL-C, non-hdl-c, and apob as markers of cardiovascular risk. Slide # Contents 2 Table A1. List of candidate reports 8 Table A2. List of covariates/model adjustments

More information

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010

Ischemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories

More information

The Diabetes Link to Heart Disease

The Diabetes Link to Heart Disease The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM

More information

A Simplified Indian Diabetes Risk Score for Screening for Undiagnosed Diabetic Subjects

A Simplified Indian Diabetes Risk Score for Screening for Undiagnosed Diabetic Subjects Original Article# A Simplified Indian Diabetes Risk Score for Screening for Undiagnosed Diabetic Subjects V Mohan*, R Deepa*, M Deepa*, S Somannavar*, M Datta** Abstract Aim : The aim of this study was

More information

CAN EFFECTIVENESS BE MEASURED OUTSIDE A CLINICAL TRIAL?

CAN EFFECTIVENESS BE MEASURED OUTSIDE A CLINICAL TRIAL? CAN EFFECTIVENESS BE MEASURED OUTSIDE A CLINICAL TRIAL? Mette Nørgaard, Professor, MD, PhD Department of Clinical Epidemiology Aarhus Universitety Hospital Aarhus, Denmark Danish Medical Birth Registry

More information

Global health; understanding, approach and major issues

Global health; understanding, approach and major issues Global health; understanding, approach and major issues Gabriel Gulis Unit of health promotion research Institute of public health, Faculty of medical sciences University of Southern Denmark Esbjerg, Denmark

More information

The Whitehall II study originally comprised 10,308 (3413 women) individuals who, at

The Whitehall II study originally comprised 10,308 (3413 women) individuals who, at Supplementary notes on Methods The study originally comprised 10,308 (3413 women) individuals who, at recruitment in 1985/8, were London-based government employees (civil servants) aged 35 to 55 years.

More information

Microvascular Disease in Type 1 Diabetes

Microvascular Disease in Type 1 Diabetes Microvascular Disease in Type 1 Diabetes Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine The Course

More information

Distraction techniques

Distraction techniques Introduction are a form of coping skills enhancement, taught during cognitive behavioural therapy. These techniques are used to distract and draw attention away from the auditory symptoms of schizophrenia,

More information

Effect of population screening for type 2 diabetes on mortality: long-term follow-up of the Ely cohort

Effect of population screening for type 2 diabetes on mortality: long-term follow-up of the Ely cohort Diabetologia (2011) 54:312 319 DOI 10.1007/s00125-010-1949-8 ARTICLE Effect of population screening for type 2 diabetes on mortality: long-term follow-up of the Ely cohort R. K. Simmons & M. Rahman & R.

More information

Consuming a Varied Diet can Prevent Diabetes But Can You Afford the Added Cost? Annalijn Conklin 18 January 2017, Vancouver, Canada

Consuming a Varied Diet can Prevent Diabetes But Can You Afford the Added Cost? Annalijn Conklin 18 January 2017, Vancouver, Canada 1 Consuming a Varied Diet can Prevent Diabetes But Can You Afford the Added Cost? Annalijn Conklin 18 January 2017, Vancouver, Canada 2 Overview The problem of type 2 diabetes What is diet diversity /

More information

Diabetes Care 27: , 2004

Diabetes Care 27: , 2004 Emerging Treatments and Technologies O R I G I N A L A R T I C L E A Danish Diabetes Risk Score for Targeted Screening The Inter99 study CHARLOTTE GLÜMER, MD 1,2 BENDIX CARSTENSEN, MSC 1 ANNELLI SANDBÆK,

More information

Eugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG

Eugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG Diabetes Mellitus: Update 7 What is the unifying basis of this vascular disease? Eugene J. Barrett, MD, PhD Professor of Internal Medicine and Pediatrics Director, Diabetes Center and GCRC Health System

More information

Psychosocial work stressors and risk of type 2 diabetes: Effect, impact and mechanisms

Psychosocial work stressors and risk of type 2 diabetes: Effect, impact and mechanisms UCL RESEARCH DEPARTMENT OF EPIDEMIOLOGY AND PUBLIC HEALTH DIVISION OF POPULATION HEALTH Psychosocial work stressors and risk of type 2 diabetes: Effect, impact and mechanisms Alexandros Heraclides A thesis

More information

The Metabolic Syndrome: Is It A Valid Concept? YES

The Metabolic Syndrome: Is It A Valid Concept? YES The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA

More information

Finland and Sweden and UK GP-HOSP datasets

Finland and Sweden and UK GP-HOSP datasets Web appendix: Supplementary material Table 1 Specific diagnosis codes used to identify bladder cancer cases in each dataset Finland and Sweden and UK GP-HOSP datasets Netherlands hospital and cancer registry

More information

Update on Cardiovascular Outcome Trials in Diabetes. Rury R. Holman, FMedSci NIHR Senior Investigator 11 th February 2013

Update on Cardiovascular Outcome Trials in Diabetes. Rury R. Holman, FMedSci NIHR Senior Investigator 11 th February 2013 Update on Cardiovascular Outcome Trials in Diabetes Rury R. Holman, FMedSci NIHR Senior Investigator 11 th February 2013 Residual Vascular Risk in People with Diabetes 2 Analyses based on 530,083 participants

More information

T2 Diabetes in Sep-16. Stephen Leow Disclosures. Why do we treat diabetes? Agenda. Targets

T2 Diabetes in Sep-16. Stephen Leow Disclosures. Why do we treat diabetes? Agenda. Targets Stephen Leow Disclosures I have received honoraria, sat on the advisory boards or received grants from Novo Nordisk, Sanofi Aventis, Eli Lilly, Boehringer Ingleheim, Jansenn Cilag, Mundipharma, BioCSL,

More information

Outcomes: Initially, our primary definitions of pneumonia was severe pneumonia, where the subject was hospitalized

Outcomes: Initially, our primary definitions of pneumonia was severe pneumonia, where the subject was hospitalized The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.

More information

Adolescent renal and cardiovascular disease protection in type 1 diabetes AdDIT Study

Adolescent renal and cardiovascular disease protection in type 1 diabetes AdDIT Study Keystone, Colorado, July 2013 Practical Ways to Achieve Targets in Diabetes Care Adolescent renal and cardiovascular disease protection in type 1 diabetes AdDIT Study Professor David Dunger Department

More information

SHORT COMMUNICATION. Diabetologia (2013) 56: DOI /s

SHORT COMMUNICATION. Diabetologia (2013) 56: DOI /s Diabetologia (2013) 56:1542 1546 DOI 10.1007/s00125-013-2914-0 SHORT COMMUNICATION The pro-inflammatory biomarker soluble urokinase plasminogen activator receptor (supar) is associated with incident type

More information

Urbanization and the Determinants of Health: The Cities Changing Diabetes Programme

Urbanization and the Determinants of Health: The Cities Changing Diabetes Programme Urbanization and the Determinants of Health: The Cities Changing Diabetes Programme Rome December 11, 2017 A. David Napier Professor Medical Anthropology, University College London Director Science, Medicine,

More information

JAMA. 2011;305(24): Nora A. Kalagi, MSc

JAMA. 2011;305(24): Nora A. Kalagi, MSc JAMA. 2011;305(24):2556-2564 By Nora A. Kalagi, MSc Cardiovascular disease (CVD) is the number one cause of mortality and morbidity world wide Reducing high blood cholesterol which is a risk factor for

More information

SUPPLEMENTARY DATA. Supplementary Figure S1. Search terms*

SUPPLEMENTARY DATA. Supplementary Figure S1. Search terms* Supplementary Figure S1. Search terms* *mh = exploded MeSH: Medical subject heading (Medline medical index term); tw = text word; pt = publication type; the asterisk (*) stands for any character(s) #1:

More information

NeuRA Schizophrenia diagnosis May 2017

NeuRA Schizophrenia diagnosis May 2017 Introduction Diagnostic scales are widely used within clinical practice and research settings to ensure consistency of illness ratings. These scales have been extensively validated and provide a set of

More information

Comprehensive Diabetes Treatment

Comprehensive Diabetes Treatment Comprehensive Diabetes Treatment Joshua L. Cohen, M.D., F.A.C.P. Professor of Medicine Interim Director, Division of Endocrinology & Metabolism The George Washington University School of Medicine Diabetes

More information

Web Extra material. Comparison of non-laboratory-based risk scores for predicting the occurrence of type 2

Web Extra material. Comparison of non-laboratory-based risk scores for predicting the occurrence of type 2 Web Extra material Comparison of non-laboratory-based risk scores for predicting the occurrence of type 2 diabetes in the general population: the EPIC-InterAct Study Outline Supplementary Figures Legend...

More information

The GUIDANCE study. Kamlesh Khunti University of Leicester, UK. on behalf of the GUIDANCE Study Group

The GUIDANCE study. Kamlesh Khunti University of Leicester, UK. on behalf of the GUIDANCE Study Group The GUIDANCE study Guillaume Charpentier, Kris Doggen, Noëmi Debacker, Kees Gorter, Odile Juy Christiane Kellner, Kamlesh Khunti, Oliver Kuß, Ulf Lindblad, Arne Melander, Lena Minning, Ulrich Müller, John

More information

Discontinuation and restarting in patients on statin treatment: prospective open cohort study using a primary care database

Discontinuation and restarting in patients on statin treatment: prospective open cohort study using a primary care database open access Discontinuation and restarting in patients on statin treatment: prospective open cohort study using a primary care database Yana Vinogradova, 1 Carol Coupland, 1 Peter Brindle, 2,3 Julia Hippisley-Cox

More information

Update on Diabetes. Ketan Dhatariya. Why it s Not Just About Glucose Lowering Any More. Consultant in Diabetes NNUH

Update on Diabetes. Ketan Dhatariya. Why it s Not Just About Glucose Lowering Any More. Consultant in Diabetes NNUH Update on Diabetes Why it s Not Just About Glucose Lowering Any More Ketan Dhatariya Consultant in Diabetes NNUH The Story So Far.. DCCT Retinopathy Neuropathy Nephropathy Intensive glucose control in

More information

Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?

Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy? Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists

More information

Results. NeuRA Motor dysfunction April 2016

Results. NeuRA Motor dysfunction April 2016 Introduction Subtle deviations in various developmental trajectories during childhood and adolescence may foreshadow the later development of schizophrenia. Studies exploring these deviations (antecedents)

More information

Advanced IPD meta-analysis methods for observational studies

Advanced IPD meta-analysis methods for observational studies Advanced IPD meta-analysis methods for observational studies Simon Thompson University of Cambridge, UK Part 4 IBC Victoria, July 2016 1 Outline of talk Usual measures of association (e.g. hazard ratios)

More information

Optimizing Postpartum Maternal Health to Prevent Chronic Diseases

Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Optimizing Postpartum Maternal Health to Prevent Chronic Diseases Amy Loden, MD, FACP, NCMP Disclosures Research: None Financial: none applicable to this presentation PRIUM QEssentials Market Research

More information

Prediabetes: Metformin vs. Lifestyle Intervention Tannaz Moin, MD, MBA, MSHS

Prediabetes: Metformin vs. Lifestyle Intervention Tannaz Moin, MD, MBA, MSHS Prediabetes: Metformin vs. Lifestyle Intervention Tannaz Moin, MD, MBA, MSHS Assistant Professor, David Geffen School of Medicine at UCLA Division of Endocrinology, Diabetes and Metabolism HSR&D Center

More information

Stepwise screening for diabetes identifies people with high but modifiable coronary heart disease risk. The ADDITION study

Stepwise screening for diabetes identifies people with high but modifiable coronary heart disease risk. The ADDITION study Diabetologia (2008) 51:1127 1134 DOI 10.1007/s00125-008-1013-0 ARTICLE Stepwise screening for diabetes identifies people with high but modifiable coronary heart disease risk. The ADDITION study A. Sandbaek

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Pedersen SB, Langsted A, Nordestgaard BG. Nonfasting mild-to-moderate hypertriglyceridemia and risk of acute pancreatitis. JAMA Intern Med. Published online November 7, 2016.

More information

Update on CVD and Microvascular Complications in T2D

Update on CVD and Microvascular Complications in T2D Update on CVD and Microvascular Complications in T2D Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine

More information

Update on Falls Prevention Research

Update on Falls Prevention Research Update on Falls Prevention Research Jasmine Menant NSW Falls Prevention Network Rural Forum 24 th August 2018 Acknowledgements: Prof Stephen Lord, Dr Daina Sturnieks Recent falls risk factor studies Lubaszy

More information

European Perspective on Paediatric Diabetes Care

European Perspective on Paediatric Diabetes Care Keystone, Colorado, July 2013 Practical Ways to Achieve Targets in Diabetes Care European Perspective on Paediatric Diabetes Care Professor David Dunger Department of Paediatrics Practical Ways to Achieve

More information

New Paradigms of Type 2 Diabetes. From:

New Paradigms of Type 2 Diabetes. From: New Paradigms of Type 2 Diabetes From: www.nusi.org Presenter Disclosure Presenters Jason Fung Relationships with commercial interests: Grants/Research Support: None Grants/Speakers Bureau/Honoraria: Consulting

More information

Title: Statins for haemodialysis patients with diabetes? Long-term follow-up endorses the original conclusions of the 4D study.

Title: Statins for haemodialysis patients with diabetes? Long-term follow-up endorses the original conclusions of the 4D study. Manuscript type: Invited Commentary: Title: Statins for haemodialysis patients with diabetes? Long-term follow-up endorses the original conclusions of the 4D study. Authors: David C Wheeler 1 and Bertram

More information

Results. NeuRA Treatments for internalised stigma December 2017

Results. NeuRA Treatments for internalised stigma December 2017 Introduction Internalised stigma occurs within an individual, such that a person s attitude may reinforce a negative self-perception of mental disorders, resulting in reduced sense of selfworth, anticipation

More information

Frede Olesen. Frede Olesen

Frede Olesen. Frede Olesen Professor, DrMedSc, GP, FRCGP(hon.) The Research Unit for General Practice, Aarhus University Chairman of the board of The Danish Cancer Society FO@alm.au.dk Denmark - City of Aarhus How to get be)er

More information

Comparison of Probability of Stroke Between the Copenhagen City Heart Study and the Framingham Study

Comparison of Probability of Stroke Between the Copenhagen City Heart Study and the Framingham Study 80 Comparison of Probability of Stroke Between the Copenhagen City Heart Study and the Framingham Study Thomas Truelsen, MB; Ewa Lindenstrtfm, MD; Gudrun Boysen, DMSc Background and Purpose We wished to

More information

Results. NeuRA Herbal medicines August 2016

Results. NeuRA Herbal medicines August 2016 Introduction have been suggested as a potential alternative treatment which may positively contribute to the treatment of schizophrenia. Herbal therapies can include traditional Chinese medicines and Indian

More information

Copyright 2017 by Sea Courses Inc.

Copyright 2017 by Sea Courses Inc. Pre-Diabetes: Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic, electronic, or mechanical,

More information

School of Population and Public Health SPPH 503 Epidemiologic methods II January to April 2019

School of Population and Public Health SPPH 503 Epidemiologic methods II January to April 2019 School of Population and Public Health SPPH 503 Epidemiologic methods II January to April 2019 Time: Tuesday, 1330 1630 Location: School of Population and Public Health, UBC Course description Students

More information

Traumatic brain injury

Traumatic brain injury Introduction It is well established that traumatic brain injury increases the risk for a wide range of neuropsychiatric disturbances, however there is little consensus on whether it is a risk factor for

More information

MEXICO CITY, MEXICO COPENHAGEN DENMARK RULE OF HALVES ANALYSIS HOW-TO GUIDE

MEXICO CITY, MEXICO COPENHAGEN DENMARK RULE OF HALVES ANALYSIS HOW-TO GUIDE MEXICO CITY, MEXICO COPENHAGEN DENMARK RULE OF HALVES ANALYSIS HOW-TO GUIDE CITIES ARE A FOCAL POINT FOR TACKLING DIABETES 415 MILLION PEOPLE HAVE DIABETES WORLDWIDE 1 2/3OF PEOPLE WITH DIABETES LIVE IN

More information

Diabetes Specific Features. Dealing with Diabetes and Depression. Diabetes Nepal Depression. Overview. Depression. Risk factors for Depression

Diabetes Specific Features. Dealing with Diabetes and Depression. Diabetes Nepal Depression. Overview. Depression. Risk factors for Depression Nepal 13 Dealing with and Overview Prevalence of and Potential Mechanisms Consequences of co-morbidity Clinical Implications Richard IG Holt Professor in and Endocrinology Nepal, Kathmandu 16 February

More information

Cognitive ageing and dementia: The Whitehall II Study

Cognitive ageing and dementia: The Whitehall II Study Cognitive ageing and dementia: The Whitehall II Study Archana SINGH-MANOUX NIH: R01AG013196; R01AG034454; R01AG056477 MRC: K013351, MR/R024227 BHF: RG/13/2/30098 H2020: #643576 #633666 Outline Lifecourse

More information

Supplementary webappendix

Supplementary webappendix Supplementary webappendix This webappendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Ray K K, Seshasai S R K, Wijesuriya S,

More information

Comparison of machine learning models for the prediction of live birth following IVF treatment: an analysis of 463,669 cycles from a national

Comparison of machine learning models for the prediction of live birth following IVF treatment: an analysis of 463,669 cycles from a national Comparison of machine learning models for the prediction of live birth following IVF treatment: an analysis of 463,669 cycles from a national database Session title: Session 53: Machine learning and artificial

More information

NIDA Par9cipa9on in Major NIH Pain Consor9um Ini9a9ves

NIDA Par9cipa9on in Major NIH Pain Consor9um Ini9a9ves NIDA Par9cipa9on in Major NIH Pain Consor9um Ini9a9ves David A. Thomas, Ph.D. Deputy Director, Division of Clinical Neuroscience and Behavioral Research, Na9onal Ins9tute on Drug Abuse NIH Pain Consor9um

More information

Initiating Insulin in Primary Care for Type 2 Diabetes Mellitus. Dr Manish Khanolkar, Diabetologist, Auckland Diabetes Centre

Initiating Insulin in Primary Care for Type 2 Diabetes Mellitus. Dr Manish Khanolkar, Diabetologist, Auckland Diabetes Centre Initiating Insulin in Primary Care for Type 2 Diabetes Mellitus Dr Manish Khanolkar, Diabetologist, Auckland Diabetes Centre Outline How big is the problem? Natural progression of type 2 diabetes What

More information

UK Liver Transplant Audit

UK Liver Transplant Audit November 2012 UK Liver Transplant Audit In patients who received a Liver Transplant between 1 st March 1994 and 31 st March 2012 ANNUAL REPORT Advisory Group for National Specialised Services Prepared

More information

GLP 1 agonists Winning the Losing Battle. Dr Bernard SAMIA. KCS Congress: Impact through collaboration

GLP 1 agonists Winning the Losing Battle. Dr Bernard SAMIA. KCS Congress: Impact through collaboration GLP 1 agonists Winning the Losing Battle Dr Bernard SAMIA KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web: www.kenyacardiacs.org Disclosures I have

More information

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam

John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Latest Insights from the JUPITER Study John J.P. Kastelein MD PhD Professor of Medicine Dept. of Vascular Medicine Academic Medial Center / University of Amsterdam Inflammation, hscrp, and Vascular Prevention

More information

Health Economic Evaluation of Adult ADHD in Denmark.

Health Economic Evaluation of Adult ADHD in Denmark. Health Economic Evaluation of Adult ADHD in Denmark. Dr David Daley Professor of Psychological Intervention and Behaviour Change Division of Psychiatry, School of Community Health Science, University of

More information

Results. NeuRA Forensic settings April 2016

Results. NeuRA Forensic settings April 2016 Introduction Prevalence quantifies the proportion of individuals in a population who have a disease during a specific time period. Many studies have reported a high prevalence of various health problems,

More information

EXPERIENCED STATISTICAL CONSULTANT

EXPERIENCED STATISTICAL CONSULTANT G.H.Laier Research & Analysis EXPERIENCED STATISTICAL CONSULTANT Gunnar Hellmund Laier is a dedicated independently minded consultant with natural insights in a multitude of topic areas besides sciences,

More information

Post-challenge hyperglycaemia is associated with premature death and macrovascular complications

Post-challenge hyperglycaemia is associated with premature death and macrovascular complications Diabetologia (2003) 46[Suppl1]:M17 M21 DOI 10.1007/s00125-002-0932-4 Post-challenge hyperglycaemia is associated with premature death and macrovascular complications Q. Qiao 1, 2, J. Tuomilehto 2, 3, K.

More information

Improvement of drug adherence using single pill combinations:

Improvement of drug adherence using single pill combinations: Improvement of drug adherence using single pill combinations: what is the evidence? Prof. Michel Burnier Service of Nephrology and Hypertension, CHUV, Lausanne, Switzerland Potentialcauses of non-adherence

More information

Real World Evidence: From Efficacy to Effectiveness

Real World Evidence: From Efficacy to Effectiveness Real World Evidence: From Efficacy to Effectiveness Professor Kamlesh Khunti University of Leicester, UK Leicester Diabetes Centre at University Hospitals of Leicester NHS Trust, 2015. Not to be reproduced

More information

The Burden of the Diabetic Heart

The Burden of the Diabetic Heart The Burden of the Diabetic Heart Dr. Ghaida Kaddaha (MBBS, MRCP-UK, FRCP-london) Diabetes Unit Rashid Hospital Dubai U.A.E Risk of CVD in Diabetes Morbidity and mortality from CVD is 2-4 fold higher than

More information

Endocrinopathy and Leukocyte Telomere Length in HIV+ Individuals in the CARMA Cohort

Endocrinopathy and Leukocyte Telomere Length in HIV+ Individuals in the CARMA Cohort Endocrinopathy and Leukocyte Telomere Length in HIV+ Individuals in the CARMA Cohort Kristen M. Sokalski, Alice Mai, Jackson Chu, Hélène Côté, Evelyn J. Maan, Arianne Albert, Neora Pick, Deborah Money,

More information

Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona,

Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Marshall Tulloch-Reid, MD, MPhil, DSc, FACE Epidemiology Research Unit Tropical Medicine Research Institute The University of the West Indies, Mona, Jamaica At the end of this presentation the participant

More information

1. How does the response to therapy compare in elderly versus middle age adults with diabetes in a randomized trial?

1. How does the response to therapy compare in elderly versus middle age adults with diabetes in a randomized trial? Jeff D. Williamson, MD, MHS Chief, Geriatric Medicine Sticht Center on Aging 1. How does the response to therapy compare in elderly versus middle age adults with diabetes in a randomized trial? 2. Are

More information

Effective Health Care Program

Effective Health Care Program Comparative Effectiveness Review Number 57 Effective Health Care Program Methods for Insulin Delivery and Glucose Monitoring: Comparative Effectiveness Executive Summary Background Diabetes mellitus is

More information

Cardiovascular Complications of Diabetes

Cardiovascular Complications of Diabetes VBWG Cardiovascular Complications of Diabetes Nicola Abate, M.D., F.N.L.A. Professor and Chief Division of Endocrinology and Metabolism The University of Texas Medical Branch Galveston, Texas Coronary

More information

Impact of HbA1c testing on cardiovascular morbidity and mortality: A Regression Discontinuity Design study

Impact of HbA1c testing on cardiovascular morbidity and mortality: A Regression Discontinuity Design study Impact of HbA1c testing on cardiovascular morbidity and mortality: A Regression Discontinuity Design study PROJECT GROUP Irene Petersen (Department of Primary Care & Population Health, University College

More information

Early Diagnosis of T1D Through An3body Screening

Early Diagnosis of T1D Through An3body Screening Early Diagnosis of T1D Through An3body Screening Andrea Steck, M.D. Barbara Davis Center for Childhood Diabetes Keystone Conference July 15, 2017 Presenter Disclosure Andrea Steck Disclosed no conflict

More information