Carl Johan Östgren

Can diabetes medication be reduced in elderly patients? : An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control

AIM To explore the feasibility of withdrawal of diabetes medication in elderly patients with HbA1c<or=6.0%. METHODS HbA1c was measured in 98 patients with known diabetes in 17 nursing homes in Sweden. Thirty-two subjects with HbA1c <or=6.0% participated in the drug withdrawal study. After measuring plasma glucose on 3 consecutive days, diabetes drugs were reduced, i.e. complete withdrawal of oral anti-diabetic drugs (OADs), complete insulin withdrawal when doses were <or=20units/day and reduced by half in patients on more than 20units/day. RESULTS We identified 31 episodes of plasma glucose <or=4.4mmol/l, most of them nocturnal (n=17). Mean HbA1c was 5.2+/-0.4% compared to 7.1+/-1.6% in the non-intervention group. Three months after the diabetes drug discontinuation, 24 patients (75%) remained in the intervention group and mean HbA1c was then 5.8.+/-0.9%. Six months after baseline investigation mean HbA1c in the intervention group was 5.8+/-1.1% compared with 6.6+/-1.4% in the non-intervention group. CONCLUSIONS Hypoglycaemic events are common among elderly patients with type 2 diabetes. The withdrawal of diabetes medication in elderly with tight glycaemic control is safe and may decrease the risk for hypoglycaemia.

Abdominal obesity and low-grade systemic inflammation as markers of subclinical organ damage in type 2 diabetes

AIM This study aimed to explore the associations between abdominal obesity, inflammatory markers and subclinical organ damage in 740 middle-aged patients with type 2 diabetes. METHODS Waist circumference (WC) and sagittal abdominal diameter (SAD) were measured, and blood samples were analyzed for C-reactive protein (CRP) and IL-6. Carotid intima-media thickness (IMT) was evaluated by ultrasonography, and aortic pulse wave velocity (PWV) measured with applanation tonometry. RESULTS Abdominal obesity as determined by SAD and WC was significantly correlated with IL-6 (WC: r=0.27, P<0.001; SAD: r=031, P<0.001), CRP (WC: r=0.29, P<0.001; SAD: r=0.29, P<0.001), IMT (WC: r=0.09, P=0.013; SAD: r=0.11, P=0.003) and PWV (WC: r=0.18, P<0.001; SAD: r=0.21, P<0.001). In multiple linear regressions with IMT and PWV as dependent variables, and age, gender, statin use, systolic blood pressure (SBP), body mass index (BMI), CRP and HbA1c as independent variables, both SAD and WC remained associated with IMT and PWV. On stepwise linear regression and entering both SAD and WC, the association between SAD and PWV was stronger than the association between WC and PWV. CONCLUSION Both SAD and WC are feasible measures of obesity, and both provide information on inflammation, atherosclerosis and arterial stiffness in type 2 diabetes, while SAD appears to be slightly more robustly associated with subclinical organ damage than WC.

Circadian blood pressure variation in patients with type 2 diabetes – relationship to macro- and microvascular subclinical organ damage

AIMS To explore the association between nocturnal blood pressure (BP) dipper status and macro- and microvascular organ damage in type 2 diabetes. METHODS Cross-sectional data from 663 patients with type 2 diabetes, aged 55-66 years, were analysed. Nurses measured office BP and ambulatory BP during 24h. Individuals with ≥ 10% difference in nocturnal systolic blood pressure (SBP) relative to daytime values were defined as dippers. Non-dippers were defined as <10% nocturnal decrease in SBP. Estimated glomerular filtration rate (GFR) was calculated and microalbuminuria was measured by albumin:creatinine ratio (ACR). Aortic pulse wave velocity (PWV) was measured with applanation tonometry over the carotid and femoral arteries. RESULTS We identified 433 dippers and 230 subjects with a nocturnal non-dipping pattern. Nocturnal SBP dipping was independently of office SBP associated with decreased PWV (p = 0.008), lower ACR (p = 0.001) and NT-proBNP (p = 0.001) and increased GFR (p<0.001). CONCLUSIONS We conclude that diurnal BP variation provides further information about early macro- and microvascular subclinical organ damage that goes beyond standardized office BP measurements in patients with type 2 diabetes.

Association between serum 25(OH)D3 and cardiovascular morbidity and mortality in people with Type 2 diabetes: a community-based cohort study

We aimed to explore the association between vitamin D and cardiovascular morbidity and mortality in people with Type 2 diabetes recruited from a community‐based study because there is limited and inconsistent research of this group.