Jolien Janssen

Satisfaction of well-controlled type 2 diabetes patients with three-monthly and six-monthly monitoring

BackgroundPatient’s satisfaction with monitoring frequency is of interest when implementing six-monthly monitoring for well-controlled type 2 diabetes patients. Here we want to determine the satisfaction of well-controlled type 2 diabetes patients with either three-monthly or six-monthly diabetes monitoring and their future preference.MethodsSurvey among 2215 well-controlled type 2 diabetes patients (not using insulin, HbA1c ≤58 mmol/mol, systolic blood pressure ≤145 mmHg and total cholesterol ≤5.2 mmol/l) who participated in the EFFIMODI study, a randomised controlled patient-preference equivalence trial. At baseline, participants were asked whether they had a strong preference for three-monthly or six-monthly monitoring or not. If not, they were randomised to either three-monthly or six-monthly monitoring, while the others were monitored according to their preference. After eighteen months, all participants were asked whether they were satisfied with the monitoring frequency and about their future preference. Patient characteristics associated with satisfaction were also examined.ResultsMost patients (70.8%) would like to continue their monitoring frequency. Patients from the preference groups were more often satisfied than randomised patients (92.7% and 88.1%, respectively) and patients monitored three-monthly were more often satisfied than patients monitored six-monthly (93.5% and 88.5%, respectively). Higher age, better physical health, less diabetes-related distress, higher diabetes treatment satisfaction and less perceived hyper- and hypoglycaemias were associated with a higher monitoring satisfaction.ConclusionsMost well-controlled type 2 diabetes patients were satisfied with their monitoring frequency and would like to continue it. Although the satisfaction for three-monthly monitoring was slightly higher, the satisfaction with six-monthly monitoring was still rather high (88.5%).Trial registrationCurrent controlled trials ISRCTN93201802.

Mobilisation of haemopoietic progenitors in CML: a second course of intensive chemotherapy does not improve Ph-negativity in stem cell harvests

We collected peripheral blood stem cells (PBSC) in 19 early chronic phase CML patients following each of two consecutive cycles of intensive chemotherapy (CT) to evaluate whether an additional cycle of CT would increase Philadelphia (Ph)-negativity of the PBSC harvest. Autologous SCT (autoSCT) was performed if a major cytogenetic response (MCR) of the PBSC harvest was obtained. CT consisted of cytarabine 200 mg/ m2/day (days 1–7)/idarubicin 12 mg/m2/day (days 1–2) (cycle one) and cytarabine 2000 mg/m2/day (days 1–6)/amsacrine 120 mg/m2/day (days 1–3) (cycle two). One patient died of fungal pneumonia after the first cycle. Stem cells were harvested in 18 patients after cycle one and in 16 patients after cycle two. After the first cycle, all patients showed a cytogenetic response of their graft (MCR in eight patients: three complete, five partial), after cycle two, seven patients obtained an MCR (one complete, six partial). Seven patients became eligible for autoSCT. All patients proceeded with IFNα maintenance. Currently, 16 patients are alive. At the latest cytogenetic examination of bone marrow, four patients showed an MCR and four a minor response. In conclusion, although a second cycle of CT may contribute to elimination of leukemia residing in the patient, it appeared to be ineffective in improving the Ph-negativity of the PBSC graft. Bone Marrow Transplantation (2000) 25, 1147–1155.

Undiagnosed cognitive impairment, health status and depressive symptoms in patients with type 2 diabetes.

AIMS Type 2 diabetes (T2DM) is associated with cognitive impairment. We examined whether undiagnosed cognitive impairment in T2DM-patients is associated with a reduced health status and depressive symptoms. METHODS In an observational study, 225 T2DM-patients aged ≥70years were examined at their homes and (some of them) at a memory clinic for undiagnosed cognitive impairment (dementia or mild cognitive impairment [MCI], defined according to internationally accepted criteria). Questionnaires assessing health status (SF-36, EQ-5D, EQ-VAS) and depressive symptoms (CES-D) were filled out. Health status and depressive symptoms were compared between patients with and without cognitive impairment. RESULTS Patients with cognitive impairment (n=57) showed significantly lower scores on the physical and mental summary scores of the SF-36 than patients with normal cognition (difference: 3.5 (95%-CI 0.7-6.3, p=0.02, effect size 0.41) and 2.9 (95%-CI 0.3-5.6; p=0.03, effect size 0.37). EQ-5D index and EQ-VAS scores were significantly lower in patients with cognitive impairment. Depression (CES-D≥16) occurred almost twice as often in patients with cognitive impairment (RR 1.8; 95%-CI: 1.1-3.0). CONCLUSIONS Undiagnosed cognitive impairment in T2DM-patients is associated with a reduced health status and more depressive symptoms. Detection of cognitive impairment in T2DM-patients identifies a vulnerable patient group that could benefit from tailored treatment and care.

Case-finding for cognitive impairment among people with Type 2 diabetes in primary care using the Test Your Memory and Self-Administered Gerocognitive Examination questionnaires: the Cog-ID study.

To evaluate two cognitive tests for case‐finding for cognitive impairment in older patients with Type 2 diabetes.

Hoe weet je of cognitieve stoornissen waarschijnlijk zijn

SamenvattingInleiding Het kan voor huisartsen lastig zijn om bij patiënten met cognitieve klachten vast te stellen of er sprake is van milde cognitieve stoornissen of dementie. Wij stelden een diagnostisch algoritme op dat hierbij behulpzaam kan zijn, met als belangrijkste uitgangspunt dat de voorafkans op een cognitieve stoornis – ingeschat op basis van de (hetero) anamnese – bepaalt welke aanvullende test het meeste nut heeft.Methode De voorafkans is als volgt ingedeeld: niet waarschijnlijk, mogelijk en waarschijnlijk. Voor elk van deze situaties hebben we op basis van literatuuronderzoek en vooraf opgestelde criteria over de gewenste testkarakteristieken de meest geschikte test gekozen.Resultaten Is een cognitieve stoornis niet waarschijnlijk, dan kan een foutloze kloktekentest helpen om de patiënt gerust te stellen. Is er mogelijk sprake van een cognitieve stoornis, dan lijkt de Montreal Cognitive Assessment het meest geschikt om deze uit te sluiten of juist waarschijnlijker te maken. Is het waarschijnlijk dat de patiënt een cognitieve stoornis heeft, dan kan de Mini-Mental State Examination een stoornis nog waarschijnlijker maken.Conclusie Wij hopen dat huisartsen met dit algoritme zo optimaal mogelijk gebruik kunnen maken van cognitieve tests.

How to choose the most appropriate cognitive test to evaluate cognitive complaints in primary care

BackgroundDespite the wealth of research devoted to the performance of individual cognitive tests for diagnosing cognitive impairment (including mild cognitive impairment and dementia), it can be difficult for general practitioners to choose the most appropriate test for a patient with cognitive complaints in daily practice.In this paper we present a diagnostic algorithm for the evaluation of cognitive complaints in primary care. The rationale behind this algorithm is that the likelihood of cognitive impairment -which can be determined after history taking and an informant interview- should determine which cognitive test is most suitable.MethodsWe distinguished three likelihoods of cognitive impairment: not likely, possible or likely. We selected cognitive tests based on pre-defined required test features for each of these three situations and a review of the literature. We incorporated the cognitive tests in a practical diagnostic algorithm.ResultsBased on the available literature, in patients with complaints but where cognitive impairment is considered to be unlikely the clock-drawing test can be used to rule out cognitive impairment. When cognitive impairment is possible the Montreal cognitive assessment can be used to rule out cognitive impairment or to make cognitive impairment more likely. When cognitive impairment is likely the Mini-Mental State Examination can be used to confirm the presence of cognitive impairment.ConclusionsWe propose a diagnostic algorithm to increase the efficiency of ruling out or diagnosing cognitive impairment in primary care. Further study is needed to validate and evaluate this stepwise diagnostic algorithm.