T. Lauritzen

Psychosocial problems and barriers to improved diabetes management: results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study.

Aims  To examine patient‐ and provider‐reported psychosocial problems and barriers to effective self‐care and resources for dealing with those barriers.

Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study

Aims/hypothesisWe assessed country-level and individual-level patterns in patient and provider perceptions of diabetes care.MethodsThe study used a cross-sectional design with face-to-face or telephone interviews of diabetic patients and healthcare providers in 13 countries from Asia, Australia, Europe and North America. Participants were randomly selected adults with type 1 or type 2 diabetes (n=5,104), and randomly selected diabetes-care providers, including primary-care physicians (n=2,070), diabetes specialist physicians (n=635) and nurses (n=1,122). Multivariate analysis was used to examine the relationships between outcomes and both country and respondent characteristics, and the interaction between these two factors.ResultsProviders rated chronic-care systems and remuneration for chronic care as mediocre. Patients reported that ease of access to care was high, but not without financial barriers. Patients reported moderate levels of collaboration among providers, and providers indicated that several specialist disciplines were not readily available to them. Patients reported high levels of collaboration with providers in their own care. Provider endorsement of primary prevention strategies for type 2 diabetes was high. Patients with fewer socio-economic resources and more diabetes complications had lower access (and/or higher barriers) to care and lower quality of patient–provider collaboration. Countries differed significantly for all outcomes, and the relationships between respondent characteristics and outcomes varied by country.Conclusions/interpretationThere is much need for improvement in applying the chronic-care model to the treatment and prevention of diabetes in all of the countries studied. Each country must develop its own priorities for improving diabetes care and comparison with other countries can help identify strengths as well as weaknesses.

Insulin and glucose profiles during continuous subcutaneous insulin infusion compared with injection of a long-acting insulin in Type 2 diabetes.

Aims  To compare insulin and glucose profiles during basal continuous subcutaneous infusion of a rapid‐acting insulin analogue and once daily subcutaneous injection of a long‐acting insulin analogue in Type 2 diabetes.

The pro-inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is associated with incident type 2 diabetes among overweight but not obese individuals with impaired glucose regulation: effect modification by smoking and body weight status

Aims/hypothesisRecent evidence links the soluble urokinase plasminogen activator receptor (suPAR), a stable biomarker of systemic immune activation, to several chronic diseases, including type 2 diabetes. suPAR is also associated with adiposity and smoking. We hypothesised that this biomarker would be linked to incident type 2 diabetes in individuals with impaired glucose regulation and that this association would be modified by smoking and body weight status.MethodsThe study included 1,933 participants with impaired glucose regulation, who were drawn from the Danish arm of the Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION) and for whom data on suPAR, BMI and smoking were available. Logistic regression analysis was used to estimate the odds for incident type 2 diabetes per twofold increase in suPAR levels. Interactions between both smoking and body weight status and suPAR were tested.ResultsDuring a 3-year follow-up (599 incident diabetes cases), there was a 48% overall increase in the odds of developing type 2 diabetes per twofold increase in suPAR (p = 0.006). This association was modified by body weight status in overweight, but not in obese individuals (OR 2.36, 95% CI 1.48, 3.76 in overweight group), and by smoking status (OR 2.05, 95% CI 1.20, 3.51 in non-smokers). After adjustment for other diabetes risk factors, the association between suPAR and type 2 diabetes was attenuated in the whole sample and among non-smokers, but remained robust among overweight participants.Conclusions/interpretationsuPAR may be a good novel biomarker for systemic sub-clinical inflammation and immune activation linked to incident type 2 diabetes risk in overweight individuals and non-smokers. The observed interactions with adiposity and smoking should be investigated further.

Does early intensive multifactorial treatment reduce total cardiovascular burden in individuals with screen-detected diabetes? Findings from the ADDITION-Europe cluster-randomized trial

Aims  To describe the total cardiovascular burden (cardiovascular morbidity or mortality, revascularization or non‐traumatic amputation) in individuals with screen‐detected diabetes in the ADDITION‐Europe trial and to quantify the impact of the intervention on multiple cardiovascular events over 5 years.

Multiple mealtime administration of biphasic insulin aspart 30 versus traditional basal‐bolus human insulin treatment in patients with type 1 diabetes

Aim:  The aim of this study was to compare the effect of multiple mealtime injections of biphasic insulin aspart 30 (30% fast‐acting insulin aspart in the formulation, BIAsp30) to traditional basal‐bolus human insulin regimen (HI) on glycaemic control in patients with type 1 diabetes.

Pharmacokinetic profiles of biphasic insulin aspart 30/70 and 70/30 in patients with Type 1 diabetes: a randomized double-blinded crossover study

Aims  To compare pharmacokinetic characteristics of two biphasic insulin aspart (BIAsp) formulations: BIAsp30 and BIAsp70 (30% and 70%, respectively, of fast‐acting insulin aspart) during 15 days of multiple dosing (thrice daily).

Overnight CSII as supplement to oral antidiabetic drugs in type 2 diabetes.

Aim:  To evaluate the potential advantages of a constant overnight subcutaneous delivery of insulin in type 2 diabetic patients who fail to achieve glycaemic control on oral antidiabetics.

Pharmacokinetics and pharmacodynamics of different modes of insulin pump delivery. A randomized, controlled study comparing subcutaneous and intravenous administration of insulin aspart

Diabet. Med. 28, 230–236 (2011)

Circadian variation in the pharmacokinetics of steady state continuous subcutaneous infusion of growth hormone in adult growth hormone deficient patients

BACKGROUND Previous studies in growth hormone (GH)-deficient (GHD) patients have indicated a possible diurnal variation in the pharmacokinetics (PK) of GH after subcutaneous (sc) GH administration. Thus, higher GH levels were observed during the night with continuous sc infusion, and increased GH bioavailability was reported following daily sc injections in the evening compared to morning. OBJECTIVE The aim was to study whether diurnal variability in the PK of sc administered exogenous GH can be reproduced under standard conditions for all study participants, e.g. supine rest. DESIGN AND METHODS Eight male GHD patients (59.8 ± 8 years, body mass index 29.7 ± 4.9 kg/m(2)) received a continuous sc infusion of GH (3mg/24h) for 60 h on two different occasions. Diurnal variation in PK of GH was studied during steady state in the last 24h of the infusion period. RESULTS Median GH levels were higher at night time (23:00 h-07:00 h) than during the day (10:00 h-18:00 h) for visit 1 [5.1 (4.5-7.2 ng/ml/0.5h) vs. 4.6 (3.7-5.7 ng/ml/0.5h); p<0.05], and reproducible results of diurnal GH variation were obtained during visit 2 [5.7 (4.6-7.4) ng/ml/0.5h vs. 4.6 (3.8-6.0) ng/ml/0.5h, p<0.05]. Reproducible results between days 1 and 2 were also obtained during 08:30 h-20:30 h and 20:30 h-08:30 h, respectively. CONCLUSIONS Previous findings of higher nocturnal GH levels were confirmed during steady state continuous sc GH infusion under standard conditions. The underlying mechanisms, e.g. whether GH absorption, distribution or elimination is primarily affected need to be further elucidated.