Mogelijke belangenverstrengeling: De afdeling van CvW heeft in de afgelopen jaren financiële onde... more Mogelijke belangenverstrengeling: De afdeling van CvW heeft in de afgelopen jaren financiële ondersteuning van farmaceutische industrieën ontvangen om wetenschappelijk onderzoek te verrichten ('unrestricted research grants'). Dit artikel was een deelonderzoek van een promotieonderzoek waaraan de stichting Zuivel, Voeding en Gezondheid en (zeer ten dele) Bayer hebben bijgedragen onder de bovengenoemde voorwaarden. Dit artikel is eerder verschenen als: Van de Laar FA, Van de Lisdonk EH, Lucassen PLBL, Stafleu A, Mulder J, Van den Hoogen HJM, Rutten GEHM, Van Weel C. Eating behaviour and adherence to diet in patients with type 2 diabetes mellitus. Diabet Med 2006;23:788-94. Publicatie gebeurt met toestemming van de uitgever.
Accumulation of advanced glycation end products (AGEs) is enhanced by chronic hyperglycemia and o... more Accumulation of advanced glycation end products (AGEs) is enhanced by chronic hyperglycemia and oxidative stress and this process may contribute to the pathogenesis of vascular disease. Skin autofluorescence (AF), a measure of accumulation of AGEs in skin collagen, is associated with vascular disease in patients with diabetes. Because central obesity enhances oxidative stress people with central obesity might already have increased accumulation of AGEs before diabetes or cardiovascular disease become manifest. To test this hypothesis, we compared the distribution of skin AF and its association with clinical and biochemical parameters in individuals with and without central obesity. Skin AF was measured by a validated AGE Reader in 816 persons with and 431 persons without central obesity, aged 20–70 y. Mean skin AF increased with age and smoking and was higher in centrally obese individuals compared with non-obese individuals (p = 0.001, after adjustment for age and smoking p = 0.13). Mean skin AF in the subgroups without central obesity and without other risk factors (n = 106), central obesity without other risk factors (n = 74) and central obesity with other risk factors (n = 742) was 1.63 ± 0.37, 1.74 ± 0.44 and 1.87 ± 0.43 AU, respectively (p for trend < 0.001, after adjustment for age and smoking p for trend = 0.12). In the group with central obesity age, current smoking, alcohol consumption, waist circumference, creatinine clearance and hs-CRP were independently associated with skin AF (R2 = 29.4%). Waist circumference hardly contributed to the explained variance. The relationship between waist circumference and skin AF is not as obvious as we hypothesized.
Perceptions of illness are important determinants of health behaviour. A better understanding of ... more Perceptions of illness are important determinants of health behaviour. A better understanding of perceptions of obesity might allow more effective interventions that challenge these perceptions through lifestyle modification programs. Although several studies have evaluated causal attributions with regard to obesity, other domains of illness perception, such as the perceived consequences of obesity and perceived controllability, have not yet been studied. The aim of the current study was to explore perceptions regarding causes, consequences, control, concerns and time course of obesity of centrally obese adults, with and without an elevated cardiometabolic risk and with or without weight loss, 3 years after screening for metabolic syndrome, and to compare these perceptions. Three groups were selected from a longitudinal study dependent on the baseline and 3-year follow-up profiles: individuals with central obesity and metabolic syndrome at both time points (&amp;amp;amp;amp;amp;amp;#39;persistent cardiometabolic-risk group&amp;amp;amp;amp;amp;amp;#39;, n = 80), those with central obesity but without metabolic syndrome on either occasion (&amp;amp;amp;amp;amp;amp;#39;persistent obese group&amp;amp;amp;amp;amp;amp;#39;, n = 63), and formerly obese individuals (&amp;amp;amp;amp;amp;amp;#39;improved cardiometabolic-risk group&amp;amp;amp;amp;amp;amp;#39;, n = 49). Perceptions of obesity were assessed using an adapted version of the Brief Illness Perception Questionnaire (BIPQ, range 0-10). Chi-square and Kruskal-Wallis tests were performed to compare the &amp;amp;amp;amp;amp;amp;#39;persistent cardiometabolic risk&amp;amp;amp;amp;amp;amp;#39; group with the other two groups with regard to patient characteristics and BIPQ scores. Both males and females who improved their cardiometabolic risk perceived their obesity as shorter (median (IQR): 3.0 (4.0) vs. 6.0 (3.0), p &amp;amp;amp;amp;amp;amp;lt; 0.001) and experienced greater personal control over their weight (7.0 (3.0) vs. 5.0 (3.0), p = 0.002) compared to those who did not improve. Females who improved their cardiometabolic risk experienced fewer identity and illness concerns, this was not found for males. Other scores did not differ between groups. Obese adults with an improved cardiometabolic risk profile felt greater personal control and considered their obesity to be of shorter duration. Persistence of central obesity with additional cardiometabolic risk factors had a larger impact on female than male participants with respect to identity and illness concerns. Whether discussing &amp;amp;amp;amp;amp;amp;#39;personal control&amp;amp;amp;amp;amp;amp;#39; is a favourable element in lifestyle intervention should now be assessed in the setting of a controlled trial.
The worldwide epidemic of type 2 diabetes (T2DM) underlines the need for diabetes prevention stra... more The worldwide epidemic of type 2 diabetes (T2DM) underlines the need for diabetes prevention strategies. In this study the feasibility and effectiveness of a nurse led lifestyle program for subjects with impaired fasting glucose (IFG) is assessed. A cluster randomized clinical trial in 26 primary care practices in the Netherlands included 366 participants older than 45 years with newly diagnosed IFG and motivated to change their lifestyle (intervention group, n = 197; usual care group, n = 169). The one-year intervention, consisting of four to five individual nurse-led consultations, was directed at improving physical activity and dietary habits. The primary outcome measure was body mass index (BMI). Linear and logistic multilevel analyses and a process evaluation were performed. Both groups showed small reductions in BMI at 1 and 2 years, but differences between groups were not significant. At both 1 and 2-year follow-up the number of participants physically active for at least 30 minutes at least five days a week was significantly improved in the intervention group compared to the usual care group (intervention group vs. usual care group: OR1year = 3.53; 95 % CI = 1.69-7.37 and OR2years = 1.97; 95 % CI = 1.22-3.20, respectively). The total drop-out rate was 24 %. Process evaluation revealed that participants in the intervention group received fewer consultations than advised, while some practice nurses and participants considered the RM protocol too intensive. This relatively simple lifestyle program in subjects with IFG resulted in a significant improvement in reported physical activity, but not in BMI. Despite its simplicity, some participants still considered the intervention too intensive. This viewpoint could be related to poor motivation and an absence of disease burden due to IFG, such that participants do not feel a need for behavioural change. Although the intervention provided some benefit, its wider use cannot be advised. Current Controlled Trials ISRCTN41209683 , date of registration 16/10/2013h .
To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 2... more To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. A cross-sectional study. All Dutch care groups (n=97). 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. The association between quality management, overall and in 6 domains ('organisation of care', 'multidisciplinary teamwork', 'patient centredn...
To assess the change in level of diabetes quality management in primary care groups and outpatien... more To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P < 0...
To investigate the associations of vitamin B12 (cobalamin and holotranscobalamin) status with dep... more To investigate the associations of vitamin B12 (cobalamin and holotranscobalamin) status with depression, cognition and neuropathy in patients with type 2 diabetes using metformin. In an observational study, among 550 type 2 diabetes patients using metformin, cobalamin and holotranscobalamin (holoTCII) levels were measured at the annual diabetes checkup, and deficiencies were defined as <148 and <21 pmol/L, respectively. Depression and cognitive function were assessed with corresponding International Classification of Primary Care codes and questionnaires; neuropathy with medical record data and a questionnaire. Confounding variables were retrieved from medical records. Multivariable logistic and linear regressions were used with cobalamin status as independent variable; depression, cognition and neuropathy as dependent variables. The mean duration of diabetes was 8.4 years (±5.8); mean duration of metformin use was 64.1 months (±43.2), with a mean metformin dose of 1,306 mg/d...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2014
Many programmes to detect and prevent cardiovascular disease (CVD) have been performed, but the o... more Many programmes to detect and prevent cardiovascular disease (CVD) have been performed, but the optimal strategy is not yet clear. To present a systematic review of cardiometabolic screening programmes performed among apparently healthy people (not yet known to have CVD, diabetes, or cardiometabolic risk factors) and mixed populations (apparently healthy people and people diagnosed with risk factor or disease) to define the optimal screening strategy. Systematic review of studies performed in primary care in Western countries. MEDLINE, Embase, and CINAHL databases were searched for studies screening for increased cardiometabolic risk. Exclusion criteria were studies designed to assess prevalence of risk factors without follow-up or treatment; without involving a GP; when fewer than two risk factors were considered as the primary outcome; and studies constrained to ethnic minorities. The search strategy yielded 11 445 hits; 26 met the inclusion criteria. Five studies (1995-2012) were...
Secondary prevention is efficient in reducing morbidity and mortality after a myocardial infarcti... more Secondary prevention is efficient in reducing morbidity and mortality after a myocardial infarction (MI). However, both short-term and long-term mortality after MI remains relativity high in type 2 diabetes patients. To evaluate repeat prescriptions of secondary prevention medication (anti-thrombotic agent, beta-blocker and statin) in type 2 diabetes patients with a previous MI. Data of 1009 type 2 diabetes patients with a previous MI were extracted from the Julius General Practitioners' Network database. The proportion of patients with recent repeat prescriptions of guideline-based medication was determined. Furthermore, repeat prescriptions was determined 6 months, 1 year, 2 years and 5 years after MI. Generalized linear models were used to examine changes over time. Multivariate logistic regression analysis was used to analyse the association between patient characteristics and prescription. Only 46% of all type 2 diabetes patients with a previous MI had a recent repeat presc...
In recent years, most Dutch general practitioners started working under the umbrella of diabetes ... more In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way to measure quality management is unknown and it has not yet been studied at the level of outpatient clinics or care groups. We aimed to assess quality management of type 2 diabetes care in care groups and outpatient clinics. Quality management was measured with online questionnaires, containing six domains (see below). They were divided into 28 subdomains, with 59 (care groups) and 57 (outpatient clinics) questions respectively. The mean score of the domains reflects the overall score (0-100%) of an organisation. Two quality managers of all Dutch care groups and outpatient clinics were invited to fill out the questionnaire.Sixty care groups (response...
Diabetes mellitus is associated with an increase in the risk of dementia and the proportion of pa... more Diabetes mellitus is associated with an increase in the risk of dementia and the proportion of patients who convert from mild cognitive impairment (MCI) to dementia. In addition to MCI and dementia, the stages of diabetes-associated cognitive dysfunction include subtle cognitive changes that are unlikely to affect activities of daily life or diabetes self-management. These diabetes-associated cognitive decrements have structural brain correlates detectable with brain MRI, but usually show little progression over time. Although cognitive decrements do not generally represent a pre-dementia stage in patients below the age of 60-65 years, in older individuals these subtle cognitive changes might represent the earliest stages of a dementia process. Acknowledgment of diabetes-associated cognitive decrements can help to improve understanding of patients' symptoms and guide management. Future challenges are to establish the importance of screening for cognitive impairment in people wit...
... mellitus type 2 Guy Rutten Wim de Grauw Margriet Bouma Lex Goudswaard Keywords commentaar Á d... more ... mellitus type 2 Guy Rutten Wim de Grauw Margriet Bouma Lex Goudswaard Keywords commentaar Á diabetes mellitus Á farmacotherapie Á hartfalen ... Zo lieten eerdere onderzoeken van TZD's een reductie van een voortschrij-dende intimamediaverdikking zien. ...
Mogelijke belangenverstrengeling: De afdeling van CvW heeft in de afgelopen jaren financiële onde... more Mogelijke belangenverstrengeling: De afdeling van CvW heeft in de afgelopen jaren financiële ondersteuning van farmaceutische industrieën ontvangen om wetenschappelijk onderzoek te verrichten ('unrestricted research grants'). Dit artikel was een deelonderzoek van een promotieonderzoek waaraan de stichting Zuivel, Voeding en Gezondheid en (zeer ten dele) Bayer hebben bijgedragen onder de bovengenoemde voorwaarden. Dit artikel is eerder verschenen als: Van de Laar FA, Van de Lisdonk EH, Lucassen PLBL, Stafleu A, Mulder J, Van den Hoogen HJM, Rutten GEHM, Van Weel C. Eating behaviour and adherence to diet in patients with type 2 diabetes mellitus. Diabet Med 2006;23:788-94. Publicatie gebeurt met toestemming van de uitgever.
Van Bruggen JAR, Gorter KJ, Stolk RP, Rutten GEHM. Delen en delegeren zijn geen panacee voor bete... more Van Bruggen JAR, Gorter KJ, Stolk RP, Rutten GEHM. Delen en delegeren zijn geen panacee voor betere diabeteszorg. Huisarts Wet 2006;49(12):598-605. Achtergrond Een verbeterde samenwerking tussen artsen en andere zorgverleners zou leiden tot een kwaliteitsimpuls voor de diabeteszorg. Het is de vraag of deze verwachting op voldoende bewijs is gebaseerd. Methode Systematische zoekopdracht in Medline (1990Medline ( -2005 naar reviews, RCT's en overige effectevaluaties rond delen en/of delegeren van diabeteszorg. Resultaten Onze zoekactie leverde 2406 treffers op. Uiteindelijk sloten wij 22 onderzoeken in: 5 over het delen, 13 over het delegeren en 4 over het delen en delegeren van de zorg. Alle onderzoeken over het delen en/of delegeren van diabeteszorg, toonden een verbetering van het zorgproces aan. Het HbA1c nam af in 7 reviews en in 4 van de overige onderzoeken. De bloeddruk daalde in 4 niet-gerandomiseerde onderzoeken en in 3 van de 7 RCT's, maar in niet één van de ingesloten reviews. Het cholesterol verminderde in 2 reviews, 1 RCT en 4 niet-gerandomiseerde onderzoeken. Conclusie De ingesloten onderzoeken laten zien dat het delen en/of delegeren van de zorg het zorgproces verbetert en het HbA1c verlaagt. De overige cardiovasculaire risicofactoren verbeteren echter niet. Een echt nauwkeurige inschatting van het effect van delen en delegeren binnen de Nederlandse diabeteszorg is om een aantal redenen niet mogelijk.
Mogelijke belangenverstrengeling: De afdeling van CvW heeft in de afgelopen jaren financiële onde... more Mogelijke belangenverstrengeling: De afdeling van CvW heeft in de afgelopen jaren financiële ondersteuning van farmaceutische industrieën ontvangen om wetenschappelijk onderzoek te verrichten ('unrestricted research grants'). Dit artikel was een deelonderzoek van een promotieonderzoek waaraan de stichting Zuivel, Voeding en Gezondheid en (zeer ten dele) Bayer hebben bijgedragen onder de bovengenoemde voorwaarden. Dit artikel is eerder verschenen als: Van de Laar FA, Van de Lisdonk EH, Lucassen PLBL, Stafleu A, Mulder J, Van den Hoogen HJM, Rutten GEHM, Van Weel C. Eating behaviour and adherence to diet in patients with type 2 diabetes mellitus. Diabet Med 2006;23:788-94. Publicatie gebeurt met toestemming van de uitgever.
Accumulation of advanced glycation end products (AGEs) is enhanced by chronic hyperglycemia and o... more Accumulation of advanced glycation end products (AGEs) is enhanced by chronic hyperglycemia and oxidative stress and this process may contribute to the pathogenesis of vascular disease. Skin autofluorescence (AF), a measure of accumulation of AGEs in skin collagen, is associated with vascular disease in patients with diabetes. Because central obesity enhances oxidative stress people with central obesity might already have increased accumulation of AGEs before diabetes or cardiovascular disease become manifest. To test this hypothesis, we compared the distribution of skin AF and its association with clinical and biochemical parameters in individuals with and without central obesity. Skin AF was measured by a validated AGE Reader in 816 persons with and 431 persons without central obesity, aged 20–70 y. Mean skin AF increased with age and smoking and was higher in centrally obese individuals compared with non-obese individuals (p = 0.001, after adjustment for age and smoking p = 0.13). Mean skin AF in the subgroups without central obesity and without other risk factors (n = 106), central obesity without other risk factors (n = 74) and central obesity with other risk factors (n = 742) was 1.63 ± 0.37, 1.74 ± 0.44 and 1.87 ± 0.43 AU, respectively (p for trend < 0.001, after adjustment for age and smoking p for trend = 0.12). In the group with central obesity age, current smoking, alcohol consumption, waist circumference, creatinine clearance and hs-CRP were independently associated with skin AF (R2 = 29.4%). Waist circumference hardly contributed to the explained variance. The relationship between waist circumference and skin AF is not as obvious as we hypothesized.
Perceptions of illness are important determinants of health behaviour. A better understanding of ... more Perceptions of illness are important determinants of health behaviour. A better understanding of perceptions of obesity might allow more effective interventions that challenge these perceptions through lifestyle modification programs. Although several studies have evaluated causal attributions with regard to obesity, other domains of illness perception, such as the perceived consequences of obesity and perceived controllability, have not yet been studied. The aim of the current study was to explore perceptions regarding causes, consequences, control, concerns and time course of obesity of centrally obese adults, with and without an elevated cardiometabolic risk and with or without weight loss, 3 years after screening for metabolic syndrome, and to compare these perceptions. Three groups were selected from a longitudinal study dependent on the baseline and 3-year follow-up profiles: individuals with central obesity and metabolic syndrome at both time points (&amp;amp;amp;amp;amp;amp;#39;persistent cardiometabolic-risk group&amp;amp;amp;amp;amp;amp;#39;, n = 80), those with central obesity but without metabolic syndrome on either occasion (&amp;amp;amp;amp;amp;amp;#39;persistent obese group&amp;amp;amp;amp;amp;amp;#39;, n = 63), and formerly obese individuals (&amp;amp;amp;amp;amp;amp;#39;improved cardiometabolic-risk group&amp;amp;amp;amp;amp;amp;#39;, n = 49). Perceptions of obesity were assessed using an adapted version of the Brief Illness Perception Questionnaire (BIPQ, range 0-10). Chi-square and Kruskal-Wallis tests were performed to compare the &amp;amp;amp;amp;amp;amp;#39;persistent cardiometabolic risk&amp;amp;amp;amp;amp;amp;#39; group with the other two groups with regard to patient characteristics and BIPQ scores. Both males and females who improved their cardiometabolic risk perceived their obesity as shorter (median (IQR): 3.0 (4.0) vs. 6.0 (3.0), p &amp;amp;amp;amp;amp;amp;lt; 0.001) and experienced greater personal control over their weight (7.0 (3.0) vs. 5.0 (3.0), p = 0.002) compared to those who did not improve. Females who improved their cardiometabolic risk experienced fewer identity and illness concerns, this was not found for males. Other scores did not differ between groups. Obese adults with an improved cardiometabolic risk profile felt greater personal control and considered their obesity to be of shorter duration. Persistence of central obesity with additional cardiometabolic risk factors had a larger impact on female than male participants with respect to identity and illness concerns. Whether discussing &amp;amp;amp;amp;amp;amp;#39;personal control&amp;amp;amp;amp;amp;amp;#39; is a favourable element in lifestyle intervention should now be assessed in the setting of a controlled trial.
The worldwide epidemic of type 2 diabetes (T2DM) underlines the need for diabetes prevention stra... more The worldwide epidemic of type 2 diabetes (T2DM) underlines the need for diabetes prevention strategies. In this study the feasibility and effectiveness of a nurse led lifestyle program for subjects with impaired fasting glucose (IFG) is assessed. A cluster randomized clinical trial in 26 primary care practices in the Netherlands included 366 participants older than 45 years with newly diagnosed IFG and motivated to change their lifestyle (intervention group, n = 197; usual care group, n = 169). The one-year intervention, consisting of four to five individual nurse-led consultations, was directed at improving physical activity and dietary habits. The primary outcome measure was body mass index (BMI). Linear and logistic multilevel analyses and a process evaluation were performed. Both groups showed small reductions in BMI at 1 and 2 years, but differences between groups were not significant. At both 1 and 2-year follow-up the number of participants physically active for at least 30 minutes at least five days a week was significantly improved in the intervention group compared to the usual care group (intervention group vs. usual care group: OR1year = 3.53; 95 % CI = 1.69-7.37 and OR2years = 1.97; 95 % CI = 1.22-3.20, respectively). The total drop-out rate was 24 %. Process evaluation revealed that participants in the intervention group received fewer consultations than advised, while some practice nurses and participants considered the RM protocol too intensive. This relatively simple lifestyle program in subjects with IFG resulted in a significant improvement in reported physical activity, but not in BMI. Despite its simplicity, some participants still considered the intervention too intensive. This viewpoint could be related to poor motivation and an absence of disease burden due to IFG, such that participants do not feel a need for behavioural change. Although the intervention provided some benefit, its wider use cannot be advised. Current Controlled Trials ISRCTN41209683 , date of registration 16/10/2013h .
To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 2... more To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. A cross-sectional study. All Dutch care groups (n=97). 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. The association between quality management, overall and in 6 domains ('organisation of care', 'multidisciplinary teamwork', 'patient centredn...
To assess the change in level of diabetes quality management in primary care groups and outpatien... more To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P < 0...
To investigate the associations of vitamin B12 (cobalamin and holotranscobalamin) status with dep... more To investigate the associations of vitamin B12 (cobalamin and holotranscobalamin) status with depression, cognition and neuropathy in patients with type 2 diabetes using metformin. In an observational study, among 550 type 2 diabetes patients using metformin, cobalamin and holotranscobalamin (holoTCII) levels were measured at the annual diabetes checkup, and deficiencies were defined as <148 and <21 pmol/L, respectively. Depression and cognitive function were assessed with corresponding International Classification of Primary Care codes and questionnaires; neuropathy with medical record data and a questionnaire. Confounding variables were retrieved from medical records. Multivariable logistic and linear regressions were used with cobalamin status as independent variable; depression, cognition and neuropathy as dependent variables. The mean duration of diabetes was 8.4 years (±5.8); mean duration of metformin use was 64.1 months (±43.2), with a mean metformin dose of 1,306 mg/d...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2014
Many programmes to detect and prevent cardiovascular disease (CVD) have been performed, but the o... more Many programmes to detect and prevent cardiovascular disease (CVD) have been performed, but the optimal strategy is not yet clear. To present a systematic review of cardiometabolic screening programmes performed among apparently healthy people (not yet known to have CVD, diabetes, or cardiometabolic risk factors) and mixed populations (apparently healthy people and people diagnosed with risk factor or disease) to define the optimal screening strategy. Systematic review of studies performed in primary care in Western countries. MEDLINE, Embase, and CINAHL databases were searched for studies screening for increased cardiometabolic risk. Exclusion criteria were studies designed to assess prevalence of risk factors without follow-up or treatment; without involving a GP; when fewer than two risk factors were considered as the primary outcome; and studies constrained to ethnic minorities. The search strategy yielded 11 445 hits; 26 met the inclusion criteria. Five studies (1995-2012) were...
Secondary prevention is efficient in reducing morbidity and mortality after a myocardial infarcti... more Secondary prevention is efficient in reducing morbidity and mortality after a myocardial infarction (MI). However, both short-term and long-term mortality after MI remains relativity high in type 2 diabetes patients. To evaluate repeat prescriptions of secondary prevention medication (anti-thrombotic agent, beta-blocker and statin) in type 2 diabetes patients with a previous MI. Data of 1009 type 2 diabetes patients with a previous MI were extracted from the Julius General Practitioners' Network database. The proportion of patients with recent repeat prescriptions of guideline-based medication was determined. Furthermore, repeat prescriptions was determined 6 months, 1 year, 2 years and 5 years after MI. Generalized linear models were used to examine changes over time. Multivariate logistic regression analysis was used to analyse the association between patient characteristics and prescription. Only 46% of all type 2 diabetes patients with a previous MI had a recent repeat presc...
In recent years, most Dutch general practitioners started working under the umbrella of diabetes ... more In recent years, most Dutch general practitioners started working under the umbrella of diabetes care groups, responsible for the organisation and coordination of diabetes care. The quality management of these new organisations receives growing interest, although its association with quality of diabetes care is yet unclear. The best way to measure quality management is unknown and it has not yet been studied at the level of outpatient clinics or care groups. We aimed to assess quality management of type 2 diabetes care in care groups and outpatient clinics. Quality management was measured with online questionnaires, containing six domains (see below). They were divided into 28 subdomains, with 59 (care groups) and 57 (outpatient clinics) questions respectively. The mean score of the domains reflects the overall score (0-100%) of an organisation. Two quality managers of all Dutch care groups and outpatient clinics were invited to fill out the questionnaire.Sixty care groups (response...
Diabetes mellitus is associated with an increase in the risk of dementia and the proportion of pa... more Diabetes mellitus is associated with an increase in the risk of dementia and the proportion of patients who convert from mild cognitive impairment (MCI) to dementia. In addition to MCI and dementia, the stages of diabetes-associated cognitive dysfunction include subtle cognitive changes that are unlikely to affect activities of daily life or diabetes self-management. These diabetes-associated cognitive decrements have structural brain correlates detectable with brain MRI, but usually show little progression over time. Although cognitive decrements do not generally represent a pre-dementia stage in patients below the age of 60-65 years, in older individuals these subtle cognitive changes might represent the earliest stages of a dementia process. Acknowledgment of diabetes-associated cognitive decrements can help to improve understanding of patients' symptoms and guide management. Future challenges are to establish the importance of screening for cognitive impairment in people wit...
... mellitus type 2 Guy Rutten Wim de Grauw Margriet Bouma Lex Goudswaard Keywords commentaar Á d... more ... mellitus type 2 Guy Rutten Wim de Grauw Margriet Bouma Lex Goudswaard Keywords commentaar Á diabetes mellitus Á farmacotherapie Á hartfalen ... Zo lieten eerdere onderzoeken van TZD's een reductie van een voortschrij-dende intimamediaverdikking zien. ...
Mogelijke belangenverstrengeling: De afdeling van CvW heeft in de afgelopen jaren financiële onde... more Mogelijke belangenverstrengeling: De afdeling van CvW heeft in de afgelopen jaren financiële ondersteuning van farmaceutische industrieën ontvangen om wetenschappelijk onderzoek te verrichten ('unrestricted research grants'). Dit artikel was een deelonderzoek van een promotieonderzoek waaraan de stichting Zuivel, Voeding en Gezondheid en (zeer ten dele) Bayer hebben bijgedragen onder de bovengenoemde voorwaarden. Dit artikel is eerder verschenen als: Van de Laar FA, Van de Lisdonk EH, Lucassen PLBL, Stafleu A, Mulder J, Van den Hoogen HJM, Rutten GEHM, Van Weel C. Eating behaviour and adherence to diet in patients with type 2 diabetes mellitus. Diabet Med 2006;23:788-94. Publicatie gebeurt met toestemming van de uitgever.
Van Bruggen JAR, Gorter KJ, Stolk RP, Rutten GEHM. Delen en delegeren zijn geen panacee voor bete... more Van Bruggen JAR, Gorter KJ, Stolk RP, Rutten GEHM. Delen en delegeren zijn geen panacee voor betere diabeteszorg. Huisarts Wet 2006;49(12):598-605. Achtergrond Een verbeterde samenwerking tussen artsen en andere zorgverleners zou leiden tot een kwaliteitsimpuls voor de diabeteszorg. Het is de vraag of deze verwachting op voldoende bewijs is gebaseerd. Methode Systematische zoekopdracht in Medline (1990Medline ( -2005 naar reviews, RCT's en overige effectevaluaties rond delen en/of delegeren van diabeteszorg. Resultaten Onze zoekactie leverde 2406 treffers op. Uiteindelijk sloten wij 22 onderzoeken in: 5 over het delen, 13 over het delegeren en 4 over het delen en delegeren van de zorg. Alle onderzoeken over het delen en/of delegeren van diabeteszorg, toonden een verbetering van het zorgproces aan. Het HbA1c nam af in 7 reviews en in 4 van de overige onderzoeken. De bloeddruk daalde in 4 niet-gerandomiseerde onderzoeken en in 3 van de 7 RCT's, maar in niet één van de ingesloten reviews. Het cholesterol verminderde in 2 reviews, 1 RCT en 4 niet-gerandomiseerde onderzoeken. Conclusie De ingesloten onderzoeken laten zien dat het delen en/of delegeren van de zorg het zorgproces verbetert en het HbA1c verlaagt. De overige cardiovasculaire risicofactoren verbeteren echter niet. Een echt nauwkeurige inschatting van het effect van delen en delegeren binnen de Nederlandse diabeteszorg is om een aantal redenen niet mogelijk.
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Papers by Guy Rutten