Browsing by Subject "diabetes"

Sort by: Order: Results:

Now showing items 1-20 of 59
  • Vuori, Matti A.; Harald, Kennet; Jula, Antti; Valsta, Liisa; Laatikainen, Tiina; Salomaa, Veikko; Tuomilehto, Jaakko; Jousilahti, Pekka; Niiranen, Teemu J. (2020)
    Aims: The objective was to evaluate whether sodium intake, assessed with the gold standard 24-h urinary collections, was related to long-term incidence of death, cardiovascular disease (CVD) and diabetes mellitus (DM). Methods:A cohort of 4630 individuals aged 25-64 years collected 24-h urine samples in 1979-2002 and were followed up to 14 years for the incidence of any CVD, coronary heart disease (CHD), stroke, heart failure (HF) and DM event, and death. Cox proportional hazards models were used to estimate the association between the baseline salt intake and incident events and adjusted for baseline age, body mass index, serum cholesterol, prevalent DM, and stratified by sex and cohort baseline year. Results: During the follow-up, we observed 423 deaths, 424 CVD events (288 CHD events, 142 strokes, 139 HF events) and 161 DM events. Compared with the highest quartile of salt intake, persons in the lowest quartile had a lower incidence of CVD (hazard ratio [HR] 0.70; 95% confidence interval [CI], 0.51-0.95,p = .02), CHD (HR 0.63 [95% CI 0.42-0.94],p = .02) and DM (HR 0.52 [95% CI 0.31-0.87],p = .01). The results were non-significant for mortality, HF, and stroke. Conclusion: High sodium intake is associated with an increased incidence of CVD and DM.
  • Surrogate Markers Micro-Macro-Vasc (2018)
    Purpose Diabetic retinopathy is the most common eye complication in patients with diabetes. The purpose of this study is to identify genetic factors contributing to severe diabetic retinopathy. Methods Results A genome-wide association approach was applied. In the Genetics of Diabetes Audit and Research in Tayside Scotland (GoDARTS) datasets, cases of severe diabetic retinopathy were defined as type 2 diabetic patients who were ever graded as having severe background retinopathy (Level R3) or proliferative retinopathy (Level R4) in at least one eye according to the Scottish Diabetic Retinopathy Grading Scheme or who were once treated by laser photocoagulation. Controls were diabetic individuals whose longitudinal retinopathy screening records were either normal (Level R0) or only with mild background retinopathy (Level R1) in both eyes. Significant Single Nucleotide Polymorphisms (SNPs) were taken forward for meta-analysis using multiple Caucasian cohorts. Five hundred and sixty cases of type 2 diabetes with severe diabetic retinopathy and 4,106 controls were identified in the GoDARTS cohort. We revealed that rs3913535 in the NADPH Oxidase 4 (NOX4) gene reached a p value of 4.05 x 10(-9). Two nearby SNPs, rs10765219 and rs11018670 also showed promising p values (p values = 7.41 x 10(-8) and 1.23 x 10(-8), respectively). In the meta-analysis using multiple Caucasian cohorts (excluding GoDARTS), rs10765219 and rs11018670 showed associations for diabetic retinopathy (p = 0.003 and 0.007, respectively), while the p value of rs3913535 was not significant (p = 0.429). Conclusion This genome-wide association study of severe diabetic retinopathy suggests new evidence for the involvement of the NOX4 gene.
  • Kansaneläkelaitos Kela (Kela, tilastoryhmä, 2011)
  • Eich, Torsten; Stahle, Magnus; Gustafsson, Bengt; Horneland, Rune; Lempinen, Marko; Lundgren, Torbjörn; Rafael, Ehab; Tufveson, Gunnar; von Zur-Mühlen, Bengt; Olerud, Johan; Scholz, Hanne; Korsgren, Olle (2018)
    Background: Effective digestive enzymes are crucial for successful islet isolation. Supplemental proteases are essential because they synergize with collagenase for effective pancreatic digestion. The activity of these enzymes is critically dependent on the presence of Ca2+ ions at a concentration of 5-10 mM. The present study aimed to determine the Ca2+ concentration during human islet isolation and to ascertain whether the addition of supplementary Ca2+ is required to maintain an optimal Ca2+ concentration during the various phases of the islet isolation process. Methods: Human islets were isolated according to standard methods and isolation parameters. Islet quality control and the number of isolations fulfilling standard transplantation criteria were evaluated. Ca2+ was determined by using standard clinical chemistry routines. Islet isolation was performed with or without addition of supplementary Ca2+ to reach a Ca2+ of 5 mM. Results: Ca2+ concentration was markedly reduced in bicarbonate-based buffers, especially if additional bicarbonate was used to adjust the pH as recommended by the Clinical Islet Transplantation Consortium. A major reduction in Ca2+ concentration was also observed during pancreatic enzyme perfusion, digestion, and harvest. Additional Ca2+ supplementation of media used for dissolving the enzymes and during digestion, perfusion, and harvest was necessary in order to obtain the concentration recommended for optimal enzyme activity and efficient liberation of a large number of islets from the human pancreas. Conclusions: Ca2+ is to a large extent consumed during clinical islet isolation, and in the absence of supplementation, the concentration fell below that recommended for optimal enzyme activity. Ca2+ supplementation of the media used during human pancreas digestion is necessary to maintain the concentration recommended for optimal enzyme activity. Addition of Ca2+ to the enzyme blend has been implemented in the standard isolation protocols in the Nordic Network for Clinical Islet Transplantation.
  • Brboric, Anja; Vasylovska, Svitlana; Saarimäki-Vire, Jonna; Espes, Daniel; Caballero-Corbalan, Jose; Larfors, Gunnar; Otonkoski, Timo; Lau, Joey (2019)
    Background: Murine boundary cap-derived neural crest stem cells (NCSCs) are capable of enhancing islet function by stimulating beta cell proliferation as well as increasing the neural and vascular density in the islets both in vitro and in vivo. This study aimed to isolate NCSC-like cells from human bone marrow. Methods: CD271 magnetic cell separation and culture techniques were used to purify a NCSC-enriched population of human bone marrow. Analyses of the CD271+ and CD271- fractions in terms of protein expression were performed, and the capacity of the CD271+ bone marrow cells to form 3-dimensional spheres when grown under non-adherent conditions was also investigated. Moreover, the NCSC characteristics of the CD271+ cells were evaluated by their ability to migrate toward human islets as well as human islet-like cell clusters (ICC) derived from pluripotent stem cells. Results: The CD271+ bone marrow population fulfilled the criterion of being multipotent stem cells, having the potential to differentiate into glial cells, neurons as well as myofibroblasts in vitro. They had the capacity to form 3-dimensional spheres as well as an ability to migrate toward human islets, further supporting their NCSC identity. Additionally, we demonstrated similar migration features toward stem cell-derived ICC. Conclusion: The results support the NCSC identity of the CD271-enriched human bone marrow population. It remains to investigate whether the human bone marrow-derived NCSCs have the ability to improve transplantation efficacy of not only human islets but stem cell-derived ICC as well.
  • Ikäheimo, Ilona; Karjalainen, Merja; Tiihonen, Miia; Haanpää, Maija; Kautiainen, Hannu; Saltevo, Juha; Mäntyselkä, Pekka (2019)
    What is known and objective Polypharmacy and age are known to increase the risk for potential drug interactions. Type 2 diabetes has been associated with polypharmacy and several comorbidities. Currently, there is no information on whether the frequency of clinically relevant drug-drug interactions and the risk for drug adverse effects differ between older persons with and without diabetes. The aim of this study was to investigate the frequency of drug-drug interactions and the risk for drug adverse effects in these two groups in primary care. Methods The basic study population consisted of Finnish home-dwelling primary care patients aged >= 65 years (N = 3039). For each person with diabetes, two controls were selected with adjusted age and gender. To collect data, electronic primary care patient records, a structured health questionnaire and a structured health examination conducted by a physician were utilized. Using the SFINX-PHARAO (R) database, drug-drug interactions and the risk for drug adverse effects were evaluated in 182 persons with type 2 diabetes and 176 persons without diabetes. Results and discussion There were no significant differences in the frequency of drug-drug interactions or the risk for drug adverse effects in persons with and without diabetes. At least one clinically relevant interaction was found in 81 (44.5%) persons with diabetes and 73 (41.5%) persons without diabetes. The most common drugs causing interactions included non-steroidal anti-inflammatory drugs (NSAIDs) and warfarin. What is new and conclusion There is no difference in the frequency of drug-drug interactions or risk for drug adverse effects in older home-dwelling persons with and without diabetes. Due to common comorbidities and commonly used drugs among persons with diabetes, drug-drug interactions involving warfarin or NSAIDs in particular should be carefully monitored to avoid drug adverse effects.
  • Eriksson, Johan G. (2019)
    Type 2 diabetes (T2D) is a major, rapidly increasing global public health challenge. The major risk factors for T2D include overweight and obesity, lifestyle-related factors and genetic factors. Early life exposures shape the developmental trajectories and alter susceptibility to T2D. Based on epidemiological studies it has been suggested that fetal undernutrition plays a role in the etiology of T2D. A low birth weight has been considered a proxy for fetal undernutrition. A meta-analysis reported that a 1 kg increase in birth weight is associated with a roughly 20% lower risk of T2D. Although fetal life is of major importance for future health, the period spanning the first 1000 days of life, is characterized by great plasticity and largely influencing later health. Different growth trajectories during this time period have also been associated with an increased risk of T2D. Studies assessing the association between age at BMI rebound in childhood and later risk for T2D have reported a fivefold difference in T2D according to age at BMI rebound. Developmental and epidemiological cohort studies focusing on T2D have major public health implications supporting a paradigm shift; a shift from focusing upon risk factor modification in adult life to adopting a life course perspective when studying T2D. This paradigm shift will not only help us in getting a better understanding of the pathophysiology underlying T2D, but it will also open new possibilities and opportunities in the prevention of T2D and related disorders.
  • Kivimäki, Karolina (Helsingin yliopisto, 2020)
    Tämän tutkimuksen tarkoituksena oli selvittää, miten tutkittavat jakautuvat peroraalisen sokerirasituksen perusteella käyttämällä k-means-algoritmia ja selvittää, jakautuvatko tutkittavat eri ryppäisiin jo vakiintuneen glukoosinsiedon luokitteluperusteen mukaisesti, vai muodostuuko myös uudenlaisia ryhmiä. Lisäksi tarkasteltiin mihin GCK-kantajat sijoittuivat ryppäissä. Aineisto perustuu Botnia-tutkimukseen ja sen myöhempiin osatutkimuksiin. Tutkittavat olivat diabeetikkoja ja terveitä kontrolleja (N=4319). GCK-kantajia oli 113. Tutkittavat ryhmiteltiin sokerirasituksen kymmenen muuttujan (glukoosi 0 min, 30 min, 60 min ja 120 min; insuliini 0 min, 30 min, 60 min ja 120 min sekä C-peptidi 0 min ja 120 min). Ryhmittelyssä käytettiin K-means algoritmia ja R-ohjelmaa. Syntyneiden ryhmien erojen havaitsemiseen käytettiin Anovaa, ja kahdenväliset erot laskettiin Tukeyn testillä. T-testiä käytettiin vertaamaan ryppään GCK-MODY-kantajien piirteitä vastaavan ryhmän keskiarvoihin. K-means ryhmitteyssä erottui kolme ryhmää glukoosirasituksen perusteella. Ryppäät erosivat toisistaan odotetusti ryhmittelyyn käytettyjen muuttujien suhteen, mutta lisäksi eroavaisuuksia todettiin myös lipiditasoissa ja BMI:ssä, vaikka näitä muuttujia ei ollut ryhmittelyssä käytettykään. GCK-kantajien glukoosirasituskäyrien muoto mukaili koko aineiston vastaavaa, ja he olivat joka ryhmässä keskiarvoa nuorempia ja hoikempia. GCK-kantajat erottuivat kaikista selvimmin vastaavan ryhmän ei-kantajista ryppäässä 1. Ryppäässä 3 GCK-kantajilla oli hieman korkeampi HDL-kolesteroli ja matalampi BMI kuin muilla saman ryppään tutkittavilla, ja ryppääseen 3 päätyivätkin ne GCK-kantajat, joiden glukoosiaineenvaihdunta oli keskimäärin eniten häiriintynyt.
  • Vornanen, Marleena; Konttinen, Hanna; Peltonen, Markku; Haukkala, Ari (2021)
    Background Perceived disease risk may reflect actual risk indicators and/or motivation to change lifestyle. Yet, few longitudinal studies have assessed how perceived risk relates to risk indicators among different disease risk groups. We examined in a 5-year follow-up, whether perceived risks of diabetes and cardiovascular disease predicted physical activity, body mass index (BMI kg/m(2)), and blood glucose level, or the reverse. We examined further whether perceived risk, self-efficacy, and outcome beliefs together predicted changes in these risk indicators. Method Participants were high diabetes risk participants (N = 432) and low/moderate-risk participants (N = 477) from the national FINRISK 2002 study who were followed up in 2007. Both study phases included questionnaires and health examinations with individual feedback letters. Data were analyzed using gender- and age-adjusted structural equation models. Results In cross-lagged autoregressive models, perceived risks were not found to predict 5-year changes in physical activity, BMI, or 2-h glucose. In contrast, higher BMI and 2-h glucose predicted 5-year increases in perceived risks (beta-values 0.07-0.15,P-values <0.001-0.138). These associations were similar among high- and low/moderate-risk samples. In further structural equation models, higher self-efficacy predicted increased physical activity among both samples (beta-values 0.10-0.16,P-values 0.005-0.034). Higher outcome beliefs predicted lower BMI among the low/moderate-risk sample (beta-values - 0.04 to - 0.05,P-values 0.008-0.011). Conclusion Perceived risk of chronic disease rather follows risk indicators than predicts long-term lifestyle changes. To promote sustained lifestyle changes, future intervention studies need to examine the best ways to combine risk feedback with efficient behavior change techniques.
  • Abu-Farha, Mohamed; Tuomilehto, Jaakko; Abubaker, Jehad (2021)
  • Lehtonen, Sanna; Lewko, Barbara (2019)
  • Forsythe, Rachael O.; Apelqvist, Jan; Boyko, Edward J.; Fitridge, Robert; Hong, Joon P.; Katsanos, Konstantinos; Mills, Joseph L.; Nikol, Sigrid; Reekers, Jim; Venermo, Maarit; Zierler, R. Eugene; Hinchliffe, Robert J.; Schaper, Nicolaas C. (2020)
    In patients with diabetes, foot ulceration and peripheral artery disease (PAD), it is often difficult to determine whether, when and how to revascularise the affected lower extremity. The presence of PAD is a major risk factor for non-healing and yet clinical outcomes of revascularisation are not necessarily related to technical success. The International Working Group of the Diabetic Foot updated systematic review on the effectiveness of revascularisation of the ulcerated foot in patients with diabetes and PAD is comprised of 64 studies describing >13000 patients. Amongst 60 case series and 4 non-randomised controlled studies, we summarised clinically relevant outcomes and found them to be broadly similar between patients treated with open vs endovascular therapy. Following endovascular revascularisation, the 1 year and 2 year limb salvage rates were 80% (IQR 78-82%) and 78% (IQR 75-83%), whereas open therapy was associated with rates of 85% (IQR 80-90%) at 1 year and 87% (IQR 85-88%) at 2years, however these results were based on a varying combination of studies and cannot therefore be interpreted as cumulative. Overall, wound healing was achieved in a median of 60% of patients (IQR 50-69%) at 1 year in those treated by endovascular or surgical therapy, and the major amputation rate of endovascular vs open therapy was 2% vs 5% at 30days, 10% vs 9% at 1 year and 13% vs 9% at 2years. For both strategies, overall mortality was found to be high, with 2% (1-6%) perioperative (or 30day) mortality, rising sharply to 13% (9-23%) at 1 year, 29% (19-48%) at 2years and 47% (39-71%) at 5years. Both the angiosome concept (revascularisation directly to the area of tissue loss via its main feeding artery) or indirect revascularisation through collaterals, appear to be equally effective strategies for restoring perfusion. Overall, the available data do not allow us to recommend one method of revascularisation over the other and more studies are required to determine the best revascularisation approach in diabetic foot ulceration.
  • Danilova, Tatiana; Lindahl, Maria (2018)
    Mesencephalic astrocyte-derived neurotrophic factor (MANF) was originally identified as a secreted trophic factor for dopamine neurons in vitro. It protects and restores damaged cells in rodent models of Parkinson's disease, brain and heart ischemia, spinocerebellar ataxia and retina in vivo. However, its exact mechanism of action is not known. MANF is widely expressed in most human and mouse organs with high levels in secretory tissues. Intracellularly, MANF localizes to the endoplasmic reticulum (ER) and ER stress increases it's expression in cells and tissues. Furthermore, increased MANF levels has been detected in the sera of young children with newly diagnosed Type 1 (T1D) diabetes and Type 2 (T2D) diabetic patients. ER stress is caused by the accumulation of misfolded and aggregated proteins in the ER. It activates a cellular defense mechanism, the unfolded protein response (UPR), a signaling cascade trying to restore ER homeostasis. However, if prolonged, unresolved ER stress leads to apoptosis. Unresolved ER stress contributes to the progressive death of pancreatic insulin-producing beta cells in both T1D and T2D. Diabetes mellitus is characterized by hyperglycemia, caused by the inability of the beta cells to maintain sufficient levels of circulating insulin. The current medications, insulin and antidiabetic drugs, alleviate diabetic symptoms but cannot reconstitute physiological insulin secretion which increases the risk of devastating vascular complications of the disease. Thus, one of the main strategies in improving current diabetes therapy is to define and validate novel approaches to protect beta cells from stress as well as activate their regeneration. Embryonic deletion of the Manf gene in mice led to gradual postnatal development of insulin-deficient diabetes caused by reduced beta cell proliferation and increased beta cell death due to increased and sustained ER stress. In vitro, recombinant MANF partly protected mouse and human beta cells from ER stress-induced beta cell death and potentiated mouse and human beta cell proliferation. Importantly, in vivo overexpression of MANF in the pancreas of T1D mice led to increased beta cell proliferation and decreased beta cell death, suggesting that MANF could be a new therapeutic candidate for beta cell protection and regeneration in diabetes.
  • Jalonen, Emmi (Helsingin yliopisto, 2019)
    Tyypin 1 diabetesta esiintyy Suomessa eniten maailmassa. Tärkeimmät estettävissä olevat lisäsairastavuutta aiheuttavat tekijät ovat sairauden mikro- ja makrovaskulaariset komplikaatiot. The Finnish Diabetic Nephropathy Study eli FinnDiane -seurantatutkimus selvittää näiden lisäsairauksien syntymekanismeja, erityisesti munuaissairauden (nefropatia) osalta, joka tunnetaan merkittävänä kuolleisuuden riskitekijänä. Diabeettinen nefropatia lisää huomattavasti sydän- ja verisuonisairastavuutta, mikä on diabetesta sairastavien potilaiden johtava kuolinsyy. Pulssipaine on systolisen ja diastolisen verenpaineen erotus. Se on noninvasiivinen tapa mitata valtimoiden jäykkyyttä, ja esimerkiksi valtimoiden keskiverenpaineeseen verrattuna huomioi paremmin sekä systolisen että diastolisen verenpaineen vaihtelun. Aiemmassa tutkimuksessamme on osoitettu diabetesta sairastavien kiihtyneestä valtimoiden jäykistymisestä johtuva varhaisempi pulssipaineen nousu jo nuoremmalla iällä. Tässä tutkimuksessa halusimme selvittää, ennustaako kohonnut pulssipaine kuolleisuutta tyypin 1 diabetesta sairastavilla henkilöillä. Tutkimusaineisto koostui 4439 FinnDiane-tutkimukseen osallistuneesta aikuispotilaasta, joilla diabetes oli todettu alle 40-vuotiaana ja joiden insuliinihoito oli aloitettu vuoden sisään diagnoosista. Tiedot kerättiin kyselylomakkeella, jota täydennettiin vastaanotolla. Tiedot kuolemasta saatiin Tilastokeskuksen kuolinrekisteristä. Tietoa kerättiin vuosien 1994-2014 välisenä aikana. Seuranta-ajan mediaani oli 14 vuotta. 713 kuoli seuranta-aikana. Jaoimme potilaat pulssipaineen suhteen neljänneksiin, joita vertailimme Coxin regressio –menetelmää käyttäen. Kolmen matalimman neljänneksen välillä ei saatu merkittävää eroa kuolleisuudessa, mutta korkeimman pulssipaineen neljänneksessä kuolleisuus oli 1,4-kertainen edellisiin verrattuna. Lisäksi analysoimme aineistoa pulssipaineen mediaanin suhteen kahtia jaettuna. Korkeampi pulssipaine liittyi yhdenmukaisesti suurempaan kuolleisuuteen. Muita pulssipaineeseen liittyvän kuolleisuuden riskitekijöitä olivat nefropatia, miessukupuoli ja huono glukoositasapaino.
  • Snickars, Lina (Helsingin yliopisto, 2018)
    Gastropares är en komplikation vid diabetes och definieras som en fördröjning av magsäckens tömningshastighet. Allmänna symptom är uppsvälldhet, snabb mättnadskänsla, illamående och uppkastning. Gastropares är en av de mest allvarliga komplikationerna vid diabetes och eftersom det tidigare gjorts förhållandevis lite forskning om komplikationen finns det ett intresse av vidare studier i ämnet. Målet med avhandlingen är att analysera sjukdomsbilden vid gastropares hos patienter med typ 1-diabetes. Utöver diagnosen gastropares undersöks också förekomsten av gastrointestinala symptom hos studiepopulationen. Studien utförs på Folkhälsans forskningscenter, som har tillgång till ett omfattande patientmaterial på patienter med typ 1-diabetes via FinnDiane-studien. Analysen gav en prevalens för gastropares på 7,2% och en prevalens för besvärliga gastrointestinala symptom på 7%. Det framkom att patienter med gastropares generellt har betydligt mera gastrointestinala symptom, lider av mera diabetiska komplikationer och att patienterna kan kopplas till en del övriga faktorer som hög ålder, lång diabetesduration, högt blodtryck och lågt BMI. Ytterligare diskuteras problematiken kring diagnostisering av gastropares, bland annat av den orsaken att komplikationen saknar en egen diagnoskod i det vårdanmälningssystem som används för tillfället. Till följd av svår diagnostisering och avsaknad av diagnoskod finns en risk att symptom i mag- och tarmkanalen inte får tillräckligt med uppmärksamhet.
  • Kajantie, Eero; Osmond, Clive; Eriksson, Johan G. (2017)
    BACKGROUND: Women with hypertensive disorders in pregnancy are at an increased risk of cardiovascular disease and type 2 diabetes later in life. Offspring born from these hypertensive pregnancies have increased levels of cardiovascular risk factors; whether they are at an increased risk of type 2 diabetes is not known. OBJECTIVE: The objective of the investigation was to study the risk of type 2 diabetes in the adult offspring exposed to maternal preeclampsia or gestational hypertension in utero. STUDY DESIGN: We studied 5335 members of the Helsinki Birth Cohort Study, who were born between 1934 and 1944 and who lived in Finland in 1995 when the National Medication Purchase Register was initiated. We ascertained gestational hypertension and preeclampsia according to modern criteria by using maternal and birth records. We defined type 2 diabetes through purchases of antidiabetic medication recorded in the comprehensive National Medication Purchase Register, excluding the 31 subjects who had purchased only insulin. We used Cox regression to assess hazard ratios for type 2 diabetes. RESULTS: A total of 590 men (21.6%) and 433 women (16.9%) had purchased medication for diabetes. The hazard ratio for type 2 diabetes for offspring exposed to any maternal hypertension in pregnancy was 1.13 (95% confidence interval, 1.00-1.29; n = 1780). For maternal gestational hypertension, it was 1.15 (95% confidence interval, 1.00-1.33; n = 1336) and for preeclampsia 0.98 (95% confidence interval, 0.71-1.34; n = 231). For type 2 diabetes with first medication purchase before 62 years, the corresponding hazard ratios were 1.25 (95% confidence interval, 1.04-1.51); 1.28 (95% confidence interval, 1.05-1.58), and 1.18 (95% confidence interval, 0.75-1.84). The hazard ratios were similar when adjusted for birthweight SD score for gestation, length of gestation, maternal body mass index in late pregnancy, height, age, and parity and for childhood or adult socioeconomic position. An increased risk of type 2 diabetes was also associated with low birthweight SD score, independent of the association with gestational hypertension. CONCLUSION: Offspring exposed to maternal gestational hypertension in utero have an increased risk of type 2 diabetes in late adult life. This finding underlines the role of the whole spectrum of hypertensive disorders of pregnancy as risk factors of offspring disease throughout life. It also reinforces previous suggestions that adult health care providers should incorporate birth histories when evaluating an individual's risk to develop type 2 diabetes.
  • Koponen, Anne M.; Simonsen, Nina; Suominen, Sakari (2019)
    The results of this study showed the importance of autonomous motivation for healthy eating. Autonomous motivation and female gender were the determinants most strongly associated with fruits, vegetables, and berries intake among patients with type 2 diabetes. Other determinants of fruits, vegetables, and berries intake were high education, high social support, high age, and a strong sense of coherence. Autonomous motivation and self-care competence mediated the effect of perceived autonomy support from a physician on fruits, vegetables, and berries intake. Thus, physicians can promote patients' fruits, vegetables, and berries intake by supporting their autonomous motivation and self-care competence. The results are in line with self-determination theory.
  • Franzén, Markus (Helsingin yliopisto, 2020)
    Bakgrund: Avancerade glykerade slutprodukter (AGEs), som uppstår via icke-enzymatiska reaktioner i vävnader har under senare tid varit fokus för mycket forskning. AGEs ackumulering sker under en människas livstid, men accelereras under oxidativ stress och hyperglykemi. AGEs har implicerats i patogenesen i flertalet kroniska sjukdomar och deras komplikationer. Syftet med denna studie är att utreda hur hudens autofluorescens (SAF), som har verifierat att korrelera med AGEs i huden, korrelerar med morbiditet och levnadsvanor. Metoder: Denna studie baseras på ett material på 166 individer som deltagit mätningen av SAF och som varit med i Helsinki Birth Cohort Study (HBCS). HBCS är en kohortstudie av 13 345 personer födda i Helsingfors mellan åren 1934 och 1944. SAF uppmättes med AGE reader™, Diagnoptics. Faktorer som vi undersökte ifall SAF korrelerar med är: diabetes typ 1 och 2, hypertension samt vaskulär sjukdom. Vi undersökte också ifall SAF påverkas av livsstilsfaktorer såsom alkoholkonsumtion, rökning, BMI och fettprocent. Resultat: I denna studie kunde vi visa att SAF korrelerade med diabetes typ 2 samt inom diabetiker hade personer med vaskulär sjukdom högre SAF. Slutsatsen av detta är att i framtiden möjligen SAF skulle kunna användas som en tilläggsriskfaktor för vaskulär risk hos diabetiker.
  • Ibrahim, Mahmoud; Baker, Jason; Cahn, Avivit; Eckel, Robert H.; Sayed, Nuha Ali El; Fischl, Amy Hess; Gaede, Peter; Leslie, R. David; Pieralice, Silvia; Tuccinardi, Dario; Pozzilli, Paolo; Richelsen, Bjørn; Roitman, Eytan; Standl, Eberhard; Toledano, Yoel; Tuomilehto, Jaakko; Weber, Sandra L.; Umpierrez, Guillermo E. (2020)
    Abstract Hypoglycemia is common in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) and constitutes a major limiting factor in achieving glycemic control among people with diabetes. While hypoglycemia is defined as a blood glucose level under 70 mg/dL (3.9?mmol/L), symptoms may occur at higher blood glucose levels in individuals with poor glycemic control. Severe hypoglycemia is defined as an episode requiring the assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions to assure neurologic recovery. Hypoglycemia is the most important safety outcome in clinical studies of glucose lowering agents. The ADA Standards of Medical Care recommends that a management protocol for hypoglycemia should be designed and implemented by every hospital, along with a clear prevention and treatment plan. A tailored approach, using clinical and pathophysiologic disease stratification, can help individualize glycemic goals and promote new therapies to improve quality of life of patients. Data from recent large clinical trials reported low risk of hypoglycemic events with the use of newer antidiabetic drugs. Increased hypoglycemia risk is observed with the use of insulin and/or sulfonylureas. Vulnerable patients with T2D at dual risk of severe hypoglycemia and Cardiovascular (CV) outcomes show features of ?frailty?. Many of such patients may be better treated by the use of GLP-1 receptor agonists or SGLT2 inhibitors rather than insulin. CGM should be considered for all individuals with increased risk for hypoglycemia, impaired hypoglycemia awareness, frequent nocturnal hypoglycemia and with history of severe hypoglycemia. Patients with impaired awareness of hypoglycemia (IAH) benefit from real-time continuous glucose monitoring (CGM). The diabetes educator is an invaluable resource and can devote the time needed to thoroughly educate the individual to reduce the risk of hypoglycemia and integrate the information within the entire construct of diabetes self-management. Conversations about hypoglycemia facilitated by a healthcare professional may reduce the burden and fear of hypoglycemia among patients with diabetes and their family members. Optimizing insulin doses and carbohydrate intake, in addition to a short warm up before or after the physical activity sessions may help avoiding hypoglycemia. Several therapeutic considerations are important to reduce hypoglycemia risk during pregnancy including administration of rapid-acting insulin analogs rather than human insulin, pre-conception initiation of insulin analogs, and immediate postpartum insulin dose reduction. This article is protected by copyright. All rights reserved.
  • Laukkanen, Erika; Vehkalahti, Miira M; Kotiranta, Anja (2019)
    Aim To investigate the impact of systemic health and tooth-based factors on the outcome of root canal treatment (RCT). Methodology The target population consisted of all patients receiving RCT at the Helsinki University Clinic in 2008-2011. The inclusion criteria were diagnosable pre- and postoperative (minimum 6 months after root filling) radiographs and adequate patient records of RCT available. Teeth extracted for nonendodontic reasons were excluded. Patient documents including digital radiographs of 640 permanent teeth in 504 patients were scrutinized. The radiographs were assessed by two examiners under standardized conditions. The Periapical Index was used to define radiographically 'healthy' and 'healing' cases as successful. Data included systemic health, technical quality of root fillings, type of restoration and level of alveolar bone loss. Statistical evaluation of differences between groups included chi-squared tests and Fisher's exact tests. Logistic regression modelling utilizing robust standard errors to allow for clustering within patients was applied to analyse factors related to the outcome of RCT. Results The mean age of patients was 51.5 years (standard deviation (SD) 15.0; range 10-83), and 49% were female. In 41 cases (6%), the patient had diabetes mellitus (DM), in 132 (21%) cardiovascular disease and in 284 (44%) no systemic disease. The follow-up period was 6-71 months (mean 22.7). In the primary analyses, the success rate of RCT was 73.2% in DM patients and 85.6% in patients with no systemic disease (P = 0.043); other systemic diseases had no impact on success. In the multifactorial analysis, the impact of DM became nonsignificant and RCTs were more likely to succeed in the absence of apical periodontitis (AP; odds ratio (OR) = 4.4; P <0.001), in teeth with optimal root filling quality (OR = 2.5; P <0.001), in teeth restored with indirect restorations (OR = 3.7; P = 0.002) and in teeth with none/mild alveolar bone loss (OR = 2.4; P = 0.003). Conclusions DM diminished the success of RCT, especially in teeth with apical periodontitis. However, tooth-based factors had a more profound impact on the outcome of RCT. This should be considered in clinical decision-making and in assessment of RCT prognosis.