Diabetes mellitus may affect bone turnover in a number of ways, thus leading to impaired bone quality and a consequent increase in fracture risk. These factors are summarised in this commentary.
Maternal thyroid dysfunction may adversely affect fetal brain development, but more evidence is needed to refine this hypothesis. The aim of this study was to evaluate potential fetal programming by ...abnormal maternal thyroid function on child neurodevelopmental disorders.
The design was a case-cohort study within the Danish National Birth Cohort (1997-2003). From the eligible cohort of 71,706 women, a random 12% sub-cohort (n = 7624) was selected, and all women (n = 2276) whose child was diagnosed with seizures, specific developmental disorder (SDD), autism spectrum disorder (ASD), and/or attention-deficit/hyperactivity disorder (ADHD) up to December 31, 2010, were identified. All women had a blood sample drawn in early pregnancy (median week 9), and the stored sample was used for measurement of free thyroxine and thyrotropin. Method- and week-specific reference ranges were used for classification of maternal thyroid function. A weighted Cox proportional hazards model was used to estimate adjusted hazard ratio (aHR) with 95% confidence intervals (CI) for neurodevelopmental disorders in children exposed to maternal thyroid dysfunction.
The overall frequency of abnormal maternal thyroid function was 12.5% in the sub-cohort and significantly higher among cases of ASD (17.9%; aHR = 1.5 CI 1.1-2.1), but not among other types of neurodevelopmental disorders (febrile seizures: 12.7%; epilepsy: 13.1%; SDD: 12.6%; and ADHD: 14.0%). However, evaluation of subtypes of maternal thyroid dysfunction showed that maternal overt hypothyroidism (thyrotropin >10 mIU/L) was a risk factor for epilepsy in the child (aHR = 3.5 CI 1.2-10), as was overt hyperthyroidism for cases diagnosed within the first year of life (aHR = 3.0 CI 1.03-8.4). Furthermore, both maternal hypothyroidism (aHR = 1.8 CI 1.1-2.7) and overt hyperthyroidism (aHR = 2.2 CI 1.1-4.4) were risk factors for ASD in the child, and isolated low free thyroxine was associated with ASD (aHR = 4.9 CI 2.03-11.9) and ADHD (aHR = 2.3 CI 1.2-4.3) in girls but not in boys.
Abnormal maternal thyroid function in early pregnancy was associated with epilepsy, ASD, and ADHD in the child, but associations differed by subtypes of exposure and by child age and sex. More evidence on subtypes and severity of maternal thyroid function is needed, and alternative outcomes of child neurodevelopment may be warranted.
Context:
Renal complications in terms of hypercalciuria, nephrolithiasis, and nephrocalcinosis are well-known risks in primary hyperparathyroidism (PHPT) and may lead to impaired renal function.
...Evidence Acquisition:
We reviewed published evidence on the occurrence, pathophysiology, and consequences of renal complications in PHPT and highlighted areas of uncertainty that should be investigated further.
Evidence Synthesis:
In asymptomatic PHPT, renal stones are present in approximately 7% of the patients, which is a significantly higher prevalence than among patients without PHPT (1.6%). Also, before diagnosis of PHPT, risk of hospital admissions due to renal stones is increased compared with the background population, and the risk remains increased for at least 10 yr after surgical cure from PHPT. However, shortly after parathyroidectomy, risk of recurrent stone episodes is reduced to the recurrence rate among patients with idiopathic renal stone disease. In general, patients with PHPT who develop nephrolithiasis are of younger age and more often are males, compared with those who do not form renal calcifications. Although 24-h urinary calcium is decreased after parathyroidectomy, studies have shown a higher renal calcium excretion and lower serum phosphate levels in former PHPT patients compared with healthy controls, suggesting that these patients have some additional mineral disorder.
Conclusion:
All patients with a diagnosis of PHPT should initially be evaluated for renal calcifications by unenhanced helical computed tomography. If calcifications are present, parathyroidectomy is recommended. If symptoms develop after parathyroidectomy, patients should be evaluated and treated similar to other patients with renal stones.
The objective was to examine the association of physical activity and resting heart rate (RHR) with hospital-diagnosed atrial fibrillation (AF) in a Norwegian cohort.
This prospective study included ...20 484 adults (50.3% men) who participated in the third Tromsø Study survey in 1986-87. At baseline, physical activity was assessed by a validated questionnaire, and RHR was objectively measured. Participants were followed from baseline through 2010 with respect to incident cases of hospital-diagnosed AF documented on an electrocardiogram. During a mean follow-up period of 20 years (409 045 person-years), 750 participants (70.5% men) were diagnosed with AF. Compared with the low physical activity group, moderately active individuals had a 19% lower risk of any AF adjusted hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.68-0.97, whereas highly active had similar risk of AF. Vigorously active individuals showed a non-significantly higher risk of AF (adjusted HR 1.37, 95% CI 0.77-2.43). Risk of AF increased with decreasing RHR (adjusted HR 0.92, 95% CI 0.86-0.98 for each 10 b.p.m. increase in RHR), and RHR < 50 b.p.m. was a risk factor for AF (P < 0.05).
In this prospective cohort study, leisure time physical activity was associated with AF in a J-shaped pattern. Moderate physical activity was associated with a reduced risk of AF, whereas higher activity levels attenuated the benefits of moderate activity. Low RHR was a risk factor for AF. Our results support the hypothesis that moderate and vigorous physical activity may affect AF risk via different pathophysiological mechanisms.
Antithyroid drug (ATD) therapy in early pregnancy is associated with birth defects, but more data are needed to substantiate the risk associated with different types of ATD. Furthermore, the role of ...abnormal maternal thyroid function per se remains unclarified.
To evaluate the risk of birth defects associated with the use of ATD in an extended nationwide cohort and the role of abnormal maternal thyroid function in birth cohorts including stored maternal blood samples from early pregnancy.
Danish pregnant women and their live-born children, including 1,243,353 children from a Nationwide Register-Based Cohort (NRBC), 1997 to 2016; 8830 children from the Danish National Birth Cohort (DNBC), 1997 to 2003; and 14,483 children from the North Denmark Region Pregnancy Cohort (NDRPC), 2011 to 2015.
Birth defects diagnosed before 2 years of age.
In the NRBC, altogether 2718 (0.2%) children had been exposed to ATD in early pregnancy. The overall frequency of birth defects was 6.7% (95% CI, 6.7% to 6.8%) in nonexposed children and higher after exposure to methimazole/carbimazole (9.6%; 95% CI, 8.2% to 11.2%) and propylthiouracil (8.3%; 95% CI, 6.7% to 10.3%). On the other hand, the frequency of maternal thyroid dysfunction in early pregnancy was similar in the random cohort and in cases of birth defect in the DNBC (12.4 vs 12.6%, P = 0.8) and the NDRPC (15.1 vs 15.4%, P = 0.8).
Results corroborate an increased risk of birth defects associated with the use of ATD in early pregnancy and suggest that abnormal maternal thyroid function is not a major risk factor for birth defects.
In patients with prior hip fracture (HFx), little is known about time frame and risk factors of second HFx, as well as the ensuing mortality. The aim of the study was to elucidate the incidence of ...second HFx and subsequent mortality. All 169,145 patients with a first HFx in Denmark during 1977–2001 were followed for up to 25 yr and compared with the background population. Data on fractures, vital status, comorbidity, redeemed prescriptions, and socio‐demographic variables were retrieved from national registers. Median follow‐up was 3.8 yr, corresponding to 1,041,177 patient‐years. A total of 27,834 patients had a second HFx. The cumulative incidence was 9% after 1 yr and 20% after 5 yr, being significantly higher than expected (2% and 12%, respectively; p < 0.05). The RR of second HFx was 2.2 (95% CI: 2.0–2.5) at 1 yr and did not normalize until 15 yr (RR = 1.01, 95% CI: 1.0–1.02). Risk factors for a second HFx were female sex (HR = 1.36, 95% CI: 1.32–1.40), age (HR = 1.68, 95% CI: 1.60–1.76 in patients >85 yr), alcoholism (HR = 1.61, 95% CI: 1.51–1.72), any prior fracture (HR = 1.08, 95%CI :1.04–1.11), and living alone (HR = 1.06, 95% CI: 1.04–1.09). Both sexes had higher mortality at 1 and 5 yr after a second HFx compared with the background population (men—1 yr: 27% versus 9%, p < 0.05; 5 yr: 64% versus 40%, p < 0.05; women—1 yr: 21% versus 10%, p < 0.05; 5 yr: 58% versus 41%, p < 0.05). Patients with HFx are at 2‐fold risk of further HFx and the subsequent mortality is highly increased. We propose that programs for secondary prevention should be developed and tested.
Aim
Even though the association between diabetes and periodontitis is taken for granted, results on this association are conflicting within the literature. This systematic review assessed whether ...poorly controlled diabetes was associated with periodontitis onset or progression.
Methods
Electronic searches were performed in PubMed, Scopus and Embase databases. Hand search was carried out in the reference list of all articles included. Gray literature was investigated with a Google Scholar search. Prospective longitudinal studies on the association between diabetes and periodontitis were considered for this review. Studies should have presented at least two measurements of periodontal conditions over time. Data on study design, crude and adjusted estimates were collected. We used meta-analysis to estimate the pooled effect of hyperglycemia in people with diabetes on periodontitis onset or progression. Meta-regression and subgroup analyses were employed to investigate potential sources of heterogeneity between studies.
Results
Thirteen studies matched the inclusion criteria, comprising 49,262 individuals, including 3197 diagnosed with diabetes. Meta-analyses of adjusted estimates showed that diabetes increased the risk of incidence or progression of periodontitis by 86% (RR 1.86 95% CI 1.3–2.8). However, there is scarce information on the association between diabetes and periodontal destruction.
Conclusions
This study provides evidence that diabetes is associated with increased risk of periodontitis onset and progression in adults. Upcoming prospective longitudinal studies ought to overcome methodological caveats identified in this review.
We examined the association between the body mass index analyzed as a continuous variable and by categorization according to World Health Organization criteria (normal weight, overweight and obesity) ...and the risk of a hospital (inpatient as well as outpatient) diagnosis of atrial fibrillation or flutter.
Population-based prospective cohort study conducted from December 1993 to December 2001 among 47
589 participants (22
482 men and 25
107 women) without preexisting cardiovascular or endocrine disease and with a mean age at baseline of 56 years (range 50–64 years) in the Danish Diet, Cancer, and Health Study. Subjects were followed up in the Danish National Registry of Patients and in the Danish Civil Registration System.
During follow-up (mean, 5.7 years) atrial fibrillation or flutter developed in 553 subjects (372 men and 181 women). The adjusted hazard ratio for atrial fibrillation or flutter per unit of increase in the body mass index was 1.08 (95% confidence interval CI: 1.05 to 1.11) in men and 1.06 (95% CI: 1.03 to 1.09) in women. When using normal weight as a reference, the adjusted hazard ratio for atrial fibrillation or flutter by overweight was 1.75 (95% CI: 1.35 to 2.27) in men and 1.39 (95% CI: 0.99 to 1.94) in women. The adjusted hazard ratio by obesity was 2.35 (95% CI: 1.70 to 3.25) in men and 1.99 (95% CI: 1.31 to 3.02) in women.
Overweight and obesity are associated with an increased risk of a diagnosis of atrial fibrillation or flutter.
Lowering glucose levels is a complex task for patients with type 1 diabetes, and they often lack contact with health care professionals. Intermittently scanned continuous glucose monitoring (isCGM) ...has the potential to aid them with blood glucose management at home. The aim of this study was to investigate the long-term effect of isCGM on HbA.sub.1c in type 1 diabetes patients with poor glycaemic control in a region-wide real-world setting. All patients with type 1 diabetes receiving an isCGM due to poor glycaemic control (greater than or equal to70 mmol/mol greater than or equal to8.6%) in the period of 2020-21 in Region North Denmark ("T1D-CGM") were compared with all type 1 diabetes patients without isCGM ("T1D-NOCGM") in the same period. A multiple linear regression model adjusted for age, sex, diabetes duration and use of continuous subcutaneous insulin infusion was constructed to estimate the difference in change from baseline HbA.sub.1c between the two groups and within subgroups of T1D-CGM. A total of 2,527 patients (T1D-CGM: 897; T1D-NOCGM: 1,630) were included in the study. The estimated adjusted difference in change from baseline HbA.sub.1c between T1D-CGM vs T1D-NOCGM was -5.68 mmol/mol (95% CI: (-6.69 to -4.67 mmol/mol; p<0.0001)). Older patients using isCGM dropped less in HbA.sub.1c. Our results indicate that patients with type 1 diabetes in poor glycaemic control from Region North Denmark in general benefit from using isCGM with a sustained 24-month improvement in HbA.sub.1c, but the effect on HbA.sub.1c may be less pronounced for older patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background Diabetes mellitus is associated with an increased risk of hip fracture. The aim of
this cohort study was to investigate whether glucose-lowering drugs influence the risk of hip ...fracture in patients with incident diabetes. Methods A study was performed on a cohort of patients with incident type 2 diabetes. Diabetes diagnosis was defined using information from the Danish National Patient Registry and reimbursement information of glucose-lowering drugs from the Register of Medicinal Product Statistics. The period of observation was from 01.01.1996 till 31.12.2011. The primary exposure was glucose-lowering drugs and the primary endpoint was hip fracture. Unadjusted, adjusted, and propensity score adjusted Cox regressions were performed. Results 5
244 patients with type 2 diabetes with a mean follow up of 5.5 years were included in the study. Use of sulphonylureas within the last 90 days was associated with hip fracture in patients with type 2 diabetes, hazard ratio 1.64 (95
% confidence interval: 1.54,1.75), whereas ever use of sulohonylyreas was not associated with an increased risk of fractures. Use of sulphonylureas within the last 90 days was also associated with an increased risk of fractures at other sites. Use of glitazones within the last 90 days was associated with an increased risk of hip fracture, hazard ratio 2.07 (95
% confidence interval: 1.39,3.07), whereas ever use was not associated with an increased risk. Conclusions Current use of sulphonylureas was associated with hip fracture in patients with type 2 diabetes. Speculatively, this may be due to hypoglycemia resulting in falls.
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