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Articles by T. Lauritzen
Total Records ( 8 ) for T. Lauritzen
  T. Parkner , T. Laursen , E. T. Vestergaard , H. Hartvig , J. S. Smedegaard , T. Lauritzen and J. S. Christiansen
 

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 Type2 diabetes.

Methods Twenty-one patients with Type2 diabetes treated with oral glucose-lowering agents were randomized in this two-period crossover study to an equivalent 24-h dose of continuous subcutaneous infusion of insulin aspart and subsequently once-daily bedtime subcutaneous injection of insulin glargine, or vice versa, for eight consecutive days. Plasma profiles of insulin and glucose were recorded.

Results On the last day of each treatment period, the area under the curve (AUC) for glucose was 10% lower on the continuous subcutaneous infusion regimen compared with the insulin injection regimen (P=0.002). This was accomplished by a flat exogenous insulin infusion profile compared with a peaking profile with injected insulin (AUC was 74% higher after injection compared with pre-injection levels (P=0.001)). During the last 6days in each treatment period, the intra-subject variability of exogenous fasting insulin levels in the mornings was 41% lower during insulin infusion compared with insulin injection (P=0.012). The corresponding intra-subject variability for fasting glucose only showed a tendency to be lower during infusion as compared to the injection regimen (28%; P=0.104). Thirteen symptomatic-only or minor hypoglycaemic episodes were recorded during the entire infusion period compared with three episodes during the injection period.

Conclusions Basal continuous subcutaneous infusion of a rapid-acting insulin analogue improved plasma insulin (more flat insulin profile with a lower variability) and glucose (lower AUC) profiles compared with once-daily subcutaneous injection of a long-acting insulin analogue in Type2 diabetes.

  E-M. Dalsgaard , T. Lauritzen , T. Christiansen , K. S. Mai , K. Borch-Johnsen and A. Sandbaek
 

Aims The prevalence of diabetes is increasing, and screening of high-risk populations is recommended. A low attendance rate has been observed in many Type 2 diabetes screening programmes, so that an analysis of factors related to attendance is therefore relevant. This paper analyses the association between socioeconomic factors and attendance for Type 2 diabetes screening.

Methods Persons aged 40–69 years (n = 4603) were invited to participate in a stepwise diabetes screening programme performed in general practitioners' offices in the county of Aarhus, Denmark in 2001. The study was population-based and cross-sectional with follow-up. The association between screening attendance in the high-risk population and socioeconomic factors was analysed by odds ratio.

Results Forty-four percent of the estimated high-risk population attended the screening programme. In those with known risk for Type 2 diabetes, attenders were more likely to be older, to be unemployed and to live in the countryside than non-attenders. The risk for Type 2 diabetes was unknown for 21% of the study population; this group was younger and less likely to be cohabitant, skilled, or employed and to have middle or high income than the study population with known risk score for diabetes.

Conclusions A low attendance rate was found in this screening programme for Type 2 diabetes. No substantial socioeconomic difference was found between attenders and non-attenders in the high-risk population. Further research is needed to uncover barriers to screening of Type 2 diabetes in socioeconomically deprived persons.

  C. A. Ihlo , T. Lauritzen , J. Sturis , O. Skyggebjerg , J. S. Christiansen and T. Laursen
  Aims To study the pharmacokinetics and pharmacodynamics of three different modes of insulin infusion delivered by means of an insulin pump: subcutaneous bolus insulin injection once an hour, continuous subcutaneous insulin infusion and continuous intravenous insulin infusion. Methods In random order, ten patients with Type 1 diabetes mellitus received insulin aspart with subcutaneous bolus insulin injection, continuous subcutaneous insulin infusion and continuous intravenous insulin infusion. The insulin aspart doses were individualized. Results A non-random, sinus-like variation of serum insulin aspart over time was found with subcutaneous bolus insulin injection compared with continuous subcutaneous insulin infusion and continuous intravenous insulin infusion (P < 0.0001). Random variation of serum insulin aspart over time was significantly higher with continuous intravenous insulin infusion compared with subcutaneous bolus insulin injection (P = 0.023) and continuous subcutaneous insulin infusion (P = 0.013). Mean serum insulin aspart did not differ significantly between subcutaneous bolus insulin injection, continuous subcutaneous insulin infusion and continuous intravenous insulin infusion (P = 0.17). Thus, absolute bioavailability was near 100% for both subcutaneous bolus insulin injection and continuous subcutaneous insulin infusion. Statistically significant differences were seen in mean plasma glucose and mean glucose infusion rate, with the highest mean plasma glucose and the lowest mean glucose infusion rate with continuous intravenous insulin infusion, suggesting a slightly lower bioefficacy of continuous intravenous insulin infusion compared with subcutaneous bolus insulin injection and continuous subcutaneous insulin infusion. Conclusions Small but statistically significant differences in pharmacokinetics and pharmacodynamics between subcutaneous bolus insulin injection, continuous subcutaneous insulin infusion and continuous intravenous insulin infusion were observed. However, no major clinically relevant differences were found, suggesting that, for a basal subcutaneous insulin aspart pump therapy, relatively infrequent pump stroke frequency may suffice.
  T. L. Guldberg , P. Vedsted , J. K. Kristensen and T. Lauritzen
  Aims: To evaluate the effect of an electronic feedback system to general practitioners on quality of Type 2 diabetes care. Methods: A cluster randomized, controlled trial with 15 months follow-up. Eighty-six general practices (158 general practioners) in a Danish county caring for 2458 people 40–70 years old with Type 2 diabetes were randomized to receive or not to receive electronic feedback on quality of care. People with Type 2 diabetes were identified using a validated algorithm. Primary end-points were processes of care according to guidelines on prescriptions redeemed for Type 2 diabetes treatments, measuring of glycated haemoglobin and cholesterol and visits to ophthalmologists. Secondary end-points were changes in level of glycated haemoglobin and serum cholesterol. Data were analysed using generalized linear models accounting for clustering at practice level. Results: During follow-up, people with Type 2 diabetes in the intervention group more often redeemed recommended prescriptions than people in the control group, respectively, as follows: oral antidiabetic treatment (32.8 vs. 12.0%, P = 0.002), insulin treatment (33.8 vs. 12.4%, P < 0.001), lipid-lowering medication (38.3 vs. 18.6%, P = 0.004) and blood pressure medication (27.6 vs. 16.3%, P = 0.026). There were no differences in mean glycated haemoglobin and serum cholesterol between the two groups. Conclusions: Electronic feedback to general practitioners on the quality of Type 2 diabetes care resulted in significantly improved quality regarding processes of care according to guidelines. It was not possible to demonstrate any effect on secondary end-point measures within the follow-up period. Electronic feedback on quality of diabetes care can be effective in improving adherence to treatment according to evidence-based guidelines.
  M. van den Donk , A. Sandbaek , K. Borch-Johnsen , T. Lauritzen , R. K. Simmons , N. J. Wareham , S. J. Griffin , M. J. Davies , K. Khunti and G. E. H. M. Rutten
  Aims  To describe and compare attendance rates and the proportions of people identified with Type 2 diabetes mellitus in people with previously unknown diabetes who participated in screening programmes undertaken in general practice in the UK, Denmark and the Netherlands as part of the ADDITION-Europe study.

Methods  In Cambridge, routine computer data searches were conducted to identify individuals aged 40-69 years at high risk of Type 2 diabetes using the Cambridge Diabetes Risk Score. In Denmark, the Danish Diabetes Risk Score was mailed to individuals aged 40-69 years, or completed by patients visiting their general practitice. In the Netherlands, the Hoorn Symptom Risk Questionnaire was mailed to individuals aged 50-69 years. In these three centres, high-risk individuals were invited to attend subsequent steps in the screening programme, including random blood glucose, HbA1c, fasting blood glucose and/or oral glucose tolerance test. In Leicester, eligible people aged 40-69 years were invited directly for an oral glucose tolerance test. In all centres, Type 2 diabetes was defined according to World Health Organization 1999 diagnostic criteria.

Results  Attendance rates ranged from 20.2% (oral glucose tolerance test in Leicester without pre-stratification) to 95.1% (random blood glucose in opportunistic screening in Denmark in high-risk people). The percentage of people with newly detected Type 2 diabetes from the target population ranged from 0.33% (Leicester) to 1.09% (the Netherlands).

Conclusions  Screening for Type 2 diabetes was acceptable and feasible, but relatively few participants were diagnosed in all participating centres. Different strategies may be required to increase initial attendance and ensure completion of screening programmes.

  J. A. Black , S. J. Sharp , N. J. Wareham , A. Sandbaek , G. E. H. M. Rutten , T. Lauritzen , K. Khunti , M. J. Davies , K. Borch-Johnsen , S. J. Griffin and R. K. Simmons
 

Aims

Little is known about the long-term effects of intensive multifactorial treatment early in the diabetes disease trajectory. In the absence of long-term data on hard outcomes, we described change in 10-year modelled cardiovascular risk in the 5 years following diagnosis, and quantified the impact of intensive treatment on 10-year modelled cardiovascular risk at 5 years.

Methods

In a pragmatic, cluster-randomized, parallel-group trial in Denmark, the Netherlands and the UK, 3057 people with screen-detected Type 2 diabetes were randomized by general practice to receive (1) routine care of diabetes according to national guidelines (1379 patients) or (2) intensive multifactorial target-driven management (1678 patients). Ten-year modelled cardiovascular disease risk was calculated at baseline and 5 years using the UK Prospective Diabetes Study Risk Engine (version 3β).

Results

Among 2101 individuals with complete data at follow up (73.4%), 10-year modelled cardiovascular disease risk was 27.3% (sd 13.9) at baseline and 21.3% (sd 13.8) at 5-year follow-up (intensive treatment group difference -6.9, sd 9.0; routine care group difference -5.0, sd 12.2). Modelled 10-year cardiovascular disease risk was lower in the intensive treatment group compared with the routine care group at 5 years, after adjustment for baseline cardiovascular disease risk and clustering (-2.0; 95% CI -3.1 to -0.9).

Conclusions

Despite increasing age and diabetes duration, there was a decline in modelled cardiovascular disease risk in the 5 years following diagnosis. Compared with routine care, 10-year modelled cardiovascular disease risk was lower in the intensive treatment group at 5 years. Our results suggest that patients benefit from intensive treatment early in the diabetes disease trajectory, where the rate of cardiovascular disease risk progression may be slowed.

  H. T. Maindal , A. H. Carlsen , T. Lauritzen , A. Sandbaek and R. K. Simmons
 

Aim

To assess whether a 12-week participant-driven health education programme offered to individuals with screening-detected hyperglycaemia in Danish primary care would lead to improvements in cardiovascular risk factors, health behaviour and patient-reported outcomes after 3 years.

Methods

We conducted a randomized controlled trial in 509 patients with screening-detected hyperglycaemia (impaired fasting glucose, impaired glucose tolerance or Type 2 diabetes) from 33 general practices in Denmark. Individuals were pre-randomized to receive (i) routine care (n = 187), or (ii) an invitation to participate in the Ready to Act health education programme (n = 322). The programme was delivered over 12 weeks in primary care and focused on motivation, action experience, informed decision-making and social involvement to promote health behaviour change. The primary outcome was 10-year modelled cardiovascular risk.

Results

Of 322 individuals, 123 (38%) received the intervention and 436/509 individuals (86%) returned for follow-up assessment. There was no difference between the trial groups in modelled cardiovascular risk at 3 years (relative difference: 1.01; 95% CI: 0.84 to 1.23). Total cholesterol was lower (−0.24mmol/l, 95% CI: −0.45 to −0.03, P = 0.027), and patient activation was higher in the intervention than in the control group (5.3, 95% CI: 0.97 to 9.7). No other between-group differences were observed for any cardiovascular risk factor, health behaviour or patient-reported outcome variables. Subgroup analyses suggested that the intervention was more beneficial in those with impaired fasting glucose/impaired glucose tolerance than in those with Type 2 diabetes.

Conclusion

For patients with screening-detected hyperglycaemia, a participant-driven health education programme was not associated with improvements in most clinical, behavioural and patient-reported outcomes after 3 years of follow-up.

  B. Guigas , J. E. de Leeuw van Weenen , N. van Leeuwen , A. M. Simonis-Bik , T. W. van Haeften , G. Nijpels , J. J. Houwing-Duistermaat , M. Beekman , J. Deelen , L. M. Havekes , B. W. J. H. Penninx , N. Vogelzangs , E. van t Riet , A. Dehghan , A. Hofman , J. C. Witteman , A. G. Uitterlinden , N. Grarup , T. Jorgensen , D. R. Witte , T. Lauritzen , T. Hansen , O. Pedersen , J. Hottenga , J. A. Romijn , M. Diamant , M. H. H. Kramer , R. J. Heine , G. Willemsen , J. M. Dekker , E. M. Eekhoff , H. Pijl , E. J. de Geus , P. E. Slagboom and L. M. t Hart
 

Aims

Modulation of dopamine receptor D2 (DRD2) activity affects insulin secretion in both rodents and isolated pancreatic β-cells. We hypothesized that single nucleotide polymorphisms in the DRD2/ANKK1 locus may affect susceptibility to Type 2 diabetes in humans.

Methods

Four potentially functional variants in the coding region of the DRD2/ANKK1 locus (rs1079597, rs6275, rs6277, rs1800497) were genotyped and analysed for Type 2 diabetes susceptibility in up to 25 000 people (8148 with Type 2 diabetes and 17687 control subjects) from two large independent Dutch cohorts and one Danish cohort. In addition, 340 Dutch subjects underwent a 2-h hyperglycaemic clamp to investigate insulin secretion. Since sexual dimorphic associations related to DRD2 polymorphisms have been previously reported, we also performed a gender-stratified analysis.

Results

rs1800497 at the DRD2/ANKK1 locus was associated with a significantly increased risk for Type 2 diabetes in women (odds ratio 1.14 (1.06-1.23); = 4.1*10−4) but not in men (odds ratio 1.00 (95% CI 0.93-1.07); = 0.92) or the combined group. Although rs1800497 was not associated with insulin secretion, we did find another single nucleotide polymorphism in this locus, rs6275, to be associated with increased first-phase glucose-stimulated insulin secretion in women (= 5.5*10−4) but again not in men (= 0.34).

Conclusion

The present data identify DRD2/ANKK1 as a potential sex-specific Type 2 diabetes susceptibility gene.

 
 
 
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