Development of metabolic syndrome components in adults with a healthy obese phenotype: a 3-year follow-up.

OBJECTIVE: There is a lack of data on the progression from a healthy obese phenotype toward an unhealthy obese phenotype and the development of metabolic syndrome (MetS). Our aim was to assess the development of MetS 3 years after screening in centrally obese individuals with a healthy obese phenotype and to evaluate the usefulness of repeated screening. DESIGN AND METHODS: Eighty-eight individuals (mean age 47 years, 88% female) with central obesity as their only MetS component (ATP III criteria) at baseline screening were re-evaluated for MetS status after 3 years. RESULTS: At follow-up, the cardiometabolic risk profile in centrally obese individuals with a healthy phenotype showed a tendency toward deterioration. Thirty-two percent developed at least one additional MetS component, 7% had developed MetS. Nobody had developed type 2 diabetes. An increased triglyceride level (n = 16) and an increased blood pressure (n = 18) were the components most often present at follow-up. The people developing additional MetS components had a lower education level compared with the group that preserved the healthy centrally obese phenotype (80 vs. 71% lower educated, P = 0.35). They also had slightly worse baseline levels of the risk factors. CONCLUSION: The number of centrally obese individuals developing an unhealthy phenotype in this relatively short follow-up period emphasizes the need for a regular surveillance of cardiometabolic parameters in centrally obese individuals. However, it is questionable whether a repeated screening for type 2 diabetes every 3 years, as recommended by the American Diabetes Association, in this category of patients is appropriate.

Preferences and opinions of patients with Type 2 diabetes on education and self-care: a cross-sectional survey.

OBJECTIVE: To assess the preferences of patients with Type 2 diabetes regarding self-care activities and diabetes education. RESEARCH DESIGN AND METHODS: Questionnaire survey carried out in general practices and outpatient clinics across the Netherlands. OUTCOMES: preferred setting for education, preferred educator, and preferred and most burdensome self-care activity. Multinomial logistic regression analysis assessed associations between outcomes and patient characteristics, preferences and opinions. RESULTS: Data of 994 consecutive individuals were analysed (mean 65 years; 54% male; 97% Caucasian; 21% low education level; 80% primary care). Of these, 19% thought they had poor to average glycaemic control, 61% thought they were over-weight and 32% thought they took too little exercise. Eighty per cent of respondents preferred diabetes education during regular diabetes check-ups. Patients taking insulin preferred education to be given by nurses [odds ratio (OR) 2.45; 95% confidence interval (CI) 1.21-4.96]. Individuals who thought their health to be poor/average preferred education to be given by doctors (OR 1.65; 95% CI 1.08-2.53). Physical exercise was the preferred self-care activity of those who thought they took too little exercise (OR 1.97; 95% CI 1.32-2.93) but was preferred less by patients with mobility problems (OR 0.65; 95% CI 0.43-0.97). Patients with eating disinhibition reported keeping to a healthy diet (OR 4.63; 3.00-7.16) and taking medication (OR 1.66; 95% CI 1.09-2.52) as the most burdensome self-care activities. Age was not an independent determinant of any preference. CONCLUSIONS: When providing education for patients with newly diagnosed Type 2 diabetes, healthcare providers should consider making a tailored education plan, irrespective of the patient's age.

Incidence and antibiotic prescription rates for common infections in patients with diabetes in primary care over the years 1995 to 2003.

OBJECTIVE: To assess changes in incidence and in antibiotic prescription rates for infections of the lower respiratory tract (LRTI) and urinary tract (UTI) in patients with diabetes (DM) over the years 1995 to 2003. METHODS: This was a retrospective cohort study as part of the University Medical Center Utrecht General Practitioners Research Network. We included patients with DM aged > or = 45 years. We assessed incidence and antibiotic prescription rates for LRTI and UTI. Incidence rates were calculated as episodes per 1000 person-years. Antibiotic prescription rates were calculated per 100 episodes of LRTI and UTI. RESULTS: The study population increased over the years 1995 to 2003. The male-to-female ratio and mean age of the study population remained constant over these years. The incidence rate for LRTI remained stable (13%; p=0.442), and for UTI the incidence rate increased by 40% (p=0.037). Antibiotic prescription rates increased in LRTI by 60% (p<0.001) and in cystitis by 15% (p=0.029). CONCLUSIONS: Incidence rates for UTI and antibiotic prescription rates for LRTI in diabetes have increased over the years 1995 to 2003. In particular, attention should be paid to the increasing use of antibiotics in DM patients with LRTI.

Low yield of population-based screening for Type 2 diabetes in the Netherlands: the ADDITION Netherlands study.

BACKGROUND: About 10 years ago, it was estimated that half of all people with diabetes were unrecognized. Since then, according to the national guidelines, case finding for diabetes in general practice has become common in the Netherlands, resulting in a substantial increase of the prevalence of known diabetes. Nevertheless, the need for population-based screening is advocated, especially by the national federation of diabetes patients. OBJECTIVE: To evaluate the efficiency of population-based screening for Type 2 diabetes. METHODS: From 2002 to 2004, we performed a four-step screening procedure [questionnaire, random glucose measurement, fasting glucose measurement and oral glucose tolerance test (OGTT)] and a three-step procedure (without random glucose measurement) in 79 general practices in the southwestern region of the Netherlands. RESULTS: A total of 56 978 non-diabetic subjects, aged 50-70 years, were asked to complete the questionnaire. Those with a score above threshold underwent further glucose testing. Eventually, 586 participants (1.0%) were diagnosed with Type 2 diabetes (in four-step procedure 285 subjects and in three-step procedure 301). Impaired glucose regulation was assessed in 1011 participants (1.8%). Dropout rate in the screening programme among participants who should undergo an OGTT was 23.4%. The risk score was higher if glucose metabolism was more disturbed. CONCLUSION: In the Netherlands, the yield of population-based screening is low. The dropout among high-risk individuals was high. Given the decreasing prevalence of undiagnosed diabetes and the possibility of opportunistic screening on a continuous basis, opportunistic screening for diabetes might be more appropriate than population-based screening. Further research on this topic is needed.

[Summary of the Dutch College of General Practitioners' "Gout" Standard]. / Samenvatting van de standaard 'Jicht' van het Nederlands Huisartsen Genootschap.

The typical form of acute gout can be clinically diagnosed. The term 'complicated gout' is used if there are more than three acute attacks of gout per year, tophi or urate stones in the urinary tracts. In the case of recurrent probable acute gout, a diagnostic fine needle aspirate from the joint during an attack is indicated. First choice treatment of acute gout consists of NSAIDs. Colchicine is the second choice treatment and the third choice treatment consists of corticosteroids. Excessive alcohol use should be limited. Treatment of chronic gout depends on the uric acid excretion in the 24-hour urine. If the level of excretion is too low, the first choice should be benzbromarone, and if the uric acid output is too high, allopurinol should be the treatment of first choice. Increased fluid intake is recommended; maintenance treatment with colchicine is not advised. Consultation with or referral to a rheumatologist is indicated in the case of doubt about the diagnosis of 'acute gout' or 'complicated gout', or (suspected) bacterial arthritis and insufficient treatment effect.