[Preference policy for levothyroxine: switch between brands may lead to symptoms and extra costs]. / Werkt preferentiebeleid voor levothyroxinepreparaten?

A considerable percentage of the Dutch population has primary hypothyroidism and is therefore lifelong treated with levothyroxine. Recently, Dutch healthcare insurance companies made plans to change their reimbursement policies with regard to levothyroxine. This policy change implies that the healthcare insurer will only reimburse one specific brand of levothyroxine usually the most inexpensive brand with the aim of reducing healthcare costs. The more expensive brands will no longer be reimbursed, forcing patients to switch between brands. However, clinical experience and previous research reveal that substitution between levothyroxine brands can lead to symptoms both with and without changes of serum thyroxine levels. Do the advantages of levothyroxine substitution even outweigh the disadvantages?

[A gastric pacemaker in obese type 2 diabetic patients]. / Een maagpacemaker bij patiënten met obesitas en diabetes mellitus type 2.

The combination of obesity and type 2 diabetes mellitus forms a growing global epidemic. The primary treatment for patients with this combination of conditions is to advise them to adopt a healthier lifestyle, but only a few patients succeed in doing this. Patients with type 2 diabetes who have to switch to insulin treatment can experience negative consequences, such as weight gain and an increased risk of hypoglycaemia. An alternative treatment that does not have these adverse effects is a gastric pacemaker, which can be implanted via laparoscopy: the patients lose weight and show an improvement in glucose regulation. The gastric pacemaker uses non-excitatory stimulation to influence the amplitude of gastric contraction. It simultaneously stimulates afferent fibres of the vagal nerve to influence the cerebral satiation centre, which is involved in registration of satiety and in insulin secretion and resistance. A randomized trial on the effects of the gastric pacemaker in patients with obesity and type 2 diabetes mellitus is currently being conducted in the Atrium Medical Centre in Heerlen.

Similar adverse pregnancy outcome in native and nonnative dutch women with pregestational type 2 diabetes: a multicentre retrospective study.

Objective. To assess the incidence of adverse pregnancy outcome in native and nonnative Dutch women with pregestational type 2 diabetes (T2D) in a multicenter study in The Netherlands. Methods. Maternal characteristics and pregnancy outcome were retrospectively reviewed and the influence of ethnicity on outcome was evaluated using independent t-test, Mann-Whitney U-test, and chi-square test. Results. 272 pregnant women (80 native and 192 non-native Dutch) with pregestational T2D were included. Overall outcome was unfavourable, with a perinatal mortality of 4.8%, major congenital malformations of 6.3%, preeclampsia of 11%, preterm birth of 19%, birth weight >90th percentile of 32%, and a Caesarean section rate of 42%. In nonnative Dutch women, the glycemic control was slightly poorer and the gestational age at booking somewhat later as compared to native Dutch women. However, there were no differences in incidence of preeclampsia/HELLP, preterm birth, perinatal mortality, macrosomia, and congenital malformations between those two groups. Conclusions. A high incidence of adverse pregnancy outcomes was found in women with pregestational T2D, although the outcome was comparable between native and non-native Dutch women. This suggests that easy access to and adequate participation in the local health care systems contribute to these comparable outcomes, offsetting potential disadvantages in the non-native group.