Biomedical subjects

A Sandbaek

Publications and source records attributed to A Sandbaek.

14 recordsLinked to original sources

PubMed2006

Progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screening programme in general practice: the ADDITION Study, Denmark.

AIMS/HYPOTHESIS: To estimate the 1-year progression rates from both IFG and IGT to diabetes in individuals identified in a pragmatic diabetes screening programme in general practice (the ADDITION Study, Denmark [Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care]). METHODS: Persons aged 40-69 years were screened for type 2 diabetes based on a high-risk, stepwise strategy. At baseline, anthropometric measurements, blood samples and questionnaire data were collected. A total of 1,160 persons had IFG or IGT at baseline: 811 (70%) accepted re-examination after 1 year. Glucose tolerance classification was based on the 1999 WHO definition. At follow-up, diabetes was based on one diabetic glucose value of fasting blood glucose or 2-h blood glucose. RESULTS: At baseline, 308 persons had IFG and 503 had IGT. The incidence of diabetes was 17.6 and 18.8 per 100 person-years in the two groups, respectively. CONCLUSIONS/INTERPRETATION: IFG and IGT identified in general practice during a stepwise, high-risk screening programme for type 2 diabetes have high 1-year progression rates to diabetes. Consequently, intensive follow-up and intervention strategies are recommended for these high-risk individuals.

Adult↗

PubMed2005

The comparison of venous plasma glucose and whole blood capillary glucose in diagnoses of Type 2 diabetes: a population-based screening study.

AIM: To evaluate the degree of concordance between venous plasma glucose (PG) and capillary whole blood glucose (BG) in diagnosing Type 2 diabetes and to compare the prevalence of confirmed and unconfirmed Type 2 diabetes. METHODS: All 40- to 69-year olds without known diabetes listed with five general practices were invited for screening (2051 persons). People identified by screening as being at high risk for having diabetes (random BG (rBG) > or = 4.5 mmol/l or HbA1c > or = 5.9%) were examined using BG and PG. The main outcome measures were confirmed diabetes cases (one diabetic glucose value plus symptoms or two diabetic glucose values on two different days) and unconfirmed diabetes (one diabetic glucose value on the first day of testing). RESULTS: One thousand and twenty-eight (50%) accepted screening. Diabetes was confirmed by BG or PG in 22 patients (1.8%), and in 14 of these by both BG and PG. Four patients in whom diabetes was confirmed only by BG had unconfirmed diabetes by PG. Three of four people in whom diabetes was confirmed only by PG had unconfirmed diabetes according to BG. The prevalence of unconfirmed diabetes was 3.3% and the prevalence of confirmed diabetes 2.1%. CONCLUSION: Confirmed diabetes can be diagnosed by either BG or PG. BG seems more convenient than PG for use in general practice. The prevalence of confirmed diabetes was lower than the prevalence of unconfirmed diabetes.

Adult↗

PubMed2004

Population-based stepwise screening for unrecognised Type 2 diabetes is ineffective in general practice despite reliable algorithms.

AIMS/HYPOTHESIS: The yield of screening programmes for Type 2 diabetes in the existing healthcare setting might be lower than anticipated from tests of screening algorithms in data from epidemiological surveys. Our aims were to evaluate the reliability of the algorithms and the effectiveness of a proposed stepwise screening programme for Type 2 diabetes in general practice. METHODS: The screening programme had four steps: (i) mail-distributed self-administered risk-chart; (ii) screening tests: random blood glucose (RBG) and HbA(1)c; (iii) diagnostic procedure 1 for fasting blood glucose (FBG) (if RBG >/=5.5 mmol/l or HbA(1)c >/=6.1%); and (iv) OGTT as diagnostic procedure 2 (if 5.6</=FBG<6.1 mmol/l or HbA(1)c >/=6.1%). Abnormalities of glucose metabolism were classified according to the WHO 1999 criteria, based on capillary whole blood. The subjects were all patients between 40 and 69 years of age ( n=60,926) who were registered in 88 general practices and had not been previously diagnosed with diabetes. RESULTS: A total of 11,263 individuals had a high-risk risk-score and attended the screening consultation (step 1 test-positive). Of these, 30.1% needed diagnostic tests (step 2 test-positive) and 27.2% of these needed an OGTT (step 3 test-positive). The test-positive proportions were equal to the proportions obtained in data from a population-based survey from Step 2 onwards, and the algorithms were thus reliable. The identification rate was only 19% of all prevalent undiagnosed diabetes according to a recently published prevalence estimate. This was due to a large dropout rate among high-risk individuals prior to entry into the programme. CONCLUSIONS/INTERPRETATION: Population-based mail-distributed stepwise screening for Type 2 diabetes in general practice is ineffective, despite reliable screening algorithms, primarily because many high-risk individuals fail to participate.

Adult↗

PubMed2003

Screening for Type 2 diabetes--should it be now?

AIMS: Screening for Type 2 diabetes has been recommended in several countries due to the increasing prevalence of diabetes. This review evaluates whether Type 2 diabetes is a disease that fulfils the criteria for screening set by the World Health Organization. METHODS: Literature search was performed on the literature bases MedLine, Pub Medical, NIDDK, Cochrane Library and CINAHL using the MeSH terms 'non-insulin-dependent-diabetes-mellitus' and mass screening. Using this strategy we identified studies specifically evaluating screening strategies and diagnostic tests for Type 2 diabetes. The evaluation of psychosocial consequences included studies related to other chronic diseases. This literature was used to evaluate whether the WHO criteria for screening were fulfilled. RESULTS: The papers were reviewed but a meta-analysis was not possible, as no randomized controlled clinical trials were performed in the area of screening. CONCLUSION: Type 2 diabetes does not fulfil the criteria for population-based mass screening. No screening and intervention studies have been performed, systematically evaluating the positive and negative effects of screening. Furthermore, intervention studies up until now have been restricted to clinically diagnosed patients with diabetes, and most of these have recruited patients with long diabetes duration and early complications. These groups will have a worse prognosis and thus probably show greater benefits of such intervention. Finally, the psychosocial and health economic consequences of screening and intervention for Type 2 diabetes are largely unknown. Thus, systematic screening and intervention trials should be encouraged, and meanwhile intensified case finding and opportunistic screening in high-risk groups should be performed.

Cost-Benefit Analysis↗

PubMed2003

Comparability of venous and capillary glucose measurements in blood.

AIM: Diabetes and glucose intolerance are diagnosed by measurement of glucose in blood. Glucose is usually measured as venous plasma or capillary whole blood and diagnostic criteria frequently provide equivalence estimates for these two methods. This study examined the relationship between glucose measured in capillary and venous samples collected at random, fasting and 2 h after oral glucose. METHODS: Simultaneous measurements of venous plasma and capillary blood glucose were performed on random samples in 609 people, fasting samples in 685 people, and 2 h after oral glucose samples in 463 people. Separate capillary and venous samples were collected each time. A variance component model was used to construct conversion algorithms between venous and capillary results. RESULTS: The relationship between venous and capillary glucose values varied, with venous plasma being higher than capillary blood for random and fasting samples but lower for sampling 2 h after oral glucose. Discrepancies were observed between measured capillary blood values and the published WHO capillary blood equivalence values for venous plasma values for all except a fasting venous value of 7.0 mmol/l. For example, for a fasting venous plasma glucose of 6.1 mmol/l the WHO equivalent value is 5.6 mmol/l, while the measured value was 5.2 mmol/l, and for a 2-h venous plasma glucose of 11.1 mmol/l the WHO value is 11.1 mmol/l, while the measured result was 11.7 mmol/l. CONCLUSIONS: These results highlight the difficulty in equating glucose levels from one sampling and measuring procedure to another, and raise uncertainties about current published equivalence values which could lead to misclassifications in glucose tolerance status.

Analysis of Variance↗

PubMed2001

HbAlc in an unselected population of 4438 people with type 2 diabetes in a Danish county.

OBJECTIVE: To describe the use and level of HbA1c in a large unselected Type 2 diabetic population in Denmark. In addition, to describe the characteristics of the patients and the general practitioners in relation to the monitoring of HbA1c. DESIGN: Data were collected from public data files for the period January 1993 to December 1997. SETTING: The County of Vejle with a background population of 342,597 citizens, 303,250 of whom were listed with participating general practitioners. PATIENTS: The Type 2 diabetic population alive and resident in the county on 1 January 1997. RESULTS: In a population of 4438 Type 2 diabetics, 73% had a minimum of one annual HbA1c measurement in 1997. No HbA1c measurement was associated with a long history of diabetes, diet treatment or old age. Poor glycaemic regulation was found in 65% of the Type 2 diabetics in 1997. Poor glycaemic regulation was associated with tablet or insulin treatment, age under 70 years and long history of diabetes. The interpractice variation was huge. CONCLUSION: The quality of HbA1c monitoring of Type 2 diabetics needs to be improved. Possibilities for improvement seem to be present.

Aged↗

PubMed2001

Use and validation of public data files for identification of the diabetic population in a Danish county.

INTRODUCTION: This study aims to describe the process of identifying people known to have diabetes through public data files, to validate this method, and to describe models for optimization of such identification processes. PATIENTS AND METHODS: In a study population of 303,250 citizens, the diabetics were identified by combining information from public data files with information from general practitioners. Data validity was checked by comparing the results of data searches in public data files against information from general practitioners and a random sample of diabetics. Two models were defined to optimize the use of public data files for identification of diabetics. In model A the minimum number of parameters needed to obtain a sensitivity as high as possible was identified. In model B the optimal combination of parameters needed to obtain a high positive predictive value combined with a high sensitivity was identified. RESULTS: A total of 5449 diabetics were identified. Of those 4438 (81%) were classified as Type 2 diabetics and 1011 (19%) were classified as Type 1 diabetics. The data validation revealed that one person was misclassified as a diabetic and 93 persons were misclassified as non-diabetics. In model A the identification parameters included: "prescription", "HbA1c", "chiropodist service" and "glucose service". In model B the optimal combination of parameters was identified as: minimum two HbA1c measurements, minimum one visit to a chiropodist, minimum one prescription or minimum one abnormal HbA1c during one year. CONCLUSION: Public data files are suitable for identification of both Type 1 and Type 2 diabetics. Models have been developed to identify diabetics and to promote the possibilities of long-term follow-up and quality assessment in an unselected diabetic population in a region.

Adult↗

PubMed2000

Adaptation of the Diabetes Health Profile (DHP-1) for use with patients with Type 2 diabetes mellitus: psychometric evaluation and cross-cultural comparison.

AIMS: To adapt the Diabetes Health Profile (DHP-1) for use with English speaking patients with Type 2 diabetes mellitus and to evaluate the psychometric properties of the adapted measure in a UK and Danish sample of insulin, tablet and diet-treated patients with Type 2 diabetes. METHODS: Following linguistic adaptation using the forward-backward translation procedure, the 32-item DHP-1 was sent to 650 and 800 consecutively selected UK and Danish patients with Type 2 diabetes. Construct validity was assessed using principal axis factoring. Factor stability was assessed across language groups using the coefficient of congruence. Reliability was evaluated using Cronbach's alpha and multi-trait analysis, including item convergent/discriminant validity. Subscale discriminant validity was assessed through known groups with one-way ANOVA and post hoc Scheffe tests for multiple comparisons. RESULTS: Eighteen items (56.25%) were retained following initial item analysis. A three-factor solution accounting for 45.6% and 40.3% of the total explained variance was identified in the UK and Danish samples, respectively. Factors were interpreted as psychological distress (PD), barriers to activity (BA) and disinhibited eating (DE). Factor congruence between language groups ranged from 0.98 to 0.99 and Cronbach's alpha ranged between 0.70 and 0.88. Item scaling success for both language versions was 88.9%. BA scores discriminated between treatment groups in both language groups (F = 24.24, P < 0.001; F = 7.68, P < 0.001) and PD scores in the UK sample (F = 20.97, P < 0.001). CONCLUSIONS: The DHP-18 developed for use with patients with Type 2 diabetes has been shown to have satisfactory internal reliability and validity and measurement equivalence across language groups.

Affect↗

PubMed1999

Randomized controlled trial of the effect of medical audit on AIDS prevention in general practice.

OBJECTIVE: We aimed to evaluate the effect of a medical audit on AIDS prevention in general practice. METHODS: We conducted a prospective randomized controlled study performed as 'lagged intervention'. At the time of comparison, the intervention group had completed 6 months of audit including a primary activity registration, feedback of own data and a meeting with colleagues and experts, and had received brief summaries of the meetings and reminders about the project (a full 'audit circle'). The participants were from general practices in Copenhagen and the Counties of Funen and Vejle, Denmark. One hundred and thirty-three GPs completed the project. The main outcome measures were the number of consultations involving AIDS prevention and the number of talks about AIDS initiated by the GP, and some elements of the content were registered on a chart. RESULTS: No statistically significant difference was observed in the frequency of consultations involving AIDS prevention between the intervention group (1.2% of consultations) and the control group (1.4%). Furthermore, no significant differences were observed regarding the content of these consultations or regarding the fraction of such consultations initiated by the GPs. CONCLUSIONS: Medical audit had no observed effect on AIDS prevention in general practice.

Acquired Immunodeficiency Syndrome↗

PubMed1998

[The effect of a reference program and a media campaign on the prevention of AIDS in general practice].

The objective of the study was to evaluate the effect of a reference programme and a mass media campaign about prevention of HIV. A "before-after" study including three measurements was carried out. Before, immediately after, and six months after the intervention the GPs completed questionnaires, and prospectively registered consultations involving the prevention of HIV. Immediately after the intervention the median number of consultations dealing with HIV was significantly higher (three as compared to two during ten working days). The rise in activity was due to a higher number of consultations initiated by the patients. The conclusion was that the reference programme did not cause a significant change in the GPs' behaviour. However, the mass media campaign resulted in a temporary increase in the number of patients who took the initiative to talk about HIV with their GPs.

Acquired Immunodeficiency Syndrome↗

PubMed1998

[Role of Danish general practitioners in the prevention of AIDS].

The study describes Danish general practitioners' perception of their own role and their actual behaviour in the prevention of HIV/AIDS. Data collection was carried out by questionnaire and prospective registration of consultations dealing with HIV/AIDS during a two-week period. The results showed that most of the GPs (94%) were of the opinion that GPs should play a central part in the prevention of HIV, and 90% thought that the GP should take the initiative to talk about HIV. The median number of consultations dealing with HIV was two during ten working days (range 0-18), and more than half the GPs (56%) had not themselves initiated a conversation concerning the problem. The conclusion of the study is that there was discrepancy between the GPs' vision of their role in HIV prevention and activities in practice. It is recommended that initiatives are taken to strengthen the GPs' role in AIDS prevention.

Acquired Immunodeficiency Syndrome↗

PubMed1995

[Medical audit in laboratory medicine. A description of the course and some results].

All general practitioners of the Danish counties of Funen, Vejle and North Jutland were invited to participate in a medical audit concerning laboratory medicine organised by the Audit Project Odense (APO) in co-operation with the Consultative Arrangement for General Practice, emanating from the clinical/chemical departments of Funen. During three weeks the participants registered all clinical problems which would result in one or more laboratory tests. APO performed computer registrations and analyses of the results where upon each participant received a reply letter indicating the results of his own as well as the group's registrations. At a subsequent meeting the participants discussed the conception of "good general practice" as regards the use of laboratory medicine within defined clinical problems. The course of the audit demonstrated that the APO method is suitable for identification of a number of professional problems related to general practitioners' use of laboratory medicine and to reveal the variation in general practitioners' handling of laboratory medicine. Furthermore, the project showed that continuous quality development demands profound study of and research into the professional problems which the general practitioners encounter when using laboratory medicine.

Denmark↗

PubMed1995

Role of Danish general practitioners in AIDS prevention.

OBJECTIVE: To describe Danish general practitioners' perception of their own role and to register their actual behaviour in the prevention of HIV/AIDS. DESIGN: Data collection was carried out by a) questionnaire and b) prospective registration of consultations dealing with HIV/AIDS in a two-week period in September 1992. SETTING: General practice, Denmark. SUBJECTS: One thousand general practitioners (GPs), selected at random, were asked to participate. The study population comprised 352 GPs who returned the questionnaire and participated in the prospective registration. RESULTS: Most of the GPs (94%) were of the opinion that GPs should play a central part in the prevention of HIV; 96% found that their knowledge was sufficient to advise on the prevention of HIV, and 90% thought that the GP should take the initiative to talk about HIV. The median number of consultations dealing with HIV was two during ten working days (range 0-18), and more than half the GPs (56%) had not themselves initiated a conversation concerning the problem. CONCLUSION: There was discrepancy between the GPs' vision of their role in HIV prevention and the activities in practice. It is recommended that initiatives are taken to strengthen the GPs' role in AIDS prevention.

Acquired Immunodeficiency Syndrome↗

PubMed1990

[Recurrent abdominal pain in schoolchildren 9-12 years of age].

The frequency of recurrent abdominal pain (RAP) was investigated in a material of 664 Danish schoolchildren. 15% of the children aged 9-12 years had RAP, defined as at least three episodes of abdominal pain during a period of three months with pain of an intensity which affected the behavior of the child. In general, there was no significant difference in the frequency of RAP in boys and girls in the material, however, a preponderance of girls with RAP after the age of ten years was found. The investigation showed that symptoms such as headache, limb pains and diarrhoea were experienced more frequently among children with RAP. In general, RAP occurred more frequently among children in families with high frequencies of psychosomatic symptoms. 40% of all the children questioned lived in broken homes. A tendency to increased frequency of RAP was found among these children. Children who lived in a garden city had essentially lower frequencies of RAP than children from other areas. There was an evident preponderance of children with RAP in families who lived in flats. There was no significant difference in the school and occupational education of the parents and the frequency of RAP.

Abdominal Pain↗