Gunstige cardiovasculaire effecten van liraglutide

LiraglutideNEJM

Recent zijn de resultaten van de eerste studie naar de cardiovasculaire benefits van behandeling met een GLP1RA gepresenteerd op het Amerikaanse Diabetes Congres, en gepubliceerd in het New England Journal of Medicine.

Een korte samenvatting van de studie:
The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown.
In a double-blind trial, randomly assigned patients with type 2 diabetes and high cardiovascular risk were to receive liraglutide or placebo. The primary composite outcome in the time-to-event analysis was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The primary hypothesis was that liraglutide would be noninferior to placebo with regard to the primary outcome, with a margin of 1.30 for the upper boundary of the 95% confidence interval of the hazard ratio. No adjustments for multiplicity were performed for the prespecified exploratory outcomes.
In the time-to-event analysis, the rate of the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke among patients with type 2 diabetes mellitus was lower with liraglutide than with placebo.

Lees het volledige artikel op: http://www.nejm.org/doi/full/10.1056/NEJMoa1603827#t=article

 

Bijniernet website steeds professioneler en completer

adrenalBijnierNET is een platform voor zorgaanbieders, patiënten, mantelzorgers en geïnteresseerden rondom de Bijnieraandoeningen: Bijnierschorsinsufficiëntie (Addison), Syndroom van Cushing, AGS, Primair Hyperaldosteronisme (Ziekte van Conn),  Feochromocytoom en Bijnierschorscarcinoom.

De zorg voor patiënten met zeldzame bijnieraandoeningen is van oudsher specialistisch, complex, kostbaar en arbeidsintensief. Er bestaat slechts beperkt inzicht in de organisatie, het proces en de uitkomsten van deze zorg. Teneinde de zorg voor deze bijzondere groep patiënten te verbeteren, hebben de participanten in het BijnierNET de mogelijkheden die een landelijke (digitale) community hiervoor met zich meebrengen nader uitgezocht. In het BijnierNET kunnen patiënten, zorgverleners en mantelzorgers elkaar (virtueel) ontmoeten, ervaringen uitwisselen en de kennis rond de zorg voor bijnierpatiënten – ook bij afnemend zorgaanbod – op een hoog peil behouden, mogelijk op een hoger peil brengen.

Door een betere verspreiding van de beschikbare kennis bij/van alle deelnemers kan goede zorg beschikbaar blijven.Deze inbreng van kennis kan mogelijk kostenbesparend gaan werken.

Link: www.bijniernet.nl

Promotie Margriet Sattler

margrietsattlerOp 27 mei jl is drs. G.A. (Margriet) Sattler gepromoveerd op het proefschrift: “The long-term side effects of postoperative radiation therapy in pituitary adenoma patients”

Voor meer gedetailleerde informatie, zie http://www.rug.nl/news-and-events/events/phd-ceremonies/?hfId=118185

Samenvatting van haar proefschrift / summary of her thesis:

“External beam radiation therapy radiation therapy in pituitary adenoma results in excellent local tumour control rates and improvements in excessive hormonal secretion. However, the safety of postoperative radiation therapy has been questioned in particular because of concerns related to possible long-term radiation-induced side effects, although serious late complications of radiation therapy are uncommon in pituitary adenoma patients. However, these concerns are often used to delay or reject radiation therapy.

The main aim of this thesis was to assess and compare several long-term side effects of conventional radiation therapy (i.e. incidence of second tumours, stroke, mortality, and radiological brain abnormalities, effects on cognition, and sexual function as aspect of quality of life) in pituitary adenoma patients treated with surgery and postoperative radiation therapy versus surgery alone and with a population without pituitary adenoma disease (i.e. the reference population).

None of our observational studies shows significant differences in long-term side-effects between pituitary adenoma patients treated with radiation therapy and surgery alone. However, the decision to treat with postoperative radiation therapy is based on a careful assessment of the balance of benefits and risks in the individual pituitary adenoma patient. The risk of serious radiation-induced long-term side effects is low with the radiation therapy techniques applied in the last decades and is expected to be lower with modern and more advanced radiation therapy techniques. Therefore, in most pituitary adenoma patients with otherwise uncontrolled disease, the benefits of postoperative radiation therapy outweighs the absolute small risk of serious side-effects.”

 

Role of immunology and advanced glycation endproducts – promotie Bart Groen

Role of immunology and advanced glycation end products

Promotie: Dhr. B. (Bart) Groen
Wanneer: 24 september 2014
Aanvang: 14:30
Promotors: prof. dr. T.P. Links, prof. dr. P.P. (Paul) van den Berg
Waar: Academiegebouw RUG
Faculteit: Medische Wetenschappen / UMCG

Zwangerschapscomplicaties bij diabetes door verstoorde afweer en stapeling van eiwitten

bartgroen-coverZwangere vrouwen met diabetes type 1 en 2 lopen minder kans op kinderen met aangeboren afwijkingen als hun glucosespiegel voor en tijdens de zwangerschap goed gereguleerd blijft. Ze houden echter nog steeds een verhoogde kans op complicaties tijdens de zwangerschap. Dat suggereert dat ook andere factoren betrokken zijn. UMCG-onderzoeker Bart Groen toont aan dat bij zwangere vrouwen met diabetes type 1 en 2 niet alleen de glucosespiegel verstoord is, maar ook de afweerreactie en de stapeling van versuikerde eiwitten (AGE’s) in de huid afwijken ten opzichte van gezonde zwangere vrouwen. Hij pleit voor de ontwikkeling van nieuwe behandelingen, gericht op de afweer, om zwangerschapscomplicaties bij diabetes type 1 en 2 te voorkomen. (meer…)

Role of circulating vascular progenitor cells in the development of macrovascular disease in diabetes

arkOn October 2, 2013, Joris van Ark, defended his thesis titled:

Role of circulating vascular progenitor cells in the development of macrovascular disease in diabetes.

Promotores were Prof. dr. J.L. Hillebrand and Prof. dr. B.H.R. Wolffenbuttel.

Joris  studied the role of vascular progenitor cells in diabetes. Cardiovascular diseases are the number one cause of death in industrialised countries. Macrovascular disease (MVD) contributes to this to a considerable extent. Type 2 diabetes is associated with a 2- to 4-fold increase in rates of MVD. The underlying causes of the accelerated progression of MVD in diabetes are incompletely understood. Therefore, new insights into the mechanisms behind the development of MVD are essential to develop effective therapies for the prevention and treatment of MVD in patients with diabetes. Circulating vascular progenitor cells (VPCs) contribute to the health and maintenance of blood vessels. Different types of VPCs are described which have different effects on the development of MVD. Endothelial progenitor cells (EPCs) and circulating angiogenic cells (CACs) inhibit the progression of MVD. On the other hand, smooth muscle progenitor cells (SMPCs) are able to stimulate the progression of MVD. In this thesis we investigated the role of circulating VPCs in the development of MVD in patients with type 2 diabetes. We demonstrate that the number of protective EPCs and CACs is decreased in the blood of diabetic patients. In contrast, the number of damaging SMPCs is slightly increased in these patients. Therefore, the balance between protective and damaging VPCs is disturbed in favour of the latter. This may contribute to the accelerated development of MVD in patients with diabetes. This makes VPCs a potential therapeutic target to inhibit the progression and prevent the complications of MVD in patients with type 2 diabetes.

Obesity and female infertility – promotie Walter Kuchenbecker

February 27, 2013, was the day of the thesis defense by dr. Walter K.H. Kuchenbecker. Title of his thesis was Obesity and female infertility.  Promotores were prof. J.A. Land and prof. B.H.R. Wolffenbuttel, co-promotores were dr. A. Hoek and dr. H. Groen .

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Obesity in women is associated with an increase in infertility and more pregnancy complications. The cost per live birth after fertility treatment is almost two-fold higher in women with obesity compared to women of normal weight.

Obesity related infertility and pregnancy complications are determined by body fat distribution. Accumulation of fat around the abdomen and especially accumulation of intra-abdominal fat are a risk factor for infertility and pregnancy complications. Ultrasound measurement of intra-abdominal fat is a reliable, cheap and accessible tool to study the effects of intra-abdominal fat on female reproduction. The measurement of serum adipokines, the secretory products of adipose tissue, does not adequately reflect body fat distribution parameters. Weight loss in obese and infertile women is associated with more spontaneous pregnancies and a decrease in pregnancy complications. In anovulatory women with polycystic ovary syndrome, loss of intra-abdominal fat is associated with resumption of ovulation. In structured lifestyle programmes many women who are obese and infertile show poor compliance and experience difficulty in losing weight, leading to high drop-out rates. Future studies should aim to identify risk factors for drop-out and design individualised lifestyle programmes in order to limit drop¬-out. Weight loss medication and bariatric surgery may be considered in women with severe obesity and infertility in order to achieve sufficient weight loss and limit the serious obesity related pregnancy complications. In view of the serious obesity related pregnancy complications, women with a BMI > 35 kg/m2 should not be offered fertility treatment.

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