N C Schaper

University of Copenhagen, Copenhagen, Capital Region, Denmark

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Publications (152)505.43 Total impact

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    ABSTRACT: http://www.biomedcentral.com/1471-2458/14/749/abstract (highly accessed) Health is associated with amount of daily physical activity. Recently, the identification of sedentary time as an independent factor, has gained interest. A valid and easy to use activity monitor is needed to objectively investigate the relationship between physical activity, sedentary time and health. We compared validity and reproducibility of physical activity measurement and posture identification of three activity monitors, as well as user friendliness.
    BMC Public Health 07/2014; 14(1):749. · 2.08 Impact Factor
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    ABSTRACT: The Maastricht Study is an extensive phenotyping study that focuses on the etiology of type 2 diabetes (T2DM), its classic complications, and its emerging comorbidities. The study uses state-of-the-art imaging techniques and extensive biobanking to determine health status in a population-based cohort of 10,000 individuals that is enriched with T2DM individuals. Enrollment started in November 2010 and is anticipated to last 5-7 years. The Maastricht Study is expected to become one of the most extensive phenotyping studies in both the general population and T2DM participants world-wide. The Maastricht study will specifically focus on possible mechanisms that may explain why T2DM accelerates the development and progression of classic complications, such as cardiovascular disease, retinopathy, neuropathy and nephropathy and of emerging comorbidities, such as cognitive decline, depression, and gastrointestinal, musculoskeletal and respiratory diseases. In addition, it will also examine the association of these variables with quality of life and use of health care resources. This paper describes the rationale, overall study design, recruitment strategy and methods of basic measurements, and gives an overview of all measurements that are performed within The Maastricht Study.
    European Journal of Epidemiology 04/2014; · 5.12 Impact Factor
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    ABSTRACT: Objective: Homozygous carriers of the apolipoprotein ε2 allele are at risk of type III hyperlipidemia, but do not necessarily develop this lipid disorder. In this study we investigated the role of circulating proprotein convertase subtilisin kexin type 9 (PCSK9), an important regulator of LDL receptor expression, in the development of this hyperlipidemic phenotype. Methods: In an observational study, plasma PCSK9 was measured in homozygous carriers of apolipoprotein ε2 (ε2/ε2; n=12), normal controls (n=72) and hypertriglyceridemic patients with familial combined hyperlipidemia (FCHL; n=38), who served as a hyperlipidemic reference group. Cholesterol, triglycerides and apolipoprotein B content in VLDL and LDL particles was determined by ultracentrifugation in ε2/ε2 and FCHL patients. Results: Median circulating PCSK9 levels did not differ between ε2/ε2 versus controls and hypertriglyceridemic FCHL patients (84.5 versus 82.0 and 84.9 ng/ml; p=0.2 and 0.6, respectively). Circulating PCSK9 was associated with total cholesterol and triglycerides levels in ε2/ε2 carriers (p<0.05). These associations were stronger in ε2/ε2 carriers when compared to controls (p for interaction = 0.01 and 0.02, respectively). A direct comparison with FCHL patients demonstrated a similar discrepancy for the association with plasma triglycerides and also VLDL apolipoprotein B, cholesterol and triglycerides (p for interaction = 0.01, 0.01, 0.03 and 0.03, respectively). Conclusions: plasma PCSK9 is associated with type III hyperlipidemia. Its strong relation with plasma triglycerides and total cholesterol distinguishes ε2/ε2 from controls and another type of dyslipidemia, which provides valuable information regarding the pathogenesis of this complex dyslipidemia. Furthermore, these results suggest that patients with type III hyperlipidemia may benefit from PCSK9 antagonizing therapy.
    Clinical Science 12/2013; · 4.86 Impact Factor
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    ABSTRACT: Objective Low health-related quality of life (HRQoL) has been consistently reported to be associated with poor prognosis for a variety of health outcomes in various settings. We aimed to evaluate whether HRQoL in patients presenting with new diabetic foot ulcers has prognostic significance for ulcer healing, major amputation and death.Research design and methodsWe followed 1088 patients with new diabetic foot ulcers presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale study, prospectively until healing (76.9%), major amputation (4.6%) or death (6.4%) up to a maximum of 1 year. At baseline, patient and ulcer characteristics were recorded as well as EQ-5D: a standardised instrument consisting of five domains and a VAS scale for use as a measure of HRQoL. The prognostic influence of the EQ-5D domains was evaluated in multivariable Cox regression analyses on the time-to-event data, adjusting for baseline clinical characteristics of the ulcer and co-morbidities.ResultsWhile predictive effects of HRQoL, adjusted for possible confounders, were absent for time to healing, decreased HRQoL especially in the physical domains were statistically significant for major amputation (Mobility, Self-Care, Usual Activities) and death (Self-care, Usual Activities, Pain/Discomfort).Conclusions Low HRQoL appears to be predictive for major amputation and death, but high HRQoL does not increase healing. Future studies into the influence of HRQoL on ulcer outcome are important in attempts to decrease treatment failure and mortality.
    Diabetes care 10/2013; · 7.74 Impact Factor
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    ABSTRACT: Higher plantar pressures play an important role in the development of plantar foot ulceration in diabetic polyneuropathy and earlier studies suggest that higher pressures under the forefoot may be related to a decrease in lower leg muscle strength. Therefore, in this randomised controlled trial we evaluated whether lower-extremity strength training can reduce plantar pressures in diabetic polyneuropathy. This study was embedded in an unblinded randomised controlled trial. Participants had diabetes and polyneuropathy and were randomly assigned to the intervention group (n = 48) receiving strength training during 24 weeks, or the control group (n = 46) receiving no intervention. Plantar pressures were measured in both groups at 0, 12, 24 and 52 weeks. A random intercept model was applied to evaluate the effects of the intervention on peak pressures and pressure--time-integrals, displacement of center-of-pressure and the forefoot to rearfoot pressure--time-integral-ratio. Plantar pressure patterns were not affected by the strength training. In both the intervention and control groups the peak pressure and the pressure--time-integral under the forefoot increased by 55.7 kPa (95% CI: 14.7, 96.8) and 2.0 kPa.s (95% CI: 0.9, 3.2) over 52 weeks, respectively. Both groups experienced a high number of drop-outs, mainly due to deterioration of health status and lower-extremity disabilities. Plantar pressures under the forefoot increase progressively over time in people with diabetic polyneuropathy, but in this study were not affected by strength training. Future intervention studies should take this increase of plantar pressure into account and alternative interventions should be developed to reduce the progressive lower extremity problems in these patients.Trial registrationThis study was embedded in a clinical trial with trial number NCT00759265.
    Journal of Foot and Ankle Research 10/2013; 6(1):41. · 1.47 Impact Factor
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    ABSTRACT: Increased forefoot loading in diabetic polyneuropathy plays an important role in the development of plantar foot ulcers and can originate from alterations in muscle strength, joint moments and gait pattern. The current study evaluated whether strength training can improve lower extremity joint moments and spatiotemporal gait characteristics in patients with diabetic polyneuropathy. An intervention group receiving strength training during 24 weeks and a control group receiving no intervention. Measurements were performed in both groups at t= 0, t= 12, t= 24 and t= 52 weeks at an individually preferred and standardized imposed gait velocity. The strength training did not affect the maximal amplitude of hip, knee and ankle joint moments, but did result in an increase in stance phase duration, stride time and stride length of approximately 5 %, during the imposed gait velocity. In addition, both groups increased their preferred gait velocity over one year. Future longitudinal studies should further explore the possible effects of strength training on spatiotemporal gait characteristics. The current study provides valuable information on changes in gait velocities and the progressive lower extremity problems in patients with polyneuropathy.
    Journal of applied biomechanics 09/2013; · 1.26 Impact Factor
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    ABSTRACT: The aim of this study was to identify the cascade of effects leading from alterations in force generation around the ankle joint to increased plantar pressures under the forefoot. Gait analysis including plantar pressure measurement was performed at an individually preferred and a standardized, imposed gait velocity in diabetic subjects with polyneuropathy (n=94), without polyneuropathy (n=39) and healthy elderly (n=19). The plantar flexion moment at 40% of the stance phase was negatively correlated with the displacement rate of center of pressure (r=-.749, p<.001 at the imposed, and r=-.693, p<.001 at the preferred gait velocity). Displacement rate of center of pressure was strongly correlated with forefoot loading (r=-.837, p<.001 at the imposed, and r=-.731, p<.001 at the preferred gait velocity). People with a relatively high plantar flexion moment at 40% of the stance phase, have a faster forward transfer of center of pressure and consequently higher loading of the forefoot. This indicates that interventions aimed at increasing the control of the roll-off of the foot may contribute to a better plantar pressure distribution.
    Human movement science 08/2013; · 2.15 Impact Factor
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    ABSTRACT: AIM: To identify the factors responsible for the low health-related quality of life associated with foot ulcers and the relative importance of these factors. METHODS: A total of 1232 patients with a new foot ulcer, who presented at one of the 14 centres in 10 European countries participating in the Eurodiale study, were included in this cross-sectional study. Patient and ulcer characteristics were obtained as well as results from the Euro-Qol-5D questionnaire, a health-related quality of life instrument with five domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). To analyse the relative importance of comorbidities and ulcer- and patient-related factors for health-related quality of life, linear regression models were used to calculate the relative contributions of each factor to the fit (R(2) ) of the model. RESULTS: Patients reported poor overall health-related quality of life, with problems primarily in the mobility and pain/discomfort domains. Among the comorbidities, the inability to stand or walk without help was the most important determinant of decreased health-related quality of life in all five domains. Among ulcer-related factors, ulcer size, limb-threatening ischaemia and elevated C-reactive protein concentration also had high importance in all domains. The clinical diagnosis of infection, peripheral arterial disease and polyneuropathy were only important in the pain/discomfort domain. CONCLUSIONS: The factors that determine health-related quality of life are diverse and to an extent not disease-specific. To improve health-related quality of life, treatment should not only be focused on ulcer healing but a multifactorial approach by a specialized multidisciplinary team is also important. This article is protected by copyright. All rights reserved.
    Diabetic Medicine 06/2013; · 3.24 Impact Factor
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    ABSTRACT: Diabetic foot ulceration (DFU) is associated with high morbidity and mortality, and represents the leading cause of hospitalization in patients with diabetes. Peripheral arterial disease (PAD), present in half of patients with DFU, is an independent predictor of limb loss and can be difficult to diagnose in a diabetic population. This review focuses on the evidence for therapeutic strategies in the management of patients with DFU. We highlight the importance of timely referral of patients presenting with a new foot ulcer to a multidisciplinary team, which includes vascular surgeons and interventional radiologists.
    European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 03/2013; · 2.92 Impact Factor
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    ABSTRACT: BACKGROUND: Bariatric procedures excluding the proximal small intestine improve glycemic control in type 2 diabetes within days. To gain insight into the mediators involved, we investigated factors regulating glucose homeostasis in patients with type 2 diabetes treated with the novel endoscopic duodenal-jejunal bypass liner (DJBL). METHODS: Seventeen obese patients (BMI 30-50 kg/m(2)) with type 2 diabetes received the DJBL for 24 weeks. Body weight and type 2 diabetes parameters, including HbA1c and plasma levels of glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and glucagon, were analyzed after a standard meal before, during, and 1 week after DJBL treatment. RESULTS: At 24 weeks after implantation, patients had lost 12.7 ± 1.3 kg (p < 0.01), while HbA1c had improved from 8.4 ± 0.2 to 7.0 ± 0.2 % (p < 0.01). Both fasting glucose levels and the postprandial glucose response were decreased at 1 week after implantation and remained decreased at 24 weeks (baseline vs. week 1 vs. week 24: 11.6 ± 0.5 vs. 9.0 ± 0.5 vs. 8.6 ± 0.5 mmol/L and 1,999 ± 85 vs. 1,536 ± 51 vs. 1,538 ± 72 mmol/L/min, both p < 0.01). In parallel, the glucagon response decreased (23,762 ± 4,732 vs. 15,989 ± 3,193 vs. 13,1207 ± 1,946 pg/mL/min, p < 0.05) and the GLP-1 response increased (4,440 ± 249 vs. 6,407 ± 480 vs. 6,008 ± 429 pmol/L/min, p < 0.01). The GIP response was decreased at week 24 (baseline-115,272 ± 10,971 vs. week 24-88,499 ± 10,971 pg/mL/min, p < 0.05). Insulin levels did not change significantly. Glycemic control was still improved 1 week after explantation. CONCLUSIONS: The data indicate DJBL to be a promising treatment for obesity and type 2 diabetes, causing rapid improvement of glycemic control paralleled by changes in gut hormones.
    Obesity Surgery 03/2013; · 3.10 Impact Factor
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    ABSTRACT: Context:The BclI polymorphism in the glucocorticoid receptor (GR) gene is associated with enhanced glucocorticoid (GC) sensitivity.Objective:Our objective was to investigate the association of the BclI polymorphism with body fatness and insulin resistance.Design and Setting:We conducted an observational cohort study, combining data from 2 cohort studies enriched with individuals with impaired glucose metabolism and/or diabetes mellitus type 2 (DM2).Patients and Methods:We examined 1228 participants (mean age 64.7 years, 45% women) from the Cohort Study on Diabetes and Atherosclerosis Maastricht (CODAM, n = 543) and the Hoorn Study (n = 685). Body mass index (BMI), waist and hip circumferences, and waist-to-hip ratio (WHR) were obtained; insulin resistance was estimated using the homeostasis model assessment for insulin resistance (HOMA2-IR).Results:We identified 519 noncarriers (CC), 540 heterozygous (CG) carriers, and 169 homozygous (GG) carriers of the G-allele of the BclI polymorphism. Homozygous carriers had a higher BMI (28.9 vs 27.9 kg/m(2)) and waist (99.6 vs 97.2 cm) and hip (105.5 vs 103.2 cm) circumference compared with noncarriers, also after adjustment for age, sex, cohort, glucose tolerance, and lifestyle risk factors: β = 0.94 kg/m(2) (95% confidence interval, 0.24-1.63), β = 2.84 cm (0.95;4.73) and β = 2.38 cm (0.88-3.87), respectively. Similar results were obtained when comparing homozygous carriers with heterozygous carriers: β = 1.03 kg/m(2) (0.34-1.72), β = 2.20 cm (0.31-4.08) and β = 1.99 cm (0.51-3.48), respectively. There were no differences in WHR. Ln-HOMA2-IR was higher in GG carriers compared with CG carriers; 0.29 vs 0.17 [β = 0.09 (0.01-0.17)], but this effect was attenuated after adjustment for BMI [β = 0.04 (-0.04 to 0.11)].Conclusion:Homozygous carriers of the BclI polymorphism of the GR gene have significantly greater total body fatness, contributing to higher HOMA2-IR, compared with heterozygous carriers and noncarriers.
    Journal of Clinical Endocrinology &amp Metabolism 03/2013; 98(3):E595-9. · 6.43 Impact Factor
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    ABSTRACT: BACKGROUND AND AIMS: The Study on Lifestyle intervention and Impaired glucose tolerance Maastricht (SLIM), a randomized controlled trial, directed at diet and physical activity in impaired glucose tolerant subjects was effective to improve glucose tolerance and prevent type 2 diabetes. The aim of this study was to determine the effects of the SLIM lifestyle intervention on the incidence and prevalence of the metabolic syndrome (MetS) during the active intervention and four years thereafter. METHODS AND RESULTS: MetS was diagnosed according to the NCEP ATP III criteria. At baseline, 66.4% of all participants (n = 146, age 57 ± 7 years, BMI 29.7 ± 3.6, 51.3% female) fulfilled the criteria for MetS. No significant difference in MetS prevalence was observed between the intervention (63.9%) and control group (68.9%). At the end of active intervention (average duration 4.2 ± 2.0 years), prevalence of MetS was significantly lower in the intervention group (52.6%, n = 57) compared to the control group (74.6%, n = 59) (p = 0.014). Furthermore, in participants without MetS at baseline, cumulative incidence of MetS was 18.2% in the intervention group at the end of active intervention, compared to 73.7% in the control group (Log-rank test, p = 0.011). Four years after stopping active intervention, the reduced incidence of MetS was maintained (Log-rank test, p = 0.002). CONCLUSION: In conclusion, a combined diet-and-exercise intervention to improve glucose tolerance, not only prevented type 2 diabetes, but also reduced the prevalence of MetS and prevented MetS development, showing the long-term impact of lifestyle intervention on cardiovascular risk reduction. Clinical trial registration number: NCT 00381186 (www.clincialtrials.gov).
    Nutrition, metabolism, and cardiovascular diseases: NMCD 02/2013; · 3.52 Impact Factor
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    ABSTRACT: BACKGROUND: Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing. METHODS: The influence of ulcer location on time to healing of diabetic foot ulcers was analyzed by multivariate Cox regression analysis for 1000 patients included in the Eurodiale study, a prospective cohort study of patients with diabetic foot disease. RESULTS: Median time to healing was 147 days for toe ulcers (95% CI 135-159 days), 188 days for midfoot ulcers (95% CI 158-218 days) and 237 days for heel ulcers (95% CI 205-269 days) (p < 0.01). Median time to healing for plantar ulcers was 172 days (95% CI 157-187 days) and 155 days (95% CI 138-172) for non-plantar ulcers (p = 0.71). In multivariate Cox regression analysis, the hazard ratio for ulcer healing for midfoot and heel ulcers compared to toe ulcers was 0.77 (95% CI 0.64-0.92) and 0.62 (95% CI 0.47-0.83) respectively; the hazard ratio for ulcer healing for plantar versus non-plantar ulcers was 1 (95% CI 0.84-1.19). Other factors significantly influencing time to healing were duration of diabetes, ulcer duration, presence of heart failure and presence of peripheral arterial disease. CONCLUSIONS: Time to ulcer healing increased progressively from toe to midfoot to heel, but did not differ between plantar and non-plantar ulcers. Our data also indicate that risk factors for longer time to healing differ from factors that affect the ultimate number of ulcers that heal (healing rate). Copyright © 2013 John Wiley & Sons, Ltd.
    Diabetes/Metabolism Research and Reviews 02/2013; · 2.97 Impact Factor
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    ABSTRACT: Epidemiological studies suggest that excessive sitting time is associated with increased health risk, independent of the performance of exercise. We hypothesized that a daily bout of exercise cannot compensate the negative effects of inactivity during the rest of the day on insulin sensitivity and plasma lipids. Eighteen healthy subjects, age 21±2 year, BMI 22.6±2.6 kgm(-2) followed randomly three physical activity regimes for four days. Participants were instructed to sit 14 hr/day (sitting regime); to sit 13 hr/day and to substitute 1 hr of sitting with vigorous exercise 1 hr (exercise regime); to substitute 6 hrs sitting with 4 hr walking and 2 hr standing (minimal intensity physical activity (PA) regime). The sitting and exercise regime had comparable numbers of sitting hours; the exercise and minimal intensity PA regime had the same daily energy expenditure. PA was assessed continuously by an activity monitor (ActivPAL) and a diary. Measurements of insulin sensitivity (oral glucose tolerance test, OGTT) and plasma lipids were performed in the fasting state, the morning after the 4 days of each regime. In the sitting regime, daily energy expenditure was about 500 kcal lower than in both other regimes. Area under the curve for insulin during OGTT was significantly lower after the minimal intensity PA regime compared to both sitting and exercise regimes 6727.3±4329.4 vs 7752.0±3014.4 and 8320.4±5383.7 mU•min/ml, respectively. Triglycerides, non-HDL cholesterol and apolipoprotein B plasma levels improved significantly in the minimal intensity PA regime compared to sitting and showed non-significant trends for improvement compared to exercise. One hour of daily physical exercise cannot compensate the negative effects of inactivity on insulin level and plasma lipids if the rest of the day is spent sitting. Reducing inactivity by increasing the time spent walking/standing is more effective than one hour of physical exercise, when energy expenditure is kept constant.
    PLoS ONE 01/2013; 8(2):e55542. · 3.53 Impact Factor
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    ABSTRACT: OBJECTIVE: The aim was to compare the efficacy and safety of two antibiotic regimens in patients with diabetic foot infections (DFIs). METHODS: Data of a subset of patients enrolled in the RELIEF trial with DFIs requiring surgery and antibiotics were evaluated retrospectively. DFI was diagnosed on the basis of the modified Wagner, University of Texas, and PEDIS classification systems. Patients were randomized to receive either intravenous/oral moxifloxacin (MXF, N = 110) 400 mg q.d. or intravenous piperacillin/tazobactam 4.0/0.5 g t.d.s. followed by oral amoxicillin/clavulanate 875/125 mg b.d. (PIP/TAZ-AMC, N = 96), for 7-21 days until the end of treatment (EOT). The primary endpoint was clinical cure rates in the per-protocol (PP) population at the test-of-cure visit (TOC, 14-28 days after EOT). RESULTS: There were no significant differences between the demographic characteristics of PP patients in either treatment group. At TOC, MXF and PIP/TAZ-AMC had similar efficacy in both the PP and intent-to-treat (ITT) populations: MXF: 76.4 % versus PIP/TAZ-AMC: 78.1 %; 95 % confidence interval (CI) -14.5 %, 9.0 % in the PP population; MXF: 69.9 % versus PIP/TAZ-AMC: 69.1 %; 95 % CI -12.4 %, 12.1 % in the ITT population. The overall bacteriological success rates were similar in both treatment groups (MXF: 71.7 % versus PIP/TAZ-AMC: 71.8 %; 95 % CI -16.9 %, 10.7 %). A similar proportion of patients (ITT population) experienced any adverse events in both treatment groups (MXF: 30.9 % versus PIP/TAZ-AMC: 31.8 %, respectively). Death occurred in three MXF-treated patients and one PIP/TAZ-AMC-treated patient; these were unrelated to the study drugs. CONCLUSION: Moxifloxacin has shown favorable safety and efficacy profiles in DFI patients and could be an alternative antibiotic therapy in the management of DFI. Clinical trial: NCT00402727.
    Infection 11/2012; · 2.44 Impact Factor
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    ABSTRACT: BACKGROUND: Type 2 diabetes is associated with considerable comorbidity and severe complications, which reduce quality of life of the patients and require high levels of healthcare. The Diabetes Pearl is a large cohort of patients diagnosed with type 2 diabetes, covering different geographical areas in the Netherlands. The aim of the study is to create a research infrastructure that will allow the study of risk factors, including biomarkers and genetic determinants for severe diabetes complications.Methods/designBaseline examinations began November 2009 and will continue through 2012. By the end of 2012, it is expected that 7000 patients with type 2 diabetes will be included in the Diabetes Pearl cohort. To ensure quality of the data collected, standard operation procedures were developed and used in all 8 recruitment centers. From all patients who provide informed consent, the following information is collected: personal information, medication use, physical examination (antropometry, blood pressure, electrocardiography (ECG), retina photographs, ankle-brachial index, peripheral vibration perception), self-report questionnaire (socio-economic status, lifestyle, (family) history of disease, and psychosocial well-being), laboratory measurements (glucose, A1c, lipid profile, kidney function), biobank material (storage of urine and blood samples and isolated DNA). All gathered clinical data and biobank information is uploaded to a database for storage on a national level. Biobanks are maintained locally at all recruitment centers. DISCUSSION: The Diabetes Pearl is large-scale cohort of type 2 diabetes patients in the Netherlands aiming to study risk factors, including biomarkers and genetic markers, for disease deterioration and the development of severe diabetes complications. As a result of the well-designed research design and the national coverage, the Diabetes Pearl data can be of great value to national and international researchers with an interest in diabetes related research.
    BMC Public Health 11/2012; 12(1):949. · 2.08 Impact Factor
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    ABSTRACT: Objective.  To improve the care of patients with painful diabetic polyneuropathy (PDP) by a specialized outpatient clinic for individuals referred by general practitioners and to determine the effects on pain, quality of life, and patient satisfaction. Material and Methods.  One hundred twenty-one patients were prospectively enrolled. At baseline and after 12 months at end of treatment, patients filled in a set of validated questionnaires on severity and interference of pain, quality of life, anxiety and depression, and patient satisfaction with the service offered. Setting.  The outpatient clinic is part of a regional chronic care management program, which includes both hospital-based endocrinologists and general practitioners. Results.  Twenty-eight patients (27%) did not need any further treatment after one visit to the outpatient clinic. As initial drug, pregabalin was the most commonly prescribed drug (65%); amitriptyline was prescribed in only 30% due to its contraindications. Improvements were found in all pain scores (P < 0.05). Pain interference was improved in sleep (P < 0.01), general activity, and mood (P < 0.05). More than half of the patients (65%) were satisfied with the treatment and whished no further medication changes; 52% had a treatment success defined as pain relief ≥ 30%. Medication was stopped due to inefficacy in 9% of patients and changed due to adverse effects in 20% of the patients. Conclusions.  A specialized outpatient clinic for patients with PDP is an effective health care service. Using diagnostic instruments and a defined treatment algorithm, significant pain reduction was achieved in the majority of patients in a relative short period of time.
    Pain Medicine 09/2012; 13(10):1324-33. · 2.46 Impact Factor
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    Journal of the American Medical Directors Association 09/2012; · 5.30 Impact Factor
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    ABSTRACT: /st> Painful diabetic polyneuropathy (PDP) is associated with high pain scores and is difficult to treat. Therefore, spinal cord stimulation (SCS) has been suggested as second-line treatment. In this study, the feasibility and efficacy of SCS in PDP were investigated, as well as the predictive value of clinical sensory testing for the treatment outcome. /st> Fifteen patients with intractable PDP in the lower limbs were recruited. During lead implantation, the feasibility of achieving adequate paraesthesia coverage using one stimulation lead was investigated. If trial stimulation was successful, a definitive neurostimulator was implanted. Pain intensity was scored using an 11-point numeric rating scale and patients' global impression of change scale. Additionally, neuropathic pain characteristics, quality of life, sleep quality and mood were assessed. The predictive value of clinical sensory testing for the treatment outcome was analysed. /st> Adequate paraesthesia coverage was achieved in 14 out of 15 patients. Clinically relevant pain relief was present in 11 patients after trial stimulation and 10 patients at 12 months. The quality of life was significantly increased at 2 weeks and 3 months in patients with successful SCS treatment. Several neuropathic pain characteristics and quality of sleep were improved at 2 weeks and 12 months. Preoperative clinical sensory testing did not differentiate between treatment responders from non-responders. /st> SCS seems to be an efficacious and feasible treatment for intractable PDP. In this exploratory study, it was not possible to predict the treatment outcome using clinical sensory testing. These results justify performing a randomized clinical trial.
    BJA British Journal of Anaesthesia 08/2012; 109(4):623-9. · 4.24 Impact Factor
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    ABSTRACT: Few studies have examined factors associated with diabetic foot ulcer (DFU) recurrence. Using data from patients enrolled in the prospective Eurodiale DFU study, we investigated the frequency of, and risk factors for, DFU recurrence after healing during 3-year follow-up period. At our site, 93 Eurodiale enrolled patients had a healed DFU. Among these, 14 died; of the remaining 79 patients we enrolled 73 in this study. On entry to the Eurodiale study we assessed: demographic factors (age, sex, distance from hospital); diabetes-related factors (duration, HbA1c levels); comorbidities (obesity, renal failure, smoking, alcohol abuse); and DFU-related factors (peripheral arterial disease, ulcer infection, c-reactive protein [CRP]; foot deformities). During the 3-year follow-up, a DFU recurred in 42 patients (57·5%). By stepwise logistic regression of findings at initial DFU presentation, the significant independent predictors for recurrence were plantar ulcer location (odds ratio [OR] 8·62, 95% CI 2·2-33·2); presence of osteomyelitis (OR 5·17, 95% CI 1·4-18·7); HbA1c > 7·5% ([DCCT], OR 4·07, 95% CI 1·1-15·6); and CRP > 5 mg/l (OR 4·27, 95% CI 1·2-15·7). In these patients with a healed DFU, the majority had a recurrence of DFU during a 3-year follow-up, despite intensive foot care. The findings present at diagnosis of the initial DFU that were independent risk factors associated with ulcer recurrence (plantar location, bone infection, poor diabetes control and elevated CRP) appear to define those at high risk for recurrence, but may be amenable to targeted interventions.
    International Wound Journal 06/2012; · 1.60 Impact Factor

Publication Stats

2k Citations
505.43 Total Impact Points


  • 2013
    • University of Copenhagen
      • Department of Public Health
      Copenhagen, Capital Region, Denmark
  • 2012–2013
    • St George's Healthcare NHS Trust
      Londinium, England, United Kingdom
    • Tilburg University
      Tilburg, North Brabant, Netherlands
    • University of Groningen
      Groningen, Groningen, Netherlands
  • 1992–2013
    • Maastricht Universitair Medisch Centrum
      • Central Diagnostic Laboratory
      Maestricht, Limburg, Netherlands
    • Maastricht University
      • • Interne Geneeskunde
      • • Algemene Heelkunde
      • • Department of Orthopaedic Surgery
      Maastricht, Provincie Limburg, Netherlands
  • 2011
    • Council for Public Health and Health Care, Netherlands
      's-Gravenhage, South Holland, Netherlands
    • Hogeschool Fontys
      • Research Group for Health, Innovations and Technology
      Eindhoven, North Brabant, Netherlands
  • 2008
    • Malmö University
      Malmö, Skåne, Sweden
  • 2004
    • Leiden University Medical Centre
      • Department of Endocrinology and General Internal Medicine
      Leiden, South Holland, Netherlands
  • 2000
    • Spaarne Ziekenhuis
      Haarlemmermeer, North Holland, Netherlands
  • 1999
    • Radboud University Medical Centre (Radboudumc)
      Nymegen, Gelderland, Netherlands
  • 1998
    • Academic Medical Center (AMC)
      Amsterdamo, North Holland, Netherlands
  • 1997
    • Radboud University Nijmegen
      Nymegen, Gelderland, Netherlands