Juha Saltevo

Central Hospital Central Finland · Department of Medicine

Aims The aim of this study was to evaluate the association between living alone and mortality among older patients with and without diabetes. Methods Electronic patient records were used to identify patients at least 65 years of age with a diagnosis of diabetes and two age- and sex-matched controls without diabetes for each patient with diabetes i...

Background: The aim of this study was to compare the utilization of primary healthcare services by older patients with and without type 2 diabetes. Methods: Electronic patient records were used to identify persons over 65 years of age with a diagnosis of diabetes. Two age- and sex-adjusted controls without diabetes were extracted for each person...

We evaluated the survival of a subarctic population and the significance of traditional risk factors for mortality, causes of death and their seasonal variation from the period of 1984–2014. By the end of 2014 (follow-up), 644 (34.4% from 1,869) participants had died (42.1% of cardiovascular causes, 22.4% of neoplastic diseases). The average age at...

Aims The Finnish National Diabetes Prevention Program (FIN-D2D) was the first large-scale diabetes prevention program in a primary health care setting in the world. The risk reduction of type 2 diabetes was 69% after one-year intervention in high-risk individuals who were able to lose 5% of their weight. We investigated long-term effects of one-yea...

Aims: To analyze the use of pain medication among community-dwelling people aged 65 years or older with and without type 2 diabetes in primary care. Methods: A total of 187 patients with and 176 patients without diabetes were randomly selected from a primary care sample of 389 patients with diabetes and 604 age- and gender-matched controls. Pain...

Background: Due to these changes in kidney function, aging kidneys are more prone to drug-induced impairments in renal properties. Diabetes has been associated with the declined kidney function and an elevated risk of renal failure. The aim of this study is to compare kidney function and potentially nephrotoxic drug use among home-dwelling older p...

Background: Food neophobia is considered a behavioral trait closely linked to adverse eating patterns and reduced dietary quality, which have been associated with increased risk of obesity and noncommunicable diseases. Objectives: In a cross-sectional and prospective study, we examined how food neophobia is associated with dietary quality, healt...

Objective: To assess the association between depressive symptoms and impaired glucose metabolism in the elderly population in arctic latitudes. Design: A population-based study. Setting. Community. Subjects: The study population consisted of 1,830 subjects born between the years 1915 and 1958 in the northernmost part of Finland, the Muonio-Enonteki...

What is known and objective Polypharmacy and age are known to increase the risk for potential drug interactions. Type 2 diabetes has been associated with polypharmacy and several comorbidities. Currently, there is no information on whether the frequency of clinically relevant drug‐drug interactions and the risk for drug adverse effects differ betwe...

What is known and objective Anticholinergic drug use has been associated with a risk of central and peripheral adverse effects. There is a lack of information on anticholinergic drug use in persons with diabetes. The aim of this study is to investigate anticholinergic drug use and the association between anticholinergic drug use and self‐reported s...

Background: The association between pain and diabetes in older people has been largely unexplored. The aim of this survey was to analyze the prevalence and characteristics of pain among Finnish men and women 65 or older with and without diabetes in primary care. Methods: All home-dwelling persons 65 years or older with diabetes (N = 527) and age...

Background: Alterations in lipoprotein size are associated with increased cardiovascular disease risk. Higher hemoglobin levels may indicate a higher risk of atherosclerosis and was previously associated with obesity, metabolic syndrome, and insulin resistance. No previous studies have investigated an association between hemoglobin concentration a...

Background Pain and diabetes are related to the decreased self-rated health. The aim of this population-based study was to analyze how pain affects self-rated health among people aged 65 or older with and without type 2 diabetes. Design Population-based cross-sectional cohort study. Setting Inner Savo district, Finland. Participants Home-dwellin...

In addition to sunlight and dietary sources, several genes in the metabolic pathway of vitamin D affect serum 25-hydroxyvitamin D (25OHD) concentration. It is not known whether this genetic regulation is influenced by host characteristics. We investigated the effect of age and gender on the genetic regulation of serum 25OHD concentration. In total,...

Aims/hypothesis: Recent European guidelines for non-alcoholic fatty liver disease (NAFLD) call for reference values for HOMA-IR. In this study, we aimed to determine: (1) the upper limit of normal HOMA-IR in two population-based cohorts; (2) the HOMA-IR corresponding to NAFLD; (3) the effect of sex and PNPLA3 genotype at rs738409 on HOMA-IR; and (...

Background: Glycated hemoglobin (HbA1c) is used to diagnose type 2 diabetes (T2D) and assess glycemic control in patients with diabetes. Previous genome-wide association studies (GWAS) have identified 18 HbA1c-associated genetic variants. These variants proved to be classifiable by their likely biological action as erythrocytic (also associated wi...

Cohort information, genotyping, quality control (QC), glycated hemoglobin (HbA1c), analysis and covariates. (XLSX)

Genome-wide significant SNPs identified in the genetic discovery analysis. (XLSX)

Proportion of additional variance explained over age and sex in measured glycated hemoglobin (HbA1c) by erythryocytic genetic variants and by all genome-wide significant genetic variants by ethnicity. (XLSX)

Mean difference in glycated hemoglobin (HbA1c) between the top and bottom 5 percentile of genetic score-total (GS-Total) by ancestry. (XLSX)

Additional analyses on the association of rs1050828, G6PD variant G202A, with glycated hemoglobin (HbA1c). (XLSX)

Association of lead glycated hemoglobin (HbA1c) variants with glycemic and erythrocytic traits from publicly available association results. (XLSX)

Attenuation of glycated hemoglobin variant (HbA1c) effect size in association models conditioned on fasting glucose (FG), 2hr glucose (2hrGlu), hemoglobin level (Hb), mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) for the lead HbA1c-associated variants. (XLSX)

Baseline characteristics among those who developed incident type 2 diabetes (T2D) during follow-up and among those who did not, by cohort and ethnicity. (XLSX)

Net reclassification index of type 2 diabetes (T2D) status by measured glycated hemoglobin (HbA1c) ≥ 6.5% compared to fasting glucose (FG) ≥ 7 mmol/L with and without accounting for erythrocytic genetic variants by ancestry. (XLSX)

Association of genetic score-glycemic (GS-G) and genetic score erythrocytic (GS-E) with incident type 2 diabetes (T2D) over a decade-long follow-up period by cohort and ancestry. (XLSX)

Mean difference in glycated hemoglobin (HbA1c) between the top and bottom 5 percentile of genetic score-erythrocytic (GS-E) by ancestry. (XLSX)

Diagram describing the flow of our study. (PDF)

Overview of the classification of genetic variants as glycemic, erythrocytic, or unclassified. (PDF)

Estimated number of African Americans with type 2 diabetes (T2D) in the US whose diagnosis would be missed due to the glycose-6-phosphate dehydrogenase (G6PD) variant if screened with glycated hemoglobin (HbA1c). (XLSX)

Overview of participants included in the genetic discovery analysis. (PDF)

Forest plot of association between erythrocytic genetic score with incident type 2 diabetes (T2D) over a decade-long follow-up period adjusted for glycated hemoglobin (HbA1c) as a continuous variable by ancestry. (PDF)

Authors’ funding information. (DOCX)

Background: Dapagliflozin is a sodium-glucose cotransporter-2 inhibitor approved for the treatment of type 2 diabetes. We aimed to assess the efficacy and safety of dapagliflozin as an add-on to adjustable insulin in patients with inadequately controlled type 1 diabetes. Methods: DEPICT-1 was a double-blind, randomised, parallel-controlled, thre...

Aims: To evaluate the health-related quality of life (HRQoL) and functional capacity in relation to glycemic control among older home-dwelling primary care patients. Methods: Electronic patient records were used to identify 527 people over 65 years with diabetes. Of these, 259 randomly selected subjects were invited to a health examination and 1...

Aims: Diabetes and impaired glucose metabolism cause metabolic, neural and circulatory disturbances that may predispose to adverse cooling and related symptoms during the cold season. This study assessed the prevalence of cold-related cardiorespiratory symptoms in the general population according to glycaemic status. Methods: The study populatio...

Aims/hypothesisEpidemiological studies have identified several traits associated with CHD, but few of these have been shown to be causal risk factors and thus suitable targets for treatment. Our aim was to evaluate the causal role of a large set of known CHD risk factors using single-nucleotide polymorphisms (SNPs) as instrumental variables. Method...

To dissect the genetic architecture of blood pressure and assess effects on target organ damage, we analyzed 128,272 SNPs from targeted and genome-wide arrays in 201,529 individuals of European ancestry, and genotypes from an additional 140,886 individuals were used for validation. We identified 66 blood pressure–associated loci, of which 17 were n...

To dissect the genetic architecture of blood pressure and assess effects on target organ damage, we analyzed 128,272 SNPs from targeted and genome-wide arrays in 201,529 individuals of European ancestry, and genotypes from an additional 140,886 individuals were used for validation. We identified 66 blood pressure-associated loci, of which 17 were n...

[This corrects the article DOI: 10.1371/journal.pgen.1005378.].

Consortia members and extended acknowledgments. (DOCX)

About 500,000 people suffer from diabetes in Finland, a number which is predicted to increase within the next decades. At the moment, diabetes can neither be prevented nor cured. Diabetes is associated with microvascular (kidney, eye and peripheral nerves) and macrovascular complications (coronary heart disease, stroke). These complications affect...

We performed fine mapping of 39 established type 2 diabetes (T2D) loci in 27,206 cases and 57,574 controls of European ancestry. We identified 49 distinct association signals at these loci, including five mapping in or near KCNQ1. 'Credible sets' of the variants most likely to drive each distinct signal mapped predominantly to noncoding sequence, i...

Genome-wide association studies (GWAS) have identified more than 100 genetic variants contributing to BMI, a measure of body size, or waist-to-hip ratio (adjusted for BMI, WHRadjBMI), a measure of body shape. Body size and shape change as people grow older and these changes differ substantially between men and women. To systematically screen for ag...

Genome-wide association studies (GWAS) have identified more than 100 genetic variants contributing to BMI, a measure of body size, or waist-to-hip ratio (adjusted for BMI, WHRadjBMI), a measure of body shape. Body size and shape change as people grow older and these changes differ substantially between men and women. To systematically screen for ag...

The association between thyroid function and depression is controversial. Both conditions express many similar symptoms, but the studies done give conflicting results. This study draws on a random, population-based sample of 4500 subjects aged 45-75 years old from Finland. The basic clinical study was done in 2007 for 1396 men and 1500 women (64% p...

Background The aim of this study was to investigate the relationship between changes in serum ferritin concentrations and the development of metabolic syndrome (MetS) and its components over a 6.5 year follow-up period in Finnish adults. Methods Adults born in Pieksämäki, Finland, in 1942, 1947, 1952, 1957, and 1962 (n = 1294) were invited to heal...

Aims/hypothesis: In the double-blind placebo-controlled Fenofibrate Intervention and Event Lowering in Diabetes trial (n = 9,795), fenofibrate reduced major cardiovascular events in type 2 diabetes. Sex-related differences in fenofibrate response could be clinically relevant and were pre-specified analyses. Methods: Women (n = 3,657) and men (n...

To identify serum biomarkers through metabolomics approach that distinguishes physically inactive overweight/obese women with metabolic syndrome from those who are metabolically healthy, independent of body weight and fat mass. We applied nuclear magnetic resonance spectroscopy-based profiling of fasting serum samples to examine the metabolic diffe...

To further understanding of the genetic basis of type 2 diabetes (T2D) susceptibility, we aggregated published meta-analyses of genome-wide association studies (GWAS), including 26,488 cases and 83,964 controls of European, east Asian, south Asian and Mexican and Mexican American ancestry. We observed a significant excess in the directional consist...

Cross-sectional studies have suggested that serum omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFAs) are related to favorable lipoprotein particle concentrations. We explored the associations of serum n-3 and n-6 PUFAs with lipoprotein particle concentrations and sizes in a general population cohort at baseline and after 6 years. T...

Non-alcoholic steatohepatitis (NASH) is a leading cause of chronic liver disease in Western countries. Diagnosis of NASH requires a liver biopsy. We estimated the prevalence of NASH non-invasively in a population-based study using scores validated against liver histology. Clinical characteristics, PNPLA3 genotype at rs738409, and serum cytokeratin...

Abstract Background Increased ferritin concentrations are associated with metabolic syndrome (MetS). The association between ferritin as well as hemoglobin level and individual MetS components is unclear. Erythropoietin levels in subjects with MetS have not been determined previously. The aim of this study was to compare serum erythropoietin, ferri...

To extend understanding of the genetic architecture and molecular basis of type 2 diabetes (T2D), we conducted a meta-analysis of genetic variants on the Metabochip, including 34,840 cases and 114,981 controls, overwhelmingly of European descent. We identified ten previously unreported T2D susceptibility loci, including two showing sex-differentiat...

Aims: To describe socioeconomic characteristics of participants and their effect on uptake and completion of the implementation project (FIN-D2D) for the National Type 2 Diabetes Prevention Programme. Furthermore, to assess the effectiveness of individual vs. group intervention during one-year follow-up. Methods: At baseline, 2820 men and 5764 w...

The serum fatty acid composition reflects the dietary fatty acid composition from the past few days to several weeks. However, the role of serum omega-3 (from fish and fish oils) and omega-6 (from vegetable oils) polyunsaturated fatty acids (PUFAs) in the course of metabolic syndrome is poorly understood. At the Primary Health Care Unit in Pieksämä...

Obesity and overweight are related to unfavourable lipoprotein subclass profiles. Here we studied the relation between weight change and lipoprotein particle concentrations and sizes in a general population cohort in a longitudinal setting. The cohort included 683 adults with a 6.5-year follow-up. Lipoprotein particle subclasses and mean particle s...

Metabolite predictors of deteriorating glucose tolerance may elucidate the pathogenesis of type 2 diabetes. We investigated associations of circulating metabolites from high-throughput profiling with fasting and postload glycemia cross-sectionally and prospectively on the population level. Oral glucose tolerance was assessed in two Finnish, populat...

There are sex differences in low-grade inflammation markers in obesity-related disorders. Little is known, however, about a possible sex-specific association of relative weight change from youth to adulthood with actual low-grade inflammation. The aim of this study was to identify possible sex differences in adiponectin, interleukin-1β (IL-1β), int...

Objective: To investigate the long-term effects of duration of postpartum lactation on maternal body composition and risk for cardio-metabolic disorders in later life. Design: Retrospective study. Body composition was measured using dual-energy X-ray absorptiometry and serum glucose, insulin and lipids were analysed using enzymatic photometric m...

Objectives To investigate the association between increase in physical activity and changes in cardiometabolic risk factors during a lifestyle intervention programme in routine clinical settings. Design Prospective follow-up. Setting 400 primary healthcare centres and occupational healthcare outpatient clinics in Finland. Participants Individuals a...

The aim of this work was to examine the prevalence of different metabolical phenotypes of obesity, and to analyze, by using different risk scores, how the metabolic syndrome (MetS) definition discriminates between unhealthy and healthy metabolic phenotypes in different obesity classes. The Finnish type 2 diabetes (FIN-D2D) survey, a part of the lar...

The aim of this cross-sectional study was to examine the association between serum calcium and the components of metabolic syndrome (MetS). As a part of the national prevention program of diabetes in Finland (FIN-D2D), a randomly selected study population of 4500 middle-aged men and women were recruited from three central hospital district areas. A...

In this FIN-D2D cross-sectional survey the relationship of age with HbA(1c) and fasting and 2h glucose in the oral glucose tolerance test (OGTT) was explored in apparently randomly selected healthy population. The glycaemic parameters were measured in 1344 men and 1482 women (aged 45-74 years), and among them we excluded all subjects with known dia...