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Sagittal abdominal diameter and waist circumference as markers of early organ damage in patients with Type 2 diabetes
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.ORCID iD: 0000-0002-9095-403X
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
Linköping University, Department of Medical and Health Sciences, Internal Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Endocrinology and Gastroenterology.ORCID iD: 0000-0002-1680-1000
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2011 (English)In: Journal of Clinical Metabolism & Diabetes, Vol. 2, no 1Article in journal (Refereed) Published
Abstract [en]

Aims: In a cohort of 465 patients with Type 2 diabetes aged 55-66 years the associationbetween the anthropometric measures: Waist circumference (WC) and Sagittal abdominaldiameter (SAD) versus subclinical cardiovascular organ damage by measuring Pulse wavevelocity (PWV) and Left ventricular mass index (LVMI) was studied.

Methods: Blood pressure, weight, height and WC were measured within primary care. SADwas measured by using standardized calliper equipment. Blood samples were taken foranalysis of HbA1c and serum lipids. LVMI was measured by M-mode echocardiography.Aortic PWV was measured by applanation tonometry (Sphygmocor®) over the carotid andfemoral arteries.

Results: There were significant correlations between aortic PWV and WC (r=0.23; p<0.01)and SAD (r=0.25; p<0.01). LVMI was also correlated to WC (r=0.26; p<0.01) and SAD(r=0.25; p<0.01). When analysed in a multiple regression model, SAD and WC were bothassociated with PWV and LVMI, independently of age, sex, systolic blood pressure, serumlipids and HbA1c.

Conclusion: This study shows that abdominal obesity, measured either with WC or SAD, is afeasible risk assessment tool for early subclinical organ damage in patients who have alreadydeveloped Type 2 diabetes.

Place, publisher, year, edition, pages
San Lucas Medical , 2011. Vol. 2, no 1
Keyword [en]
type 2 diabetes, obesity, pulse wave velocity, left ventricular mass
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-20579OAI: oai:DiVA.org:liu-20579DiVA: diva2:235280
Available from: 2009-09-15 Created: 2009-09-15 Last updated: 2017-03-27Bibliographically approved
In thesis
1. Monitoring blood glucose and obesity in type 2 diabetes in primary care
Open this publication in new window or tab >>Monitoring blood glucose and obesity in type 2 diabetes in primary care
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Type 2 diabetes is a common chronic disease worldwide. An important part of the treatment is monitoring and treating the elevated levels of blood glucose. But there is also a need for monitoringother risk factors that confer an increased risk for vascular complications. This thesis is based on four studies that explore different aspectsof monitoring blood glucose and obesity in patients with type 2 diabetes in primary care.

Methods: To examine the cost and effect on glycaemic control of patients performing self-monitoring of blood glucose (SMBG) an observationalstudy was performed in the county of Östergötland and Jönköping 2003-2004. The study included all known patients with type 2 diabetes at 18 primary health care centres (PHCC), excluding patients in nursery homes.

A structured observational intervention study of 98 patients with type 2 diabetes living at 17 nursery homes were done with monitoringof hypoglycaemic episodes followed by a controlled withdrawal of diabetes medication in patients with HbA1c ≤ 6.0 %.

Baseline data from the cohort study; Cardiovascularrisk in type 2 diabetes – a prospectivestudy in primary care (CARDIPP), was analysed for correlation analyses between anthropometric status and early cardiovascular organ damage, measured by pulse wave velocity (PWV) and left ventricular mass index (LVMI).

Results: When comparing users of SMBG to non-users, there was no association between improvedglycaemic control and use of SMBG. A plasma glucose profile for three consecutive days of the patients at nursery homes, indentified 31 episodes of plasma glucose levels≤ 4.4 mmol/l. A withdrawal of insulin and oral antiglycaemic medicine was performed, which after 3 months follow up was successful in 24 (75 %) of the patients.

The mean annual cost per PHCC for visits to general practitioner and nurse, insulin, SMBG and oral antiglycaemic agents was586 € (SD 435) per patient. There was no correlationbetween costs and glycaemic control at PHCC level.

In the CARDIPP study, both increased sagittalabdominal diameter and increased waist circumference were, independently of sex, age, blood pressure and HbA1c, associated to increasedPWV and LVMI.

Conclusions: Use of SMBG in primary care confers a substantialpart of the treatment costs, but is not associated with improved glycaemic control. Systematic use of SMBG for patients not treated with insulin should not be recommended. At nursery homes, patients with type 2 diabetes are at risk for harmful hypoglycaemia and may benefit from a more frequent control of plasma glucose and a less strict glycaemic control.

Increased abdominal obesity measured with either sagittal abdominal diameter or waist circumference is associated with early cardiovascularorgan damage. In addition to analyses of blood glucose, blood pressure and lipids, the monitoring of abdominal obesity is a feasible risk factor assessment tool, that provides further information about cardiovascular risk that goes beyond that of traditional risk factors.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 55 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1140
Keyword
Diabetes, primary care
National Category
Family Medicine
Identifiers
urn:nbn:se:liu:diva-20049 (URN)978-91-7393-573-9 (ISBN)
Public defence
2009-09-18, Originalet, Qulturumhuset, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
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Supervisors
Available from: 2009-09-15 Created: 2009-08-26 Last updated: 2010-03-02Bibliographically approved

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Tengblad, AndersLänne, TosteEngvall, JanNyström, FredrikÖstgren, Carl Johan

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