Association between copeptin and declining glomerular filtration rate in people with newly diagnosed diabetes. The Skaraborg Diabetes Register.

AIMS: Copeptin has shown association with development of chronic kidney disease (CKD) in people with diabetes. Early detection of individuals having the highest risk could help avoid this complication. Therefore we decided to study copeptin concentrations and estimated glomerular filtration rate (eGFR) retrospectively in people with newly diagnosed diabetes. METHODS: People with newly diagnosed type 2 diabetes in 1996-1998 from Skaraborg Diabetes Register (SDR) were reinvestigated in 2008-2010. Copeptin concentration at the time of diagnosis was determined. Creatinine and cystatin C were used for determination of eGFR at baseline and at reinvestigation (n=161). Data on cardiovascular complications were extracted from national registers. Analyzes were done with logistic regression. RESULTS: From baseline to follow up eGFR decreased with 33ml. Twenty-nine individuals (18.1%) developed CKD stage 3. There was a significant association between elevated copeptin concentrations and development of CKD stage 3 (OR=1.78, 95% CI=1.01-3.16). When adjusting for GFR at baseline the association between copeptin and GFR decline was borderline significant (OR=1.79, 95% CI=0.99-3.25, p=0.055). CONCLUSIONS: Determination of copeptin may early identify people with diabetes and high risk for CKD. To prevent complications for these individuals aggressive treatment should be discussed.

Group treatment of obesity in primary care practice: a qualitative study of patients' perspectives.

AIMS: To explore patients' experiences of very low calorie diet (VLCD) and subsequent corset treatment of obesity in a primary care setting, and to explore their perceptions of factors influencing weight control. METHODS: In western Sweden, five focus group sessions were carried out. The main themes for the discussions were the informants' perceptions of the treatment they had received and their experiences of living with obesity. The analysis was based on the Grounded Theory methodology. RESULTS: The outcomes reflect obese individuals' struggle to handle the demands of their life situation and to recognize their own resources. The core category generated was labelled ''Achieving a balance in life and adjusting one's identity''. Three categories related to the process of weight reduction were identified: living with obesity, reducing weight and developing self-management. The group treatment with VLCD was positively perceived by the participants, but the corset treatment was considered to be of less value. CONCLUSIONS: Maintenance after weight reduction was demanding and the findings indicate a need for extended support. For some individuals the corset treatment could be a psychological support. Follow-up after weight reduction programmes should focus on long-term self-help strategies.

Hypertension prevalence in obstructive sleep apnoea and sex: a population-based case-control study.

Obstructive sleep apnoea (OSA) is a recognised risk factor for hypertension (HT). The current authors investigated confounders of this association in a sex-balanced community-based sample of patients with HT (n=161) from the Skaraborg Hypertension and Diabetes Project (n=1,149) and normotensive controls (n=183) from an age and sex stratified community-based population sample (n=1,109). All participants underwent ambulatory home polysomnography. Severe OSA (apnoea-plus-hypopnoea index (AHI)>or=30 events.h-1) was found in 47 and 25% of hypertensive and normotensive males, respectively. The corresponding numbers in females were 26 and 24%, respectively. The odds ratio (OR) for HT increased across AHI tertiles from 1.0 to 2.1 (95% confidence interval: 0.9-4.5) and 1.0 to 3.7 (95% CI: 1.7-8.2) in males, but not in females where the OR increased from 1.0 to 1.8 (95% CI: 0.8-3.9) and 1.0 to 1.6 (95% CI: 0.7-3.5). Regression analysis correcting for age, body mass index (or waist-hip ratio) and smoking did not eliminate the association between OSA and HT in males. The present data suggest that obstructive sleep apnoea is highly prevalent in both the general population and in patients with known hypertension. The contribution of obstructive sleep apnoea to hypertension risk may be sex dependent and higher in males than in females.