Essen, L. van (Larissa) (2013) Prosomatostatine en de relatie met totale en cardiovasculaire mortaliteit bij patienten met type 2 diabetes mellitus. thesis, Medicine.
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Abstract
Prosomatostatin, the prohormone of somastatin, is suggested to be involved in the glucose metabolism by inhibition of the secretion of both glucagon and insulin. However, the endogenous action of somatostatin in diabetes in not fully understood. Prosomatostatin also influences the growth-hormone-insulin-like growth factor-1 axis (GH-IGF-1 axis) by inhibiting the secretion of GH and therefore it leads to low concentrations of IGF-1, which are associated with an increased risk of glucose-intolerance and increased cardiovascular risk. Aim of the current study is to investigate whether the serum concentration prosomatostatin is related to all-cause and cardiovascular mortality in patients with T2DM. Data for this study were collected from a patient population of general practitioners in the Zwolle (The Netherlands) region, which were originally collected for the ZODIAC study. It covers a total of 1687 patients with T2DM. In these patients, a number of variables is measured. For the current study the following variables were used: serumconcentration prosomatostatin, age, gender, duration of diabetes in years, smoking (yes/no), macrovascular complications (yes/no), BMI, systolic blood pressure, HbA1c, serum creatinine, cholesterol-HDL ratio and albuminuria (yes/no). With the aid of these variables three different models were composed to investigate the relationship between the serumconcentration prosomatostatin and mortality. This was done using Cox regression analysis. In the first model only prosomatostatin was used a variable. In the second model, age and gender were added as potential confounders. For the third model all above-mentioned variables were used. With the use of Harrells’s C statistic, the model which is the most capable of predicting mortality with prosomatostatin was examined. In 1326 patients, 78.6% of the total ZODIAC population, prosomatostatin concentrations were determined. The median concentration at baseline was 591.5 [449.8 - 783.3] pmol/L. Patients were followed for a median period of 6.0 [3.2 -10.0] years. During this period 413 (31.1%) patients died, of which 176 (42.6%) patients to a cardiovascular cause. The Cox regression analyzes showed for both the first and the second model significantly increased hazard ratios. This applied to both models for both total and for cardiovascular mortality. In the first model every increase of 1 pmol/L log prosomatostatin led to an increase in the hazard of mortality by 180% respectively 286%. In the second model it concerns 48% respectively 121%. However, in the third model the significant relation between log prosomatostatin and mortality disappeared. To predict mortality, the third model was the best model. With the results of this study it can be concluded that in patients with T2DM, also when correcting for age and gender, a higher total and cardiovascular mortality occurs at higher values prosomatostatin. However, when all the tested variables were added the significant relationship disappeared.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultaire begeleider: and Bilo, prof. dr. H.J.G. internist |
| Supervisor name: | Directe begeleider: and Dijk, drs. P.R. van arts-onderzoeker and Locatie: Diabetes Kenniscentrum Isala Klinieken, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:41 |
| Last Modified: | 25 Jun 2020 10:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/244 |
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